MDMA Neurotoxicity Update – Winter 1994

Winter 1994 Vol. 04, No. 3 A Time of Tests

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New data from Drs. Ricaurte and McCann to consider

The results of Dr. Ricaurte and Dr. McCann’s multi-year study were first presented at a neurosciences conference in mid-November,1993 and will be reported on in more detail in the next issue of the MAPS newsletter. The study found that the MDMA-experienced group (of which I was a member) had on average 30% lower levels of a serotonin metabolite in their spinal fluid than did the control group. Interestingly enough, the only functional and behavioral differences between the MDMA group and the controls were that the MDMA users “reported less impulsive and hostile personality traits, and greater constraint and control”. As Drs. Ricaurte and McCann point out, these differences are generally considered positive. Furthermore, these findings are perplexing in that the generally held view is that lower serotonin levels lead to more hostile and impulsive behavior, not less. As with most MDMA neurotoxicity studies so far, this one raises more questions than it resolves. More research is required to sort out the findings.

One difficulty in interpreting the results of this study is that comparing people to matched controls is as much art as science. People are wonderfully unique, especially so when it comes to serotonin. Finding a perfectly matched control is almost impossible since the normal level of brain neurotransmitters varies enormously between individuals. Nevertheless, comparing people who have used MDMA many times in the past to matched controls who have not used MDMA does have some advantages over a controlled study administering only a few doses of MDMA to its subjects. In a matched control study, people who have used MDMA a substantial number of times can be evaluated (Dr. Ricaurte’s group averaged over 50), making any serotonin changes caused by MDMA more likely to be noticed. Data from both sorts of studies, with matched controls or subjects as their own control, will be needed to assess more fully MDMA’s complex and fascinating effects.

Neurotoxicity potential is optional

If someone were seriously concerned about neutralizing the possibility of serotonin changes, (though I think the evidence doesn’t justify the effort), animal research has shown that combining the prescription drug Prozac with MDMA prevents neurotoxicity, even when Prozac is taken up to six hours after the MDMA. This works because Prozac binds to the same serotonin re-uptake sites which can be damaged by MDMA metabolites (though only when MDMA is administered at doses higher than the standard therapeutic or non-medical amount). The presence of Prozac at the re-uptake sites prevents the neurotoxic MDMA metabolites from binding, eliminating its potential effect on the re-uptake sites. An interesting paper by Dr. McCann and Dr. Ricaurte discusses the effects of the MDMA/Prozac combination (Journal of Clinical Psychopharmacology, 13 (3): pp. 214-217, 1993.)

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