July 24, 2000 -- Distracted by the seemingly safe mellow high, users of the drug ecstasy don't realize its profoundly harmful long-term effects on the brain, say researchers who've been studying the drug's effects.
Ecstasy has become a popular drug among young people, often used at all-night parties called raves. It produces mild feelings of well-being and is reported to make users more sociable, one researcher says.
Current studies suggest the drug has its effect through a massive release of the brain chemical serotonin, which can affect -- among other things -- mood, behavior, memory, learning, appetite, sleep, temperature regulation, and heart function. This becomes a problem because, in essence, the serotonin is then "used up" and is unavailable to perform its day-to-day functions. Although the body tries to replace the chemical, it has a hard time catching up.
"Consumers are not aware that ecstasy risks include death from drug overdose and long-term damage to brain cells," says Stephen J. Kish, PhD. "Here in Toronto, we now have about one ecstasy-related death a month. Three years ago, we had none. Young users do not realize the danger. The word is not getting out to them." Kish is head of the human neurochemical pathology laboratory at the Centre for Addiction and Mental Health, and associate professor of pharmacology and psychiatry at the University of Toronto School of Medicine in Canada.
Since ecstasy is an illegal drug, data on its use is not easy to come by, but available information suggests use is increasing. In 1998, 1.6% of those aged 12 to 17 used ecstasy, up from 1.3% in 1997, says H. Westley Clark MD, JD, MPH. About 5% of those aged 18 to 25 used ecstasy in 1998, up from 4.6% in 1997. Clark is the director of the Center for Substance Abuse Treatment in Bethesda, Md.
A great deal of animal research has shown that when animals are given ecstasy, the serotonin levels in their brains drops and they develop and nerve damage. "This appears to be a long-term problem that can last over a year," says Jim Winslow, PhD. He says that in the animal research to date, they have not been able to determine how long it takes to recover from the effects of ecstasy. Winslow is associate research professor at the Yerkes regional primate research center at Emory University School of Medicine in Atlanta.
In the past, some observers have argued drug levels used in animal studies were so high that similar effects wouldn't be found in humans. Now a study by Kish, published in the most recent issue of the journal Neurology, reports the same effects in a person who used ecstasy over a nine-year period, and died at age 26. He started out using the drug once a month, but from age 23 onward, used it four or five nights a week. An autopsy of his brain found serotonin levels 50 to 80% lower than in people who had not used ecstasy. "That is a striking reduction," Kish says.
If people who use ecstasy experience a massive release of serotonin, followed by substantially lower serotonin levels long-term, that would explain both the feelings of well-being they experience while using the drug, and the long-term depression, anxiety, and other symptoms they experience once it wears off.
Recent studies of people who use ecstasy also suggest its use leads to the loss of reasoning ability and memory. In addition to lowering serotonin levels, it appears to permanently damage the brain cells that produce and use serotonin.
"There is now a large body of data, mostly in animals but also in humans, indicating [ecstasy] is highly toxic to brain serotonin cells," says George A. Ricaurte, MD, PhD. "The study by Kish is very important because it shows these changes in brain cells occurring at dosage levels actually used by humans." Ricaurte is associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore.
The emerging data on the dangers of ecstasy mean parents really need to open a discussion about drugs with their children, Clark says. Too often, parents assume drug problems only apply to other people's children. "You need to talk with them about drugs and alcohol," Clark says. "While most don't use drugs, a substantial number do."