The neuropsychology of ecstasy (MDMA) use: a quantitative review

Abstract

A growing number of empirical studies have found varying neuropsychological impairments associated with use of 3,4-methylenedioxymethamphetamine (MDMA) use. We set out to determine to what extent neuropsychological abilities are impaired in MDMA users. To do so, meta-analytical methods were used to determine the magnitude of neuropsychological impairment in MDMA users across pre-specified cognitive domains. We found that cognitive impairment secondary to recreational drug use may result in what might be described as small-to-medium effects across all cognitive domains with learning and memory being most impaired. We also found that total lifetime ingestion of MDMA appears to be negatively associated with performance on tasks ranging from attention and concentration to learning and memory. Implications and limitations of these findings are discussed.

Sleep apnea in young abstinent recreational MDMA (“ecstasy”) consumers

“…The most consistent behavioral differences that have been reported in abstinent MDMA users have been subtle cognitive deficits, [23][24][25][26] behavioral impulsivity, 30,31 altered sleep architecture, 30 and altered neuroendocrine function. 32,33 The present study provides evidence that MDMA exposure increases the risk for obstructive sleep apnea, with rates of sleep apnea and hypopnea being directly related to prior MDMA exposure.…”

“…[22][23][24][25][26] This possibility is raised by the fact that chronic sleep disruption is known to have a deleterious effect on daytime cognitive functioning. 34 Thus, arousals during sleep secondary to nocturnal hypopneas and apneas could play a role in subtle changes in Blue diamonds represent apnea hypopnea index values for subjects in methylenedioxymethamphetamine (MDMA) and control groups.…”

“…[19][20][21] Although functional consequences of MDMAinduced brain serotonin neurotoxicity are not well understood, available data suggest that abstinent MDMA users have alterations in sleep architecture 22 and cognitive function. [23][24][25][26] The present study was conducted in abstinent, otherwise healthy MDMA users whose use characteristics have previously been shown to lead to persistent losses of brain serotonin transporters suggestive of serotonin neurotoxicity. In particular, MDMA users with similar use patterns in studies with identical inclusion criteria have previously been found to have a reduction in brain serotonin transporters as measured by PET.…”

Longitudinal Examination of Learning and Memory in Rats Following Adolescent Exposure to 3,4-Methylenedioxymethamphetamine or 5-Methoxy-N,N-Diisopropyltryptamine

“…In humans, both cross-sectional and, more rarely, longitudinal studies have suggested MDMA associated deficits on a variety of assessments of learning and memory performance [13]. Reported MDMA-associated impairments involve multiple cognitive domains, including executive function and planning, working memory, and retrospective as well as prospective memory [11] [31]- [37]. Unfortunately, when considered from a methodological viewpoint, definitive conclusions derived from this body of research are problematic [30].…”

Basal functioning of the hypothalamic-pituitary-adrenal (HPA) axis and psychological distress in recreational ecstasy polydrug users

“…Beyond the euphoric acute effects, however, recreational use of ecstasy is associated with a range of deleterious effects on neuropsychological and physical wellbeing. The effects on cognition are well documented and detailed in several comprehensive reviews (cf Murphy et al, 2009;Solowij & Battisti, 2008;Zakzanis et al, 2007); however, in brief, although deficits are observed across a range of cognitive domains, the most consistent effects are observed in learning and memory tasks that involve high levels of executive functioning (e.g., Reay et al 2006). Chronic use is also associated with increases in psychological morbidity.…”