Ecstasy Acute Effects on Social Cognition

MDMA (Ecstasy) Chemical Structure

Anecdotal reports suggest that some users of ecstasy (3,4-methlenedioxymethamphetamine-MDMA) experience increased feelings of empathy and are more social while under influence of the drug.  Such effects may contribute to the timing and frequency of ecstasy use and may also contribute to risk of abuse or dependence.  Understanding this phenomenon in more detail might provide clinicians with better strategies to reduce use and the associated complications of ecstasy use.

Studying acute effects of illicit drugs is difficult under natural conditions.  Users of ecstasy commonly also use alcohol, nictoine and other illicit drugs in the context of ecstasy use.  Isolating psychological effects of one agent in this type of environment is difficult if not impossible.  One alternative is to admiinster ecstasy in a laboratory setting with subjects blind to whether ecstasy or placebo is being administered.  However, this approach poses significant ethical challenges.  One approach, is to limit human study in the lab to those who have previously use ecstasy and intend to continue using.  Although imperfect, this approach limits risk of exposing ecstasy naive individuals to an illicit drug that may have reinforcing effects and increase risk of future drug use.

Chemical Structure of Methamphetamine

A study in Biological Psychiatry took this approach when over four sessions, healthy ecstasy using volunteers received either a low or high dose of MDMA, a dose of methamphetamine (METH) or placebo.  MDMA and methamphetamine share chemical (see chemical structures), pharmacological as well as psychological features.  Methamphetamine is typically considered a compound that increases CNS dopamine and norepinephrine while MDMA is felt to also increase CNS serotonin.   Ratings on a series of psychometric measures were obtained over a period of six hours after drug administration.  Visual analog scales (VAS) rated subjective feelings in a variety of domains: stimulated, bored, sedated, anxious, insightful, nauseated, loving, dizzy, sociable, confused, lonely, elated, playful, blank and restless.  Additionally, the rated themselves on the 72-item Profile of Mood States (POMS).  Subjects also completed a facial affect recognition task where they were asked to identify four facial emotions: anger, fear, happiness, sadness.

Here is a summary of the study findings for active agents compared to placebo:
MDMA (high dose) increased subjective VAS ratings of feeling "loving" and "friendly"
MDMA (low dose) increased subjective VAS ratings of "lonely"
MDMA (high dose) and METH increased VAS ratings of "playful"
METH alone increased VAS ratings of "sociability"
MDMA (high dose) reduced the accuracy of recognizing angry faces

So there is some support in this study for the anecdotal reports of increased prosocial cognition with MDMA.  The authors note their findings suggest MDMA increases social approach (sociability) rather thanThe authors note the study supports the possibility that increased social behavior with MDMA might be due to a reduced sensitivity to negative emotions of others rather than increasing recognition of positive emotions in others.  There also might be danger with this effect as social risk taking might increase potential for adverse consequences (connecting with someone you would be unlikely to connect with when not under the influence of MDMA).

Chemical structures of MDMA and methamphetamine from Wikipedia Creative Commons authored by Harbin.

Bedi G, Hyman D, & de Wit H (2010). Is ecstasy an "empathogen"? Effects of ±3,4-methylenedioxymethamphetamine on prosocial feelings and identification of emotional states in others. Biological psychiatry, 68 (12), 1134-40 PMID: 20947066

Suicide Tops Death List for Meth Heads

Methamphetamine Chemical Structure

Methamphetamine dependence can lead to an early death.  The magnitude and mechanism of this effect is not well understood.  One way to better understand effects of drug abuse/dependence on mortality is the prospective outcome study.  These types of studies tend to be costly and may require many years to yield research results.   That’s why there are not many published studies to answer the question of this post.

A recent study from Taiwan provides some valuable insight into this issue.  This study followed a cohort of 1254 individuals with a history of methamphetamine abuse and a psychiatric admission for treatment between 1990 and 2007.  National death records were queried and the methamphetamine abuse cases were compared to an age- and gender- matched control group.  One hundred thirty methamphetamine users died during follow up with the following leading categories of death:  

• Suicide n=42 (32.3%)
• Accidents n=26 (20.0%)
• Undetermined unnatural deaths n=14 (10.8%)
• Cardiovascular disease n=13 (10.0%)
• Undetermined natural deaths n=9 (6.9%)
• Liver disease n=6 (4.6%)

In this Taiwanese sample, methamphetamine abuse carried an overall six fold increase in mortality.  Unnatural deaths (suicides, accidents, homicides, undetermined natural deaths) were particularly elevated.  Male amphetamine abusers had about a 10-fold increase in unnatural deaths while female methamphetamine abusers had a remarkable 26-fold increase in unnatural death during follow up.

Being married appeared to reduce the risk of death from unnatural and natural causes in this cohort.  Use of other substances in addition to methamphetamine increased risk of death.

I would suspect that in the United States, homicide would be a greater contributor to mortality in those with a history of methamphetamine dependence.  Overall homicide rates in Taiwan are much lower than in the United States and may reduce risk for this type of unnatural death.

Interestingly, about two thirds of the cohort had exhibited methamphetamine psychosis-a psychiatric complication of methamphetamine use.  Those with a history of this type of psychosis were no more likely to die than those without a history of the psychosis.

One problem with this type of study is difficulty assessing the specific effect of methamphetamine from other potential confounding factors.  For example, methamphetamine use is higher in smokers than smokers and so some increased mortality risk could be related to effects of smoking.  Methamphetamine dependence is more prevalent in a variety of mental disorders linked to increased suicide.

Nevertheless, this study shows the magnitude and type of mortality risk linked to methamphetamine dependence.  Public health interventions that reduce the prevalence of methamphetamine dependence would like reduce the excess mortality associated with this drug.

Wikipedia Commons chemical structure of methamphetamine image authored by Harbin.

Kuo CJ, Liao YT, Chen WJ, Tsai SY, Lin SK, & Chen CC (2010). Causes of death of patients with methamphetamine dependence: A record-linkage study. Drug and alcohol review PMID: 21355920