Amphetamines are drugs that are widely used in several countries, although the patterns of use are not always the same.
In some countries, amphetamines are among the main drugs of abuse used intravenously or by inhalation, whereas in others they are taken orally and are mainly associated with party environments.
MDMA, or ecstasy, is known as the substance at the center of a “trend” during the 1990s, but it is neither a new substance—it was synthesized in the early 1900s—nor a new recreational drug, as it was already popular in the 1970s. What was new was the context in which it became widespread.
Its use essentially produces a state of increased energy, a reduced need for rest and sleep, euphoria, a heightened sense of emotional closeness to others, boldness, and impulsivity.
Ecstasy is a substance with neurotoxic potential. When taken orally, it does not tend to induce dependence easily; rather, it may be responsible for functional and structural damage to the nervous system.
People who use it often regard it as a substance that can be controlled without losing control over their behavior. They may nevertheless underestimate the risk of harm resulting from use itself, a risk that increases when consumption is repeated at short intervals or when several doses are taken consecutively.
The effects of repeated doses are cumulative. Initially, the resulting changes may be reversible. However, even when the symptoms of the “down” period disappear, repeated consumption may gradually exhaust the brain’s ability to restore its normal balance, or promote changes in brain function that persist even months after use has stopped.
Long-Term Effects
Long-term effects—that is, effects observed in people who are no longer currently using the substance—include depression, insomnia, depersonalization, and flashbacks.
Frequently reported long-term symptoms also include back pain, neck stiffness, joint stiffness accompanied by impaired movement, recurrent headaches, and abdominal cramps.
The phenomenon of the flashback illustrates how the consequences of drug use are not limited to possible effects that are simply the opposite of the substance’s immediate effects—for example, depression opposite to euphoria, anxiety opposite to disinhibition, or depersonalization opposite to the feeling of intense and effortless emotional involvement.
Some phenomena instead appear to involve the brain reproducing certain effects as though it had “learned” a pattern of activity modeled on the effects of ecstasy.
Psychoses are less common. Nevertheless, cases of long-lasting psychosis have been reported in people without a family history of psychotic disorders.
Compared with the classical model of psychosis, MDMA-induced psychoses may have somewhat different features.
They may begin with predominantly physical or somatic symptoms and a change in personality toward a darker, more apathetic mood, accompanied by a persistent feeling of having “changed,” of no longer being the same person, of being estranged from one’s own life and interests, and of being preoccupied with the fear that something is wrong.
In some individuals, a genuine psychotic component may subsequently develop, including ideas of reference—the belief that other people are referring to oneself, generally in a negative sense—persecutory delusions, and delusions involving bodily changes.
The person may believe that they have lost certain bodily functions, or may feel that parts of the body have become rigid, swollen, immobile, displaced, distorted, or otherwise altered.
Unlike classical psychoses, these delusions may develop without obvious mood disturbances, or with only minor mood changes, and without significant agitation.
Overall, it is possible to distinguish between phenomena corresponding to a kind of prolonged “down” state and symptoms corresponding instead to a form of prolonged intoxication, particularly when psychotic symptoms are present. These two patterns may nevertheless be linked by a common underlying mechanism.
Treatment of these conditions depends both on the type of symptoms presented and on the mechanism of action responsible for MDMA-related toxicity.
References
Creighton et al., 1991, British Journal of Psychiatry
McGuire et al., 1994, British Journal of Psychiatry
Cohen, 1995, Progress in Neuro-Psychopharmacology & Biological Psychiatry