By Marcello Cherchi, MD PhD
For patients
The chemical name for the drug commonly known as “ecstasy” is 3,4-methylenedioxy-N-methamphetamine, abbreviated MDMA. Users say the drug makes them feel more social and energetic, and makes sex more pleasurable. But MDMA can also cause problems in the brain, heart and muscles. Many users of the drug also experience disequilibrium/dizziness.
For clinicians
Overview
The compound 3,4-methylenedioxy-N-methamphetamine is abbreviated MDMA, and commonly known as “ecstasy.” The drug influences several neurotransmitter systems (serotonin, dopamine, norepinephrine) and endocrine systems (cortisol, prolactin, oxytocin). Its half-life is relatively short (11.0±12.6 hours in women and 7.4±2.9 hours in men), though some animal studies suggest longer-term neuroplastic effects. Users typically seek the drug’s psychotropic effects (euphoria, feelings of intimacy, stimulation) and sexual effects (increased libido, enhanced erection/lubrication, intensity of orgasm), but the drug also has significant adverse effects (agitation, anxiety, tachycardia, hypertension, cardiac arrhythmias, hyperthermia, rhabdomyolysis, methemoglobinemia). The adverse effect of disequilibrium/dizziness is commonly reported; the mechanism is unclear, though hemodynamic effects (hypertension, tachycardia, cardiac arrhythmia) are plausible.
Introduction
The compound 3,4-methylenedioxy-N-methamphetamine is abbreviated MDMA and known by a variety of street names, most popularly “ecstasy.” Users typically seek the drug’s psychotropic effects such as, “euphoria, a feeling of intimacy, altered visual perception, enhanced libido, and increased energy” (Smith et al. 2002), or its effects on sexual function such as enhanced erection/lubrication and increased intensity of orgasm (Palamar et al. 2018; Zemishlany et al. 2001). The drug’s adverse effects include agitation, anxiety, tachycardia, hypertension, cardiac arrhythmias, hyperthermia and rhabdomyolysis (Smith et al. 2002).
Pharmacology
MDMA influences several neurotransmitter systems, functioning as an “indirect serotonin, dopamine, and norepinephrine agonist” (Pardo-Lozano et al. 2012). It additionally has several endocrinological effects, producing “marked increases in cortisol, prolactin, and oxytocin” (Dolder et al. 2018).
The half-life of MDMA is 11.0±12.6 hours in women and 7.4±2.9 hours in men (Pardo-Lozano et al. 2012). Effects of MDMA “tend to be short lived” (DeBattista and Schatzberg 2024). Some animal studies describe longer-term neuroplastic changes after repeated exposure (Lanteri et al. 2014), but whether such effects also occur in humans is unclear.
Adverse effects
MDMA has been documented to provoke symptoms of disequilibrium (Baylen and Rosenberg 2006; DeBattista and Schatzberg 2024; Liechti et al. 2005; Pardo-Lozano et al. 2012; Smith et al. 2002; ter Bogt and Engels 2005).
The mechanism by which MDMA might cause disequilibrium is unclear. Several of its hemodynamic effects, such as hypertension, tachycardia and cardiac arrhythmia (Smith et al. 2002), may be contributory. A case report has described methemoglobinemia induced by MDMA (Verhaert 2011), but most presentations are not so dramatic.
Ocular motor examination
As of this writing there is almost no literature regarding ocular motor effects of MDMA. A single case report of infantile MDMA poisoning mentions “nystagmus” without further description (Boucher et al. 2009).
References
Baylen CA, Rosenberg H (2006) A review of the acute subjective effects of MDMA/ecstasy. Addiction 101: 933-47. doi: 10.1111/j.1360-0443.2006.01423.x
Boucher A, Zine A, Jaziri F, Bernard N, Jeannoel P, Descotes J (2009) Intoxication par ecstasy chez un nourrisson de 10 mois [Ecstasy poisoning in a 10-month-old infant]. Arch Pediatr 16: 1346-9. doi: 10.1016/j.arcped.2009.07.006
DeBattista C, Schatzberg AF (2024) The Black Book of Psychotropic Dosing and Monitoring. Psychopharmacol Bull 54: 8-59.
Dolder PC, Muller F, Schmid Y, Borgwardt SJ, Liechti ME (2018) Direct comparison of the acute subjective, emotional, autonomic, and endocrine effects of MDMA, methylphenidate, and modafinil in healthy subjects. Psychopharmacology (Berl) 235: 467-479. doi: 10.1007/s00213-017-4650-5
Lanteri C, Doucet EL, Hernandez Vallejo SJ, Godeheu G, Bobadilla AC, Salomon L, Lanfumey L, Tassin JP (2014) Repeated exposure to MDMA triggers long-term plasticity of noradrenergic and serotonergic neurons. Mol Psychiatry 19: 823-33. doi: 10.1038/mp.2013.97
Liechti ME, Kunz I, Kupferschmidt H (2005) Acute medical problems due to Ecstasy use. Case-series of emergency department visits. Swiss Med Wkly 135: 652-7. doi: 10.4414/smw.2005.11231
Palamar JJ, Griffin-Tomas M, Acosta P, Ompad DC, Cleland CM (2018) A comparison of self-reported sexual effects of alcohol, marijuana, and ecstasy in a sample of young adult nightlife attendees. Psychol Sex 9: 54-68. doi: 10.1080/19419899.2018.1425220
Pardo-Lozano R, Farre M, Yubero-Lahoz S, O’Mathuna B, Torrens M, Mustata C, Perez-Mana C, Langohr K, Cuyas E, Carbo M, de la Torre R (2012) Clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”): the influence of gender and genetics (CYP2D6, COMT, 5-HTT). PLoS One 7: e47599. doi: 10.1371/journal.pone.0047599
Smith KM, Larive LL, Romanelli F (2002) Club drugs: methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and gamma-hydroxybutyrate. Am J Health Syst Pharm 59: 1067-76. doi: 10.1093/ajhp/59.11.1067
ter Bogt TFM, Engels RC (2005) “Partying” hard: party style, motives for and effects of MDMA use at rave parties. Subst Use Misuse 40: 1479-502. doi: 10.1081/JA-200066822
Verhaert LL (2011) Methaemoglobinemia Induced by MDMA? Case Rep Pulmonol 2011: 494328. doi: 10.1155/2011/494328
Zemishlany Z, Aizenberg D, Weizman A (2001) Subjective effects of MDMA (‘Ecstasy’) on human sexual function. Eur Psychiatry 16: 127-30. doi: 10.1016/s0924-9338(01)00550-8
