Compared to both non-drug users and
users of other drugs, the heavy 'ecstasy' users were less
emotionally
healthy. The former users showed a trend toward less severe symptoms,
but still scored almost as high on the depression and anxiety tests.[2] The
traditional view has been that these problems were caused by neurotoxicity,
with users never fully recovering (hence the only modest improvement.)
However, in light of the evidence that even this
level of use does not reliably produce detectible damage to user's
serotonin systems,
it seems likely that these results primarily reflect psychiatric problems
with more traditional origins (emotional traumas, environmental stresses,
etc.)
Studies have also reported
differences in the average personalities of 'ecstasy' users relative
to non-users.
In one study, 'users' scored significantly higher
on a scale of novelty seeking (desire for/willingness to try new things),
were more obsessive, more hostile, more psychotic and more
likely to suffer sleep disturbances. 'Ecstasy' users categorized as
"abusers" were also less harm-avoidant than non-users, but "experimental"
users were not.[3] At least some of these differences
are no doubt due to drug use, but to what extent can only
be guessed at.
Acute (short-term) psychological problems.
Anxiety/Panic Attacks.
Panic attacks brought on by MDMA's effects
occur with some frequency. Usually, such reactions appear to occur
during the onset or peak of drug effects, and may be triggered by the
user's discomfort with the drug's effects or by a threatening/disturbing
environment. User reaction can be severe; in some cases the user may
believe they are dying. The most common outward manifestation of a
panic attack appears to be withdrawal and inactivity/unresponsiveness.
In most cases, encouraging the user to relax by assuring them that
they
are
safe and going to be OK may be enough to help them break through the
reaction. For severe cases, benzodiazepine sedatives may be useful.
Erowid reports a
case of a quite severe panic attack triggered by
the behavior of people around the user, who had combined 'ecstasy'
with liberal amounts of marijuana:
"[After taking a pill, we stopped] to
smoke another bowl or 3 and watch the moon and stars. [...]
As I finish, taking literally my last toke on the bowl, it suddenly
hits my like a brick to the face. A great feeling similar to my first
trip and bit of a body buzz, a great warm beautiful, feeling of peace
and security. That euphoria and appreciation I had been searching
for.
It felt so good [....]
My friend N had the urge for coffee, so
we stopped off at a coffee and donut shop. While N ordered,
I waited
sitting
with J, just
smiling and talking about all the great thoughts racing through
my mind. J just smiled and laughed but tried to keep up in conversation
with me. It's about 10:30 or 11 at this point, I'm not quite sure,
and a girl from our school shows up at the coffee shop with her
friend.
They come and talk to us, and the girl, K, from my sociology class,
begins to talk to me, which delights me, as I've always wanted
to talk to her, but never had the real opportunity or reason.
She informs me
that she's partly drunk, which is evident even to me, but we talk
about things from school and laugh, and seem to all be enjoying
each other's
company. She turns to me and asks if I smoke weed, to which I reply
yes, and she asks 'are you stoned right now?'. I explain to her,
that while I did get high on cannabis that evening, that was
not what was
affecting me. She asks what I'm on in a curious voice and whisper
Ecstasy to her. This is where things go down hill, as she reacts
strangely,
pulling away with a mild disgust on her face. She asks if I'm serious
to which i reply yes. She than freaks out, and tells her friend,
in a rather loud manner, which began to make me feel strange.
Her and
her friend get up, and smile at us partly, but say that they can
no longer talk to us, knowing that i'm on Ecstasy. I sit there
confused,
unable to tell if they are joking/being sarcastic, or if they are
serious. They then leave our table and go to sit with another
group of guys.
I'm left somewhat amazed and simply weirded out. I repeatedly begin
to ask my friends what just happened. They keep saying 'that's
hardcore! Those girls just completely flipped on us man, that's
not cool' I actually
remember my friend N saying this exact sentence in a very pissed
off tone, based on the treatment we just received.
I sat continuing to ask questions,
that I don't recall at the moment. What I didn't seem to notice at
the
time, I
suppose
because
I was caught up in what just occurred, is that my vision is changing
on
me. I don't
realize it immediately, but my vision is beginning to distort.
My friends faces are becoming blurry and wavy in front of
my
eyes,
every light
and color seems almost to bright to look at, and I notice myself
having difficulty seeing anything normally. My friends faces
almost appear
to be dripping in front of me. I also notice my stomach beginning
to feel very strange, with some pain, and nausea, and a feeling
of just
having a very upset body. I continue trying to talk, but my
friends notify me that I'm talking uncontrollably loudly, and
in a robotic
state, where I'm talking very slowly, with the tone of my voice
going up and down. I meet difficulty stringing fluent, intelligible
sentences
together, and find myself having difficulty communicating properly.
My hands also are moving uncontrollably slow, and I find myself
getting
distracted by waving them in front of my face. My friends
are slightly concerned, noticing the extreme, quick change
in me, and being
in such a small public place with so many people around us.
I get up suddenly and go to the washroom
feeling the need both to urinate and vomit. Unfortunately upon getting
the
washroom
(after having to
struggle to walk as normal as possible past a line up of people),
I find that I can neither urinate nor vomit. When I attempt
urination, i feel the need to go, but nothing comes out, and
I am overcome
with
nervousness and a feeling of impending doom, dread and hopelessness.
A sense of absolute fear comes over me, and I give up on urination,
and hunch over, clawing at my stomach, feeling the need to
vomit, but to know avail. Only disgusting sounds come out of
my mouth,
as I try
to force it out of me. Nothing. For 15 minutes I stood in the
washroom alone, hunched over, clutching my stomach, feeling
absolutely afraid
and unable to move or function. My body aches, and had become
excessively overheated, even though I kept myself hydrated
throughout the evening,
even at that moment with a bottle of water in hand. In all
honesty, I felt worse and more truly scared I think than I've
ever felt
in my life, truly fearing for my life. I was able to string
the sentence
'I'm going to die' together, which i repeated to myself over
and over for 10 of my 15 mins in the washroom. I stood there,
feeling
i was
going to die, and wishing I hadn't taken the pills. I cursed
myself in my mind for being so stupid, and began to talk aloud
to myself
in a mixture of prayer, despair and disgust, asking God to
not let me
die, over and over, and shouting loudly that I couldn't believe
I was going to die in the coffee shop washroom. I felt Helpless
and lost,
and was overcome with emotions. I was disgusted to be going
through this in the coffee shop washroom, while memories and
flashbacks
of my life passed in my mind. I wouldn't say my life flashed
before my
eyes, but I just kept going over a review of my life, suddenly
feeling that I had just screwed up somewhere, and that I ruined
my life for
good. I kept my gaze on the floor and then on the urinal, but
was getting dizzy with each passing moment. The floor was moving
and
breathing
beneath me, and the urinal seemed to be moving towards me.
I stopped, and pulled myself away and began to look at myself
in
the mirror
for a few moments, which was probably not a good idea in the
state I was
in. I remember a feeling of just hating myself, and fearing
for my life and for everything around. Just feeling lost. Looking
into my
eyes in the mirror, I felt I was looking into my head. I felt
like I was trapped in my mind, and unable to control my body
at all,
feeling I was about to expire very soon. It felt like some
horrible
thing was
inside me, in my head or body of whatever just not letting
me have any control. It felt like it was trying to waste my
body
to nothing
and I felt like I was on fire, and I couldn't bring my body
temp back down. I found myself coated in sweat, but didn't
even feel
able mentally
to take off my sweater by myself. I was still breathing, but
in a horribly fast and violent manner, as though I could not
catch
my breath, though
I don't know if this was later evident to my friends.
When I finally left what seemed like forever
in the Restroom, I returned to my friends as quickly and composed
as possible [...] then i forced myself out of the coffee
shop into
the parking
lot, while they followed me concerned. I collapsed into the
grass on the side of the lot, and closed my eyes a bit, trying
to block
out everything,
and just repeating to my friends that I thought was going
to die, but then contradicting myself and saying that I only
needed a
few moments
to lie down and get out of the dizziness. They sat in the
grass
with me, and just talked to me a bit, asking how I was every
2 mins. Even
with my eyes closed, in the dark of night, everything was
bright, and when I opened my eyes for a moment and then closed
them
again, I could
still see the stars in the sky. We sat out there for about
20 mins, before I forced myself to get up. I was still dizzy
as
hell, and
my friends both aided me in crossing the street. The minute
we reached
the other side, I began vomiting violently[....]
As we began to walk, I vomited once more,
but was generally OK, though still not done the trip completely.
My state
of mind was
still awful,
and not at all positive, however, the overwhelming fear
and thoughts of death were for the most part passed, as well
as most of my
stomach pain, and I was able to at least laugh with my
friends
a bit as
they tried to tell jokes, or recount humorous past events
to try and make
me feel better. I headed back to N's house, where I managed
to get past his father(who himself was drunk) and was able
to spend
the night,
as there was no way I could go home. I didn't sleep for
a long time, but managed to get a couple hours in, starting
at about
5 till 9 am.
The next day, I felt tired, and somewhat achy, but for
the most part good, and clear minded."
MDMA-induced panic attacks can in most
cases probably be avoided simply by using in a calm, non threatening
environment. Limiting the dosage taken, or staggering the dosage over
time (such as by taking half, waiting 20-30 minutes, then taking the
other half) may also help if a person is simply nervous/prone to anxiety.
(One user reported having panic attacks immediately after swallowing
a pill. Since there would be insufficient time for the drug to have
entered their system, this appears to be a case of a purely psychological
reaction to the anticipation of the drug's effects.) There have been
a few reports of panic attacks following the use of 5-HTP as
a 'pre-load'
(taken in advance of the 'ecstasy'.) Mixing with other drugs (such
as marijuana in the above case) may also increase the risk of panic
attacks.
'Hard' Come-downs.
Perhaps best described as a post-use
depression, there have been a number of reports of feeling very empty
and depressed immediately after coming down from the MDMA high. Occurrence
seems to be more common in women, and seems to be associated with high
doses/intense experiences. There isn't an obvious trigger (some people
may just be unusually vulnerable, perhaps in association with pre-existing
psychiatric
problems such as depression) nor is there any clear preventive measure
(although supplementing with 5-HTP when
you start
to 'come down'
may help.)
General 'Hangover.'
One of the functions of the serotonin
system is to control anxiety and depression. As a result, it's not
unusual for users (especially heavy/frequent users) to feel emotionally
'brittle' in the days following use. This may manifest itself in irritability,
bursts of anger, depression, etc. Problems staying focused on a task
and remembering things have also been frequently reported by users.
These problems are much more likely to occur with more frequent use;
they are all but unheard of in first-time or very infrequent users.
Fatigue is also very common the day after use, probably largely due
to sleep disruptions caused by lingering stimulant effects.
Persistent impacts of use on mental health.
There is a general lack of research in the
area of what problems emerge during and after periods of 'ecstasy'
use. However, patterns have emerged from user's anecdotal accounts
that suggest the existence of several distinctive medium- to
long-term types of problems:
'E-tardation.'
By far the most commonly reported scenario
is irritability, anxiety, and memory/concentration problems following
a period of heavy/frequent use (whether in the form of a binge or simply
as a regular part of the person's lifestyle.) In severe cases users
report difficulty thinking of words/speaking. Some users report depersonalization/derealization
(the sensation that you aren't really there, that your reflection in
the mirror is actually somebody else, etc.) Given the complete lack
of controlled observation of these users it seems presumptuous to give
a firm diagnosis or speculate on their future recovery, but the clear
trend of anecdotal user reports is for slow but complete or near-complete
recovery over a course of weeks to months (sometimes as long as a year)
once
drug use has been discontinued. Given the rather strong evidence that
true
neurotoxicity is at best a fairly
rare event even among heavy users my assumption is that this phenomenon
is primarily
due
to neuroadaptive mechanisms.
There may be some danger of such 'overindulgence' depression/anxiety
becoming entrenched and taking on a life of it's own. SSRIs and counseling
may be beneficial.
A visitor to Dancesafe offered
this rather extreme account of problems caused at least in part by
heavy 'ecstasy' use:
"In the spring of 2002 I rolled practically
every other day and then slowed down to once a weekend (multiple
pills each roll) then down to every now and then with little mini-binges
in between, sometimes I'd go 2 weeks w/o rolling sometimes I'd roll
2-3 times a week. Then fall of 2002 I had a hookup on purecaps
so I rolled every weekend.
Anyway eventually i found myself in a situation
where my mind raced constantly, I was always aggravated, my anxiety
was
through
the
roof and way too much for me to handle. instead of depression
I was angry
almost all the time, very quick to jump on people even those close
to me. I always wished I would get depressed instead where I would
want to hurt myself instead of others (sometimes when I would settle
down a little bit I would realize what I was doing but couldn't
seem to get a grip on it like I didn't have control over my own
emotions).
On some occasions I tried starting fights with complete strangers
for the most ridiculous reasons and my attitude to my fiance, who
I love more than life itself, was terrible. I would yell and
complain constantly, I was never satisfied.
It was almost part of my regular schedule that
on sundays (before I have to go back to work on monday) my anxiety
would get
so
bad that
I would just start pacing, trying to keep myself from throwing
a tantrum like a little kid over nothing, but it would always
end in me getting
very light headed, dizzy, nauseous, and keeled over gasping for
breath when I would try to talk it out. Eventually,
my fiance
got tired of this cycle and me not willing to help myself, she
said she
couldn't deal with it anymore that it was tearing her up watching
me do this to myself and said she was going to leave me. This
was the
biggest eye opener of my entire life, the second I found out
I got light headed and almost fell down, it felt like I was going
in and
out of consciousness almost. It was too late she said she had
fallen
out of love with me because I'm not the person I used to be anymore,
I fell into a huge depression and wanted to die. I took a knife
to both wrists and cut them and watched the blood run into the
sink, but
the knife wasn't sharp enough to hit the artery. Now I just have
the scars. I wanted to die so bad, all of a sudden my eyes were
wide open
and I saw all that I had done and all the hurt that I've caused
the person who I love the most, there's no words to describe
how I felt
- lower than low."
The user in this case reports largely recovering
(and reconciling with his fiance) after prolonged abstinence from
all drugs and a great deal of soul-searching.
'Drug Trauma.'
In a few rare cases, users report having
had a very negative experience with 'ecstasy' that left them emotionally
troubled (anxious, depressed) for some time (weeks to months) afterwards.
There is a certain inescapable logic to these reports: MDMA experiences
can deeply and persistently affect the user, which is why positive
MDMA experiences appear to be so therapeutic and
uplifting. However, if the experience is a negative one, the drug's
fundamental effect of engraining the experience into the user's memory
and personality is still at work, potentially causing emotional
trauma instead of healing it. The rare user reports of this phenomenon
suggest that recovery comes with time or, in one case, the trauma
was reportedly quickly and completely reversed with a positive MDMA
experience.
Psychosis.
There are several cases in the literature
of amphetamine psychosis (losing touch with reality) in several extremely
heavy users of 'ecstasy'[4] and in a light user with
a family history of possible paranoid schizophrenia.[5] There
is also one case of a young man with no prior history of 'ecstasy'
use or mental health problems who had a psychotic break following a
night of heavy drinking and 'ecstasy' use.[6] The
latter patient was brought in after pulling people from their cars
and attacking their car stereos, apparently believing himself to be
taking part in an elaborate role-playing game. With treatment, the
patient made a full recovery over two months.
Psychosis in association with MDMA seems
quite rare, probably due to the rarity of prolonged binges (somebody
staying high on MDMA for even twelve hours would be unusual,
while methamphetamine users routinely go several days without sleep
while
binging.)
A reader asks: "Isn't a psychedelic drug
high a form of psychosis anyway?" To some extent, yes; drugs like LSD,
MDMA, and even alcohol impair our ability to accurately perceive and
rationally evaluate the world around us. Traditionally, researchers
have even described psychedelic drugs as "psychotomimetics"; drugs
that imitate
psychosis.
However, compared to 'traditional' psychosis,
drug
effects
are more predictable
and usually positive, and offer the considerable comfort of knowing
that whatever altered perception of reality that comes from the drug
will fade in a matter of hours; people suffering from mental illness
have no easy or predictable escape, a much more frightening situation
even if the perceptual disturbances are similar to those a recreational
psychedelic user might actively be seeking.
On to Heatstroke.
[1] Lieb R, Schuetz CG, Pfister H, von
Sydow K, Wittchen H "Mental disorders in ecstasy users: a prospective-longitudinal
investigation." Drug Alcohol Depend 2002; 68: 195-207. Abstract.
[2] Morgan, MJ, McFie, L, Fleetwood,
LH and Robinson, JA "Ecstasy (MDMA): Are the psychological problems
associated with its use reversed by prolonged abstinence?" Psychopharmacology
(Berl) 2002; 159: 294-303. Abstract.
[3] Dughiero G, Schifano F, Forza
G "Personality dimensions and psychopathological profiles of
Ecstasy users." Hum Psychopharmacol Clin Exp 2001 16: 635-639.
Abstract.
[4] Creighton FJ, Black DL, Hyde
CE "'Ecstasy' psychosis and flashbacks." Br J Psychiatry,
1991; 159:713-5. Abstract.
[5] Williams H, Meagher D, Galligan
P "M.D.M.A. ('Ecstasy'); a Case of Possible Drug-Induced Psychosis."
Ir J Med Sci, 1993; 162(2):43-4. Abstract.
[6] Vaiva G, Boss V, Bailly D, Thomas
P, Lestavel P, Goudemand M "An 'Accidental' Acute Psychosis with
Ecstasy Use." Journal of Psychoactive Drugs, 2001; 33(1):95-8. Abstract.
