Julie Holland (Psychiatrist; MDMA expert) gives expert video advice on: How prevalent is Ecstasy use?; What are the psychological effects of Ecstasy?; How does Ecstasy affect the human brain? and more...
How prevalent is Ecstasy use?
Over twelve million Americans over the age of twelve have tried it at least once. And over two million have taken it within the last year. And then there's the Monitoring the Future study which has some 2007 data, which shows that with twelfth-graders, six and half percent have tried it sometime in their lifetime. So, there's plenty of Americans taking it and there's millions of people all over the world that are taking this drug. It's very, it's still incredibly common in England, all over Europe, in Ibiza. There are certain hot spots where there's a lot of Ecstasy use going on. Israel has got a ton of … it's got a really big rave scene still. In India, there's rave scenes spouting all over the place that came out of Goa. So, millions of people around over the world are taking this drug.
What are the psychological effects of Ecstasy?
What I usually say about MDMA is that it makes people feel happy and relaxed. And it's kind of like taking a deep breath and you just feel a little bit more comfortable, a little bit more centered. Its effects can be pretty subtle for some people especially if it's pure MDMA and there isn't any methamphetamine in it. And sometimes I'll describe it to people, it's almost just like having a glass of wine or something. You feel like a little bit more relaxed, a little bit more open to talking about things. But I think in a club setting, or when you're dancing, a lot of people feel like it gives them more energy and there's a sense of euphoria. People want to dance, they feel very connected to their body. There's something called the kinaesthetic awareness, you're very aware of your body and it feels good to you. It's just a great deal of pleasure and euphoria. And people also feel very connected to other people. So it ends up being a good, positive social experience. People are more interested in talking and connecting with other people than they typically would be.
How does Ecstasy affect the human brain?
So, the easiest way to think about it is that it really floods the brain with serotonin. Now, serotonin is a neurotransmitter that is involved in feeling good, having less anxiety, and having a feeling of satiety like you don't really need anything. Everything that you need, you have. If you want to get into a more complicated level, it blocks the reuptake of serotonin the same way that the prescription anti-depressants do. So, since there's less recycling there's more available in the synapse to go across. But also, not only does it block the recycling, but it just floods the synapse with serotonin and to a lesser extent dopamine and other chemicals involved, but it really is a primarily serotonergic affect. The increased serotonin is what makes you feel so good.
What are the side effects of using Ecstasy?
The side effects of pure MDMA are a little bit different than the side effects if you get Ecstasy that's cut with speed, and then you've got sort of more speedy side effects. But with pure MDMA some people notice a tightness in their jaw, but not everybody gets that. Your pupils will get dilated. Your skin might get a little bit flushed. You tend to have more energy, or you're more awake, more alert. You can have a teeth grinding, that's called bruxism. And at the peak effects of MDMA, you get these eye movements, these uncontrolled eye movements, these automatic eye movements. You're not moving your eyes, they're sort of moving on their own, which are sometimes called nystagmus, but they're not really nystagmus, that incorrect. They're sort of eye rolling. I think that's why some people will call taking Ecstasy "rolling", because your eyes can sort of roll around in your head when you're very high on MDMA.
Is it possible to overdose on Ecstasy?
Yes, it's possible to overdose on Ecstasy. But what typically gets people into trouble is not the amount of Ecstacy they've taken, it's either that they've taken Ecstacy and then they're dancing for five or six hours and getting overheated, or they're taking one tablet of Ecstacy and they're drinking a gallon of water and then they're over-hydrating, they're drinking too much water. Water intoxiaction is a huge problem. MDMA causes water retention. And a lot of the most famous Ecstacy overdoses and Ecstacy deaths aren't Ecstacy overdoses, they're water overdoses in conjunction with one single tablet of Ecstacy, and the MDMA causes water retention, and that's really where you come into trouble.
What are the long-term side effects of Ecstasy use?
That is still sort of up for debate. There are plenty of people doing research on chronic ecstasy users. But the problem with chronic ecstasy users is they tend to take other drugs and they tend to have had methamphetamine or speed, because they're not getting pure MDMA. So it's really hard to do that kind of research. There's one study where they gave oral MDMA to squirrel monkeys. Every two weeks they kept giving them oral, for I don't know if it was four or five separate administrations. And they showed that there was no brain damage at all. But in other studies where they're injecting high doses of MDMA repeatedly into monkeys or baboons, they are showing brain damage. So it's not, you know, it's certainly safer to use less and to take it less frequently. But I don't think anyone can tell you for sure what's safe. In terms of how often or how much.
Is Ecstasy addictive?
If you put it under strict criteria of tolerance, dependence and withdrawal then I wouldn't call it physically addictive but I think people can get into patens of use that are unhealthy, in the same way people can get into unhealthy patens getting onto their computer every night and going Second Life or to Warcraft. Physiologically I think you can run into issues of addiction but classically when we think about tolerance and withdrawal – no.
Why is Ecstasy considered neurotoxic to people?
The neurotoxicity studies really are based on these high dose intravenous or you know there injecting MDMA into these animals and escalating doses in a short period of time and they're showing neurotoxicity. The problem is that there aren't a lot of papers that are published that really mimic what typical dose patterns are, which is if somebody takes one or two pills orally and then doesn't take it again for a three of four months. So you know the neurotoxicity definitely seems to depend on the root of administration whether it's oral or whether it's injected and how frequently it's being used. The FDA has approved studies administering MDMA to people and they would not do that if they thought that MDMA was neurotoxic in these doses. So I think it's safe to say that a single oral dose 125 miligrams of a known substances which is MDMA as apposed to ecstasy is not going to be neurotoxic. So the problem comes when you're buying things that you don't know are MDMA and you're taking it to often or taking to much.