Acute psychological problems associated with MDMA use

Increased anxiety(2,26) and panic(2,28> have been described, with the three cases of the latter study complicated by prolonged agorophobia which responded to serotonergic antidepressant drugs. Major depressive disorder(29) and prolonged depersonalization with panic and suicide following ingestion (30) have also been described. Numerous cases of MDMA-related psychoses have also been reported(3 ,32,) as well as flashbacks(3 34) and even craving for chocolate/35» It has been suggested(! 2,22) that such idiosyncratic disturbances are more likely to occur in those already predisposed to psychiatric disorders. It is possible that people predisposed to mood disorders may experience their first episode of psychological disturbance earlier than they would have done had they not taken MDMA. Controlled long-term cohort studies of users, with baseline measures of risk factors, are needed to assess this.

More common adverse effects associated with the use of MDMA are more directly related to the psychostimulant effects of the drug, such as increased restlessness, headaches, and bruxism. Weekend use of MDMA has been shown to be associated with depressed mood midweek(36) which could reflect depletion of serotonin following the acute elevation that follows ingestion of MDMA. This could be a parallel to the 'crash' reported after abstinence of cocaine use (37) or as a hangover effect. Table 3 lists some of the more common adverse effects that follow MDMA use.

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Table 3 Adverse effects of MDMA use

Table 3 Adverse effects of MDMA use

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