Psychopharmacology (1998) 139 : 261�268 © Springer-Verlag 1998

ORIGINAL INVESTIGATION

A.C. Parrott · J. Lasky

Ecstasy (MDMA) effects upon mood and cognition :before, during and after a Saturday night dance

Received: 3 November 1997/Final version: 27 February 1998

Abstract Three groups of young people (aged 19�30years) were compared: 15 regular ecstasy users whohad taken MDMA (3,4-methylenedioxymethampheta-mine) on ten or more occasions; 15 novice ecstasy userswho had taken MDMA on fewer than ten previousoccasions; and 15 controls who had never takenMDMA. Each subject completed a cognitive test andmood scale battery four times: an initial drug-free base-line, at a Saturday night dance/club (on-drug), then 2days later, and 7 days later. On the Saturday night, reg-ular ecstasy users took an average of 1.80 MDMAtablets, novice users took 1.45 MDMA tablets, whilecontrols mostly drank alcohol. The consumption ofcannabis and cocaine at the club was similar acrossgroups. All three groups reported positive moods at thedance club (on-drug), although there were borderlinetrends (P < 0.10) for less sadness /depression in theMDMA subgroups. However 2 days afterwards, theecstasy users felt signiÞcantly more depressed, abnor-mal, unsociable, unpleasant, and less good tempered,than the controls. Cognitive performance on both tasks(verbal recall, visual scanning) was signiÞcantlyreduced on-MDMA. Memory recall was alsosigniÞcantly impaired in drug-free MDMA users, withregular ecstasy users displaying the worst memoryscores at every test session. This agrees with previousÞndings of memory impairments in drug-free ecstasyusers. Animal data have shown that MDMA can gen-erate long-term serotonergic neurodegereration in var-ious brain areas, including the hippocampus. Thecognitive deÞcits in drug-free recreational ecstasy users,suggest that MDMA may also be neurotoxic inhumans.

Key words MDMA · 3,4 ethylenedioxymethampheta-mine · Ecstasy · Serotonin · Memory · Cognition ·Mood · Neurotoxicity

Introduction

The synthetic amphetamine derivative MDMA (3,4-methylenedioxymethamphetamine), or �ecstasy�, Þrstbecame popular in the mid-1980s at acid house partiesand raves. Today, it is readily available as an illicit drugat many clubs and recreational venues. It has been esti-mated that half-a-million ecstasy tablets are taken eachweekend in the UK (Saunders 1995), with 13% ofBritish university students reporting they had used it(Webb et al. 1996). It is also widely consumed in otherwesternised countries (Peroutka et al. 1988; Solowij et al. 1992; Cuomo et al. 1994; Saunders 1995; Lentonet al. 1997). Because of its illegal status, it is not pos-sible to study its e¤ects upon human behaviour usingthe traditional double-blind placebo-controlledmethodology [Downing (1986) was undertaken beforeMDMA was scheduled in the USA]. Most informa-tion on the psychobiological e¤ects of MDMA there-fore comes from the following sources. Firstly, studiesof recreational drug users, who are asked to describetheir experiences on MDMA (Peroutka et al. 1988;Solowij et al. 1992; Curran and Travill 1997; Davisonand Parrott 1997; Parrott and Stuart 1997). Secondly,medical case studies, following drug-induced hyper-thermia, hyponatraemia convulsions, and psychiatricor neurological disorders (Dowling et al. 1987; Schmidt1987; Henry et al. 1992; Lee 1994; Maxwell et al. 1994;Series et al. 1994; Squier et al. 1995; McCann et al.1996; Spatt et al. 1997). Thirdly animal data, whereMDMA is administered under controlled conditionsin the laboratory; these studies have provided extensiveinformation on the neurochemical and neurotoxice¤ects of MDMA in rats and monkeys (Ricaurte et al.

A.C. Parrott (*) · J. LaskyDepartment of Psychology, University of East London,London E15 4LZ, UKe-mail : andy2@uel.ac.uk, Fax: +44-181-849-3697

1988, 1992; Steele et al. 1994; Green et al. 1995;Frederick and Paule 1997).

Recreational durg users typically describe a range ofpositive moods on-MDMA: elation, energeticness,agreeableness, and closeness to others (Peroutka et al.1988; Liester et al. 1992; Solowij et al. 1992; Davisonand Parrott 1997; Parrott 1995, 1997; Parrott andStuart 1997). However, negative moods generallydevelop during the period of neurochemical depletionafterwards, when feelings of lethargy, irritability, anddepression predominate. This cycle of positive moodson-drug, and negative moods afterwards, wasconÞrmed in a prospective study by Curran and Travill(1997). Twelve recreational ecstasy users were com-pared with 12 alcohol drinkers (controls), at a Saturdaynight dance/club, then 1 and 4 days later. The ANOVAgroup by time interaction was signiÞcant for mostmood scales, with MDMA users reporting compara-tively better moods on the Saturday night, and worsemoods in the days afterwards (Table 2 in Curran andTravill 1997). Unfortunately, the data from each periodwere not separately analysed; thus it is unclear whethermoods were signiÞcantly better while on MDMA, orsigniÞcantly worse afterwards.

Several studies have found that drug-free recreationalecstasy users display signiÞcant memory impairments,whereas their performance on other cognitive tests isgenerally normal (Krystal et al. 1992; Spatt et al. 1997;Morgan 1998; Parrott 1998; Parrott et al. 1998).Animal studies have shown that MDMA can lead toserotonergic (5-HT) neurodegeneration, in the hip-pocampus and other brain areas (Ricaurte et al. 1988,1992; Steele et al. 1994; Green et al. 1995). This sug-gests that the memory decrements in humans mayreßect serotonergic neurodegeneration (Parrott andStuart 1997; Parrott et al. 1998; Spatt et al. 1997; Szaboet al. 1997; Morgan 1998). The current study wasdesigned to provide further data on the cognitive skillsand mood states of recreational ecstasy users. The Þrstaim was to assess the acute e¤ects of MDMA self-administration upon mood and cognition. Previously,this has only been reported by Curran and Travil(1997), but they did not have a pre-drug baseline. Thesecond aim was to monitor the time course of themood/cognitive changes, during the neurochemicalrecovery period afterwards. Finally, the study investi-gated whether drug-free ecstasy users would againdemonstrate a cognitive proÞle of selective memoryimpairments.

Materials and methods

Subjects

Forty-Þve unpaid subjects were obtained using the �snowball� tech-nique, developed for illicit drug research (Solowij et al. 1992; Parrottand Stuart 1997). Word of the study was spread amongst friends

and acquaintances who regularly visited a large nightclub in theEpping Forest area of north-east London. Three subgroups weretested: 15 regular ecstasy users who stated that they had takenMDMA (3,4-methylenedioxymethamphetamine) on ten or moreprevious occasions; 15 novice ecstasy users who had taken MDMAon one to nine previous occasions; and 15 controls who stated thatthey had never taken MDMA. The ages of each group were simi-lar (21.4, 22.8, 21.3 years, respectively; overall range 19�30 years);as was their gender distribution (8 /7, 8 /7 and 10/5 : females /malesper group, respectively). Drug use at the dance/club was recordedon a self-rating questionnaire, where each user noted the drugs theyhad taken that night. The regular ecstasy users took slightly moreMDMA than the novice users (1.80 compared to 1.45 MDMAtablets), while none of the control group took any MDMA. Threeother illicit drugs were taken: cannabis, cocaine, and amphetamine.Cannabis was smoked by: three non-user controls, one noviceMDMA user, and two regular MDMA users. Cocaine was takenby: two controls, two novice MDMA users, and four regularMDMA users. One novice MDMA user took amphetamine.Alcohol was taken by ten controls, Þve novice MDMA users, andsix regular MDMA users. The number of alcoholic drinks con-sumed by each drinker was somewhat higher in the controls : 5.0drinks per control group drinker, 2.7 drinks per novice MDMAgroup drinker, 3.7 drinks per regular MDMA group drinker.

Assessment measures

These comprised auditory word recall, visual search, and a moodscale battery. Auditory recall involved lists of 16 words, presentedat one word every 2 s, over headphones from a portable taperecorder. The subject listened to the word list, waited 30 s, and wheninstructed by the experimenter, wrote down all the words they couldremember in any order. Each word list was matched for frequencyof everyday occurrence and overall word length. Two word listswere given at each test session. Eight word lists were varied acrosssessions. This �supraspan� word recall task has been shown to besensitive to the amnesic e¤ects of scopolamine (Parrott 1986).

The visual search task was presented on a hand-held minicom-puter (Apple Newton Messagepad; Tiplady 1996). A target letter�L� was embedded in an array of distractor letters in di¤erent ori-entations. The subject was required to press the target letter witha light pen as rapidly as possible. In the easy discrimination con-dition, the distractor letters were all �X�s. In the hard discrimina-tion condition, the distractor letters were �T�s. Four sizes of matrixarray were presented: 2 × 2, 3 × 3, 4 × 4, and 5 × 5. Only the 2 × 2and 4 × 4 data were analysed/presented here, since we were onlyinterested in visual scanning at two levels of di¦culty. This taskhas been shown to be sensitive to the disruptive e¤ects of alcohol(Newman et al. 1996; Tiplady 1996).

Visual analogue mood scales were presented on the NewtonMessagepad (Newman et al. 1996; Tiplady 1996). For each unipo-lar mood state, one end of the linear scale was marked �Do notfeel at all� (0), while the other end was marked �Feel completely�(100). The subject indicated their current mood state by markingthe line with a light pen (initial responses could be amended). Sixteenmood states were covered; they are listed in Table 2.

Procedures and ethics

The baseline data were collected either at the subject�s home, or thehome of the experimenter. Each subject arranged a time for thisinitial baseline test when they were drug free, had not taken MDMAfor at least 1 week, or any other illicit drug for over 24 h. The base-line session preceded when the subjects stated they were going club-bing, and when the MDMA users were planning to take ecstasy.The second test session was undertaken at the dance club venue.This was noisy and crowded, but a comparatively quiet area was

262

arranged for testing. Each subject arranged to meet the experimenter2�8 h after they had taken their MDMA tablets, or equivalent timesfor control subjects.

Unfortunately, not every subject was seen as planned, and eightof the 30 MDMA subjects (four from each group), were tested 8�16hours after taking their MDMA. The third and fourth test sessionswere undertaken 2 days and 7 days later, at venues similar to theÞrst session.

The aims and objectives of the study were fully described to eachindividual beforehand. It was emphasised that neither the experi-menters nor the University condoned the taking of illicit drugs suchas MDMA. Thus the study should not be seen as providing approvalor encouragement for the use of ecstasy or other illegal drugs, par-ticularly since they could have serious side e¤ects. It was stated thattaking part in the study was voluntary, that they could withdrawat any time without giving a reason, that the data would be treatedas strictly conÞdential, and that subject names would not bedivulged outside the study. Those who agreed to take part wererequired to sign an informed consent form. The study was approvedby the University Ethics Committee.

Results

Each mood scale was analysed by a two-way ANOVA,with subgroup and test session as the two factors (Table 1). The memory task was subjected to a similartwo-way ANOVA, while visual search was analysed bythree-way ANOVA, with di¦culty level as the third fac-tor (Table 1). The group means for the cognitive tasks

and mood scales are shown in Table 2. The data fromeach test session were also subjected to a series of one-way ANOVAs, followed by Duncan paired comparisontests. The Duncan test comparisons between the con-trol group and MDMA subgroups, are presented inTable 2. Selected Þndings are also presented graphi-cally (Figs. 1�3).

Discussion

Recreational MDMA users displayed signiÞcantlyworse memory scores than controls at every test ses-sion (Fig. 1). On the Saturday night, ecstasy usersrecalled 60�70% of the words remembered by controls;thus an acute dose of MDMA markedly reduced mem-ory ability (Fig. 1). Memory impairments were also evi-dent at the other sessions, including the initial baselineand Þnal test periods, when ecstasy had not been takenrecently (Fig. 1). These memory decrements were evi-dent in both groups of ecstasy users, but were mostpronounced in the regular users (Table 2; Fig. 1).Several previous studies have found memory decre-ments with ecstasy users. Curran and Travill (1997)compared the prose recall and serial subtraction ofnumbers (working memory task), of recreationalecstasy users and alcohol drinkers on three occasions:during a Saturday night dance while on-drug, 1 daylater, and 4 days later. Overall performance levels werecomparatively lower in the MDMA users (ANOVAgroup e¤ect : P < 0.01 for serial subtraction; P < 0.06for prose recall). However, the data for each test ses-sion were not analysed separately; thus it is unclearwhether performance was signiÞcantly impaired whileon-drug, or during the days afterwards. Poor memoryperformance has also been reported with drug-freeMDMA users. Krystal et al. (1992) found low mem-ory scores, but normal scores on other cognitive tasks,in nine recreational ecstasy users who not had takenMDMA for an average of 66 days. Parrott et al. (1998)found signiÞcantly lower immediate word recall anddelayed word recall in drug-free novice and regularMDMA users compared to non-user controls, whereasperformance on the other cognitive tasks was similaracross groups. Morgan (1998) found signiÞcant mem-ory impairments in ecstasy users, in comparison withto polydrug users who had never taken MDMA.Possible reasons for these poor memory scores are dis-cussed below.

Visual search task performance was also impairedfollowing the acute self-administration of MDMA. Inparticular, the visual scanning of regular MDMA userswas signiÞcantly slower than controls, while noviceMDMA users were impaired to a lesser extent (Table2; Fig. 2). In contrast, visual search performance wasnot generally impaired in the o¤-drug sessions,although the controls displayed superiority under some

263

Table 1 Summary of ANOVA Þndings

Cognitive tests ANOVA factors

Group Session Group Others× session

Memory recall *** *** **(total words)

Visual search × ** *** *** (Di¦culty*)2 (response time)

Visual search × * *** ** (Di¦culty**)4 (response time)

Mood scalesAbnormal *** *** ***Calm � � �

Clearheaded � *** �

Depressed + *** ***Drowsy � ** �

Energetic � � �

Good tempered � *** *Ill � � �

Interested � * �

Quick witted � *** �

Sad * *** ***Sober + *** **Steady � * *Unpleasant + *** **Unsociable � *** **Well co-ordinated * *** �

Two-tailed probabilities : +P < 0.10, *P < 0.05, **P < 0.01, ***P <0.001Others : covers the three-way ANOVA factors (involving di¦cultylevel) for the visual search task only

264

Tab

le 2

Cog

niti

ve t

est

and

moo

d sc

ale

grou

p m

eans

for

reg

ular

MD

MA

use

rs,

novi

ce M

DM

A u

sers

, an

d no

n-us

er c

ontr

ols

Pre

-clu

b ba

selin

eA

t cl

ub (

on-d

rug)

2 da

ys a

fter

7 da

ys a

fter

Non

-use

rN

ovic

eR

egul

arN

on-u

ser

Nov

ice

Reg

ular

Non

-use

rN

ovic

eR

egul

arN

on-u

ser

Nov

ice

Reg

ular

cont

rols

MD

MA

MD

MA

cont

rols

MD

MA

MD

MA

cont

rols

MD

MA

MD

MA

cont

rols

MD

MA

MD

MA

user

sus

ers

user

sus

ers

user

sus

ers

user

sus

ers

Cog

niti

ve t

ests

Mem

ory

wor

d re

call

15.1

13.9

+12

.0**

13.5

9.6*

*8.

1**

12.9

11.9

11.1

*13

.411

.7*

11.4

*V

isua

l se

arch

×2

(eas

y)1.

21.

9**

1.8*

2.8

4.1

6.8*

1.9

2.2

2.2

2.7

2.9

2.6

Vis

ual

sear

ch×

2 (h

ard)

1.7

1.8

2.1

2.9

4.7

7.4*

*2.

62.

62.

72.

73.

12.

9V

isua

l se

arch

×4

(eas

y)1.

72.

02.

2*4.

16.

48.

4+2.

52.

93.

3*2.

93.

23.

0V

isua

l se

arch

×4

(har

d)

2

.52.

72.

74.

16.

9+8.

9**

3.2

3.0

3.5

3.6

3.6

3.5

Moo

d sc

ales

Abn

orm

al

98

736

64**

74**

6

23*

26**

66

5C

alm

8386

8080

7777

7773

7784

8581

Cle

arhe

aded

8692

*94

*49

4844

9393

8891

9495

Dep

ress

ed36

45+

3431

2220

+36

59**

48+

3737

39D

row

sy

4443

27+

5741

4023

3335

+38

28*

25**

Ene

rget

ic60

6068

5162

6472

6256

*67

7070

Goo

d te

mpe

red

8984

9385

9088

8565

*72

+86

8487

Ill

1521

1327

2217

1422

1718

1714

Inte

rest

ed

6565

6768

80

8267

6770

7073

73Q

uick

wit

ted

7566

7658

5952

8279

7877

7484

Sad

2231

*18

209+

9+22

56**

53**

2225

21So

ber

9694

9246

78*

6795

9696

9696

96St

eady

9192

9350

76*

71+

9593

90*

9091

93U

nple

asan

t11

149

129

1015

36**

28+

1418

16U

nsoc

iabl

e21

27

1517

1217

1639

**33

*22

1818

Wel

l co

-ord

inat

ed77

8985

5366

6986

9392

8287

91+

Dun

can

test

tw

o-ta

iled

com

pari

sons

bet

wee

n co

ntro

ls a

nd M

DM

A u

sers

, at

eac

h te

st s

eesi

on:

+P

< 0

.10,

*

P <

0.0

5,

**P

< 0

.01

conditions (Table 2). Previous studies have generallyfound unimpaired performance in drug-free recre-ational ecstasy users, across a range of (non-memory)cognitive tasks : simple reaction time, choice reactiontime, number vigilance, and visuo-spatial ability(Krystal et al. 1992; Spatt et al. 1997; Morgan 1998;Parrott et al. 1998). Overall, therefore, drug-free ecstasyusers do not seem to be impaired in basic (non-mem-ory) cognitive skills, although Morgan (1998) has foundevidence for deÞcits in tests of higher executive func-tioning.

The di¦culty of processing cognitive informationwhile under the inßuence of MDMA, was illustratedin the tape-recorded interviews. One novice MDMAuser admitted: �When I was trying to completethe memory task my mind kept wandering�. Another

commented upon the visual search task: �The shapes seemed to keep moving and I knew that theyshouldn�t because they didn�t the Þrst time I did it. Ireally had to concentrate to pick the right one� Thememory test was also di¦cult because I just couldn�tremember any of the words.� Another MDMA usernoted: �The whole evening goes so quickly. The nextday I try and think back to the evening, I can�t remem-ber anything�. Another regular user recalled how theyused to be strongly against drug taking, but thendecided to try it : �I read this article about ecstasy beingsafer than aspirin� I now take 2�3 in the course of anevening� The shape task was extremely di¦cult�it islike there is a scene going on in your head, and I had

265

Fig. 1 Memory word recall (+ SE) in regular MDMA (ecstasy)users, novice MDMA users, and non-user controls. Non-usercontrol, novice MDMA user, ¨ regular MDMA user

Fig. 2 Visual search times (+ SE) for regular MDMA (ecstasy)users, novice MDMA users, and non-user controls (4 × 4 matrix,hard discrimination condition. Non-user control, noviceMDMA user, ¨ regular MDMA user

Fig. 3 Mood proÞles over the week in regular MDMA (ecstasy)users, novice MDMA users, and non-user controls. Comparisonbetween controls and MDMA users Duncan�s multiple range test :+P < 0.10, *P < 0.05, **P < 0.01. ● Non-users, × novice MDMAusers, ¡ regular MDMA users

to keep reminding myself to stop watching and keepon with your experiment�there was the same problemwith the memory test�. Yet another regular MDMAuser admitted Þnding the memory task di¦cult, butcommented: �I have got a bad memory anyway�.

There are several possible explanations for the poormemories of drug-free ecstasy users. It may be due tochance, but this is unlikely given the number of stud-ies where memory deÞcits have now been shown(Krystal et al. 1992; Spatt et al. 1997; Morgan 1998;Parrott et al. 1998). Alternatively, it may reßect subjectself-selection, with only people having poor memoriesdeciding to take MDMA. However, this post-hocexplanation lacks a clear rationale, particularly giventhe near-normal scores of ecstasy users on other cog-nitive tasks (i.e. they are not cognitively impaired). Athird possibility is that the memory problems arecaused by other illicit drugs, particularly cannabis.Although this explanation is initially plausible, theempirical evidence is against it. Every subject in thestudy of Curran and Travill (1997) was a cannabis user,yet the controls still displayed better cognitive perfor-mance than the ecstasy users. The three groups in thecurrent study took similar amounts of other illicit drugsat the club, yet their memory scores were quite di¤erent(Table 1). Morgan (1998) attempted to match theirMDMA users and polydrug user controls, on the pastuse of other illicit drugs, but still found relative mem-ory impairments in the MDMA group. Thus the mem-ory deÞcits in ecstasy users do not seem to be anartefact of other drug use, although this issue remainscurrently unresolved [the long-term cognitive e¤ects ofall illicit psychoactive drugs (e.g. cannabis, LSD,cocaine) need to be properly studied, but this is di¦cultbecause of their illegal status]. The Þnal explanation isthat the memory deÞcits (Fig. 1) are directly caused byMDMA.

Laboratory studies with rats and monkeys haveshown that MDMA produces serotonergic neurode-generation; this has been demonstrated in various brainareas including the hippocampus, which is importantfor memory functioning (Ricaurte et al. 1988, 1992;Steele et al. 1994; Green et al. 1995). Serotonergic neu-rotoxicity following MDMA administration has beenshown in numerous studies; moreover, the neural dam-age seems to be long-lasting: �In nonhuman primatesMDMA-induced serotonin neurotoxicity is prolongedand possibly permanent�. The dose of MDMA thatdamages serotonin neurones in monkeys is close to thattypically taken by recreational users, and smaller thanthat taken by some MDMA abusers in the setting ofraves� (McCann et al. 1996, p. 112). There is also clin-ical evidence for brain damage in humans. Spatt et al.(1997) described a recreational MDMA user who pre-sented with anterograde amnesia and marked impair-ments in episodic memory, but normal performance onother neuropsychological tests. An MRI brain scanrevealed bilateral lesions in the serotonin-rich globus

pallidus, similar to that reported in an earlierMDMA/polydrug fatality (Squier et al. 1995). PETscans of recreational ecstasy users have also demon-strated reduced levels of 5-HT transporter binding, invarious brain regions (Szabo et al. 1997). There is there-fore consistent evidence that these memory deÞcits mayreßect serotonergic neurodegeneration, directly causedby MDMA self-administration (Fig. 1). This raises thequestion: how much ecstasy needs to be taken beforecognitive deÞcits develop? Our regular users were com-paratively more impaired than the novice users, pro-viding some support for the (arbitrary) split betweenthose who have taken ecstasy on less than, or morethan, ten occasions. However, the relationship betweencognitive performance and MDMA consumption(both frequency and intensity), need to be investigatedmore fully.

Turning to the mood state data, all three groupsreported surprisingly similar moods on the Saturdaynight. Thus each subgroup reported high ratings forfeeling �good tempered� at the nightclub (Fig. 3).Ecstasy users did report a borderline trend for lowersadness and less depression than controls (P < 0.10;Fig. 3), together with greater abnormality (Table 2). Incontrast, the controls were signiÞcantly less sober andless steady, probably because of their alcohol con-sumption (Table 2). In retrospective surveys, ecstasyusers typically describe feelings of euphoria, elation,and greater acceptance of others (Peroutka et al. 1988;Liester et al. 1992; Solowij et al. 1992; Davison andParrott 1997; Parrott 1995; Parrott and Stuart 1997),probably due to an acute boost of serotonin activity(Steele et al. 1994; Green et al. 1995). The absence ofsuperior moods in our ecstasy users was therefore unex-pected (Table 2; Fig. 3). Various factors may, however,have contributed to this. Firstly, previous studies havegenerally not included non-user controls (exceptCurran and Travill 1997), and most dancers /clubberswould be expected to experience good feelings on theirSaturday night out. Secondly, our controls had takena range of other psychoactive drugs which may havecontributed to their positive moods (Table 2; Fig. 3).Future studies should include a drug-free group,although the majority of clubbers do seem to take psy-choactive drugs [Lenton et al. (1997) found that only8% of clubbers had not consumed any psychoactivesubstance]. A related problem was ceiling/ßoor e¤ects.Thus ��good tempered�� ratings were already high in thecontrol group, making it di¦cult to generate signiÞcantmood superiority in the other groups.

Two days afterwards, the ecstasy users reported arange of deleterious moods: depression, sadness, unso-ciability, unpleasantliness, and abnormality (Table 2;Fig. 3). Negative moods tend to develop during theperiod of serotonin depletion which follows an ecstasytrip. Thus lethargy, depression, moodiness, and irri-tability, are often reported in the days post-MDMA(Peroutka et al. 1988; Solowij et al. 1992; Davison and

266

Parrott 1997). In their prospective study, Curran andTravill (1997) found a range of positive moods in activeecstasy users, but mid-week blues afterwards. It is there-fore clear that MDMA can lead to marked moodswings. Feelings of depression, sadness, calmness, pleas-antliness and sociability, ßuctuated markedly over theweek in our ecstasy users, whereas these moods werefairly stable over time in the controls (Fig. 3). Curranand Travill (1997) found that some of their ecstasy usersdeveloped clinically borderline levels of midweekdepression. This was conÞrmed in the interviews here,where depression was recognised as an occupationalhazard of regular ecstasy use: ��My other friends thatdo a lot more drugs than me are sometimes reallymoody, and some cry quite often for no reason��... ��IdeÞnitely do get depressed sometimes��... ��I had theoccasional mid-week depression, and occasionallyfound myself crying for no real reason��.

Although this study was not designed to monitor themedical or physiological e¤ects of MDMA, several ofthe interviews conÞrmed its dangerous side-e¤ects (e.g.hyperthermia, hyponatraemia, convulsions, catatonicstupor, vomiting, motor tics: Dowling et al. 1987;Schmidt 1987; Henry et al. 1992; Maxwell et al. 1993;Lee 1994; McCann et al. 1996). One regular MDMAuser admitted to vomiting after each period of drugtaking; another to paranoid feelings; a third to repet-itive tingles and spontaneous arm movements: ��Halfthe time I do even realise I am moving my arm, untilmy friend tells me stop...may be there is some perma-nent damage or something��. Two severe medical emer-gencies were also described: ��My boyfriend had a reallybad time...he was getting more and more worked upand really sweating badly. His face looked mad and hiseyes were practically poping out of his head. In the endthey had to take him to hospital...He wasn�t right fordays afterwards and now won�t touch pills. I still dothem occasionally, but never more than two��. Anotherregular user recalled: ��On holiday... I took two at onceand after about 45 minutes I couldn�t move a singlemuscle and basically just collapsed on the dance ßoor.My mates took me back to the hotel, and I was sickall night long, and kept having really bad hallucina-tions. My mates were more scared than me because thenext day I couldn�t remember a lot at all. I felt terri-ble for a couple of days, but after that I was Þne. Ithasn�t put me o¤ taking them��.

In summary, the current study was the Þrst to inves-tigate the acute e¤ects MDMA self-administrationupon mood and cognitive performance, in comparisonwith pre-drug baseline. As expected, the recreationalecstasy users reported very good feelings on-MDMA;however, the other clubbers/dancers also reported goodmoods, even though they had not taken any ecstasy.The good moods of all the Saturday night clubbers,illustrate the importance of context and expectacy forgenerating positive feelings. It might be argued that ourquestionnaire was insensitive to the unique mood ele-

vating properties of ecstasy; thus questions on ��ela-tion�� or ��empathy�� might have generated signiÞcantgroup di¤erences. However, the current mood scaleswere certainly sensitive to the negative feelings whichdeveloped in the days afterwards, during serotonergicdepletion. Thus our MDMA users reported consider-able mood swings during the week they had usedecstasy (Fig. 3). The cognitive test Þndings indicatedthat the acute self-administration of MDMA markedlyimpaired information processing ability (Figs. 1, 2), andemphasised the dangers of undertaking skilled activi-ties like car driving under its inßuence (Schifano 1995).However, the most worrying Þnding was the poor mem-ory scores of the drug-free ecstasy users, particularlythose who had taken MDMA on more than ten occa-sions (Fig. 1). When combined with the animal dataon serotonergic neurotoxicity (Ricaurte et al. 1992;Green et al. 1995; Frederick and Paule 1997), they sug-gest that serotonergic nerve damage may also be occur-ring in humans (Spatt et al. 1997; Szabo et al. 1997).This is obviously very worrying, given the widespreaduse of MDMA.

Acknowledgements The authors would like to thank Dr. BrianTiplady (Astra Pharmaceuticals), for the loan of his AppleMessagepad cognitive test system, also John Turner for valuablecomments and suggestions.

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