How Ecstasy Use May Harm the Brain

In February 2011, Time ran an article titled “Ecstasy as Therapy: Have Some of Its Negative Effects Been Overblown?” That article and others like it at the time focused largely on one Harvard-led study, in which researchers found little evidence of decreased mental ability in ecstasy (MDMA) users.

But more recent studies prove that the issue is far from settled. In fact, they suggest that recreational ecstasy use might indeed have lasting, harmful effects on the brain.

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Decreased Memory

The latest headline-grabbing study was published online on July 26 in the journal Addiction. Researchers at the University of Cologne in Germany focused on more than 100 new ecstasy users, who had taken no more than five pills before the study began. These volunteers completed a battery of cognitive tests at the outset of the study and again a year later. Those who had taken 10 or more ecstasy pills during their first year of using the drug showed decreases in immediate and short-term memory.

Smaller Hippocampus

One area of the brain that plays a key role in memory is the hippocampus. In a preliminary study, Dutch researchers used MRI scans to compare the hippocampus in 10 young men who were long-time ecstasy users and seven young men who had never taken the drug. On average, the hippocampus was 10% smaller in the ecstasy group. By itself, the study didn’t prove that long-term ecstasy use can shrink the hippocampus, but it added to recent evidence suggesting that might be the case.

Loss of Serotonin

Within the brain, ecstasy acts mainly on cells that use serotonin, a chemical messenger that helps regulate mood, sleep, appetite, sexual drive, and learning and memory. According to the National Institute on Drug Abuse, ecstasy amplifies and prolongs the serotonin signal sent from one cell to another. It also causes excessive serotonin to be released.

That might sound like a good thing, because serotonin is considered a feel-good chemical. But over time, ecstasy may throw the brain’s serotonin system out of whack, ultimately leading to a decline in serotonin. And these unwanted changes may last even after people stop using the drug.

In a study in Archives of General Psychiatry, researchers at Vanderbilt University School of Medicine used PET imaging to look at the brains of 14 women who had taken ecstasy, but not within the last 90 days, as well as 10 women who had never taken the drug. The ecstasy users had increased levels of certain serotonin receptors—a sign that their brains were trying to make up for a loss of serotonin. The more ecstasy they had used in the past, the greater the changes tended to be.

Risk for Depression

Lack of serotonin is thought to be involved in depression, which led scientists to wonder whether ecstasy use increases the risk for depression down the line. A study by University of Montreal researchers, published online on April 19 in the Journal of Epidemiology and Community Health, suggests that it might. The study of more than 3,800 teens found that those who had used ecstasy in tenth grade were more likely to have symptoms of depression in eleventh grade.

There are still many unanswered questions about the long-term effects of ecstasy. For instance, it's unclear why the Harvard study in 2011 found conflicting results. But evidence is mounting that ecstasy may change the brain well after users have changed their mind about taking the drug.

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