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Drug Abuse and Addiction in Medical Illness pp 175–188Cite as

MDMA and LSD

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Abstract

MDMA is a methamphetamine derivative and powerful CNS stimulant, which is taken at dance clubs and parties under the street name of “ecstasy”. MDMA or 3,4-methylenedioxymethamphetamne is an indirect monoaminergic agonist, leading to increased levels of synaptic serotonin, dopamine, and other neurotransmitters. It also stimulates the hypothalamic–pituitary–adrenal (HPA) axis, increasing the release of many neurohormones. Recreational MDMA users at dance clubs demonstrate an 800% increase in the stress hormone cortisol. In acute terms, most ecstasy users are in a state of hyper-stimulation, and display elements of the serotonin syndrome. This is generally relieved by resting or “chilling out”, although it can develop into severe hyperthermia. Medical treatment should focus on immediate rest and cooling. Blood tests are also needed to monitor potential hyponatraemia, when excessive fluid-intake dilutes sodium levels. In the absence of rapid medical intervention, fatalities may occur. Acute MDMA disrupts attention, impairs cognitive processing, and makes car driving hazardous. The period following recreational ecstasy/MDMA is typified by neurochemical recovery, when feelings of lethargy, irritability, and depression predominate. Thermal stress and prolonged dancing when on-ecstasy can heighten the emergent neuropsychobiological problems. The dependence syndrome with MDMA has a two-factor structure, with compulsive usage and escalating doses/bingeing. Indeed chronic tolerance is almost universal amongst regular users (Table 13.1). Regular ecstasy users can display a range of neuropsychobiological problems, including memory deficits, impaired problem solving, reduced social intelligence, disrupted sleep architecture, sleep apnea, oxidative stress, and reduced immunocompetence (Table 13.2). Psychiatric symptom profiles are often raised. Interactive diathesis-stress models note that prior predisposition factors are exacerbated by repeated metabolic overstimulation. The psychedelic drug LSD is also associated with various psychiatric problems, including psychotic breakdown, paranoia, and perceptual flashbacks. These are most prevalent in regular LSD users. Medical problems with MDMA can include cardiac, renal, and hepatic damage. Neuroimaging indices often show a reduction in serotonin transporter density, consistent with the data on serotonergic neurotoxicity in laboratory animals. These multiple factors have been integrated into metabolic-distress model (Table 13.3). To summarise, MDMA is a powerful acute metabolic stressor, with a range of adverse acute effects, recovery problems, and long-term neuropsychobiological problems. The main problems with LSD are the risk of psychiatric breakdown, especially in susceptible individuals.

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Authors and Affiliations

  1. Department of Psychology, Swansea University, Swansea, SA2 8PPUK, Wales, UK

    A. C. Parrott

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Correspondence to A. C. Parrott .

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Editors and Affiliations

  1. Inst. Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, Universiteitsweg 99, Utrecht, 3584CG, Netherlands

    Joris C. Verster

  2. Dept. Psychiatry, Medical University of South Carolina, President St. 67, Charleston, 29425, South Carolina, USA

    Kathleen Brady

  3. School of Medicine, Div. Alcoholism & Drug Abuse, New York University, First Ave. 550, New York, 10016, New York, USA

    Marc Galanter

  4. Institute of Psychiatry, King's College London, National Addiction Centre, Windsor Walk 4, London, SE5 8AF, United Kingdom

    Patricia Conrod

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Parrott, A.C. (2012). MDMA and LSD. In: Verster, J., Brady, K., Galanter, M., Conrod, P. (eds) Drug Abuse and Addiction in Medical Illness. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3375-0_13

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