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Add iction (1 997 ) 92 (7 ), 82 1± 831
R E SE A R C H R E P O R T
M ood an d cog niti ve effe cts of
63,4 -m e th yl en edio xym etham p he ta m in e
(M D M A , `e csta sy ’ ): w ee k- en d `h igh ’ fo llo w ed
b y m id -w ee k l ow
H. VALER IE C URRAN & ROSS A . T RAVILL
D ep ar tm en t of P sy ch ol ogy , U n iv er sity Co lle ge Lo ndo n , U K
Abstract
A im s . Re cr eat io na l use of 63 ,4 -m e thy le ne di ox ym e th am p h eta m in e ( M D M A , `e cs ta sy ’ ) i s w id esp r ea d. T h e
pr es en t s tud y ai m ed to e xa m in e both th e acu te an d resi du a l ef fe cts of this dr ug on use rs ’ m ood a nd cog ni tiv e
fu nc tio n . Design and participants. A p ar allel g rou p d esign wa s us ed to co mpa re 1 2 p ar tici pants w ho
re po rte d ha vi ng taken M DMA w ith 1 2 p ar tici pa nt s w ho reported h av ing consu m ed o nl y alcohol, on t he
re lev an t ni gh t (day 1 ). T hese sam e pa rt ici pa nts w er e the n re -a ss ess ed th e follo w ing da y ( da y 2) a nd a ga in
mid-week (day 5). Fi nd in g s. A c ute ef fec ts of MD M A b roa d ly rep lic at ed pr ev iou s ® ndin gs . M DM A use rs
ra ted elev ate d m oo d on da y 1 but si gni ® ca ntly lo w m oo d on day 5 , at w hic h p oin t som e p ar tic ip an ts sc or ed
w ith in th e ra ng e for cli ni ca l dep r ess io n. In co nt ra st , the al co ho l gro up s ho we d les s pr on ou n ced c ha n ges ,
w hi ch f oll ow e d a U- sh ap ed cu rv e o ve r da y s w ith th e lo we st po int bei ng da y 2. T h e M D M A gr oup a lso
sh ow ed sign i® cant imp ai rm en ts on a n a tt ent ion a l /w or ki ng mem o ry task , co m p ar ed with alco h ol u se rs .
Con c lu sio n s. W e ek end use of M DM A m ay l ead to d epr ess ed m oo d m id- w eek . Po ssi ble m ec ha nis ms
un de rly i ng t he ® nd ing s a re d is cu ss ed i n te rm s o f te m po ra ry d ep le tio n o f se rot on in , se ro to ne rg ic n eu rot o xi ty a nd
ps ych o log ical a sp ects of m o od c ha ng e.
In tr od u ctio n
Desp ite legislative ac tion and m ed ia c am pa igns,
rec reati onal us e of ( 6) 3,4-m ethylene-
di ox yme th am ph eta mi ne (M D M A, `Ec sta sy’ ) re -
main s wide sp rea d (Perou tk a, 1987 ; St eel e,
McCann & R icaurte, 199 4). The effec ts o f
MDM A o n m oo d and cognition have rec eiv ed
rel ati vely little att ention fro m researchers. Th is is
pa rtl y be cau se c on trolle d la boratory stu die s with
hu ma ns ar e generally precluded for leg al and
eth ic al re as on s and s o stud ies on h um ans a re
res tri cted to recreational u ser s. N eu rotox ic e f-
fec ts of M DM A h av e bee n dem on st rat ed in ro-
dents and non-human primates, but it is not
cle ar whethe r similar eff ect s oc cu r in hum an s
(Rica urte et a l., 1992; G reen, Cr os s & G oo dw in,
199 5) . U s e o f M D M A has be en ass oc iate d w it h
sle ep d is turbance (A lle n, M cCann & R ic aurte,
199 3) and the literat ure con tains a ra nge o f case
rep orts of ind ividuals d evelo pin g psyc hiatric
pro bl em s foll ow ing M DM A u se (cf . M c Gu ire ,
Cope & Fahy, 1994; Steele et al., 199 4).
Co rre sp ond en ce: Dr H. V a ler ie Cu rra n, C lin ica l Hea lth P sycho log y, U niv er sity C ol leg e Lo nd on , Gow er S tre et,
Lo nd on W C 1E 6 BT , U K. T el : 144 (0) 1 71 38 0 78 97; f ax : 14 4 (0) 171 916 1989; e-m ai l: v.cu rran@ uc l.a c.u k
Sub m itted 19th J uly 19 96; i nit ial rev ie w com ple ted 15th O cto be r 1996; ® nal ver sio n acce pte d 20th Ja nu ar y 1997.
0965± 2140 /97/070 821± 11 $9.50 ÓSo cie ty f or th e S tud y o f Ad di ction t o Alcohol and Oth er D ru gs
Ca rf ax P ub lish in g Com pa ny
822 H . V. C urr an & R. A. Tr av ill
Although d op am ine-relea sing e ffec ts of MDM A
ha ve b een demonstrated (e .g. Yama moto &
Sp an os , 19 88) , i ts sero tonergic effects ap pear
most pro mi ne nt (Steele et a l., 1987; S chmidt,
19 87) . D e® cits in s ero to nin in hum an s could b e
associated with both detriments in cognitive
fun ct ion and dis tu rbed mo od r egu la tio n (K rys ta l
& Pr ice , 1992; St eel e t al., 199 4; C u rran &
Ko pelman , 19 96) .
Of the s tudie s of the effect s o f M D MA on
mood, m os t ha ve a ss es sed o nly acute eff ect s.
Only o ne study wa s fo un d which objectively
as ses sed e ffec ts o n co gnitiv e function, and this
in vo lved chron ic u se rs of M D MA. T wo studies
of ac ut e M D M A effe ct s w er e con du ct ed pri or
to go ve rnm enta l restrict ion s. D ow n ing (1986)
as ses sed e ffec ts o f M D M A ( av era ge do se 2 .5
mg/k g) in 21 volun teers w ith pre vious MDM A
ex per ience. Se lf-r ep ort measures o f acute effects
in clu ded eu ph oria, in creased p hysic al an d
em ot ional e nergy , heightened sensual aware ne ss
an d de creas ed a ppeti te. S om e sh ow ed gait ins ta -
bil ity , tri sm us an d in creased deep te nd on
re¯ e ct ion . O nly thre e h ad a ny a pp ar ent co gn itive
effe ct s as indexed by prob lem s p erfor ming m ath-
em at ica l ca lcu lat ions. Sim il ar m ood e ffects we re
rep or ted by Greer & T albot (19 86) in a sum -
mary of 29 cl inical sessions i n whic h M D MA
(in it ial dose ran ge 7 5± 150 mg foll ow ed late r by a
se con d 50± 75 m g dose) wa s used as an adju nc t
to psyc hothe rapy. T he re have been two re tro -
sp ect ive stu die s, re ly ing on p articipa nts’ me mor-
ies for prior use of MDM A . Pe ro ut ka , Newma n
& H arris (198 8) as ked stu dents w h o we re rec-
rea tio nal users of MD M A to comple te a qu es -
tio nn aire ab ou t ac ute an d `lin gerin g’
(.24- ho ur ) effe ct s o f M D M A. A g ain , a cu te
effe ct s li ste d in cl ude d a sense of c loseness to
others an d e up ho ria but le ss t ha n 25 % of the
sa mp le r at ed a ny ling eri ng effec ts of M D M A. In
an other retros pec tive s tud y, L ieste r et a l. (1 992)
in ter view ed 20 psy chiatrists wh o h ad use d
MDM A an d t he m o st frequentl y n ote d a cu te
effe ct s we re decreas ed m otivation to p erform
mental or p hy sical tas ks , decreased app etite and
tri sm us . Only a sm all m inority rep or ted any co g-
nitive effe cts of th e drug .
Su ch s tu dies are clearly limited by t he lack o f
ob jectiv e asse ssmen t of cognitiv e effects. In con-
tra st , Krystal & Price (199 2) as se ssed nine indi-
vid ua ls w ho ha d ex te ns ive h istories o f M D MA
us e on a w id e ba ttery of ne urops ycholog ica l
tes ts . Te st result s revea led few clinically
sig ni ® can t co gn itiv e pro bl em s. Howeve r,
co mp ared with no rmati ve d ata the re w as s om e
indic ation o f a m ild to m oderate impairm en t on
bo th imm ed ia te and d ela ye d lo gi cal m em o ry
tes ts fr om t he Weschler M emo ry S ca le. T h ere
wa s no indic ation o f depress ed m o od ( eit he r sel f-
or clin ician-rated) in these nine p eo pl e, alth oug h
it should be no ted th at they ha d n ot t ak en
M DM A f or a n av er age of 66 da ys p rio r to t he
as ses sment.
W ha t is no t kn ow n are t he cog ni tive effe cts of
M DM A fo llo wi ng a sin gl e d os e, or th e pos sib le
res idual effects on cognitio n an d/ or moo d a few
da ys l ate r. L ev els of 5-HT , a cu tely el eva ted by
M DM A , are th en de ple ted fo r an un kn ow n pe-
rio d, such th at m ood a nd co gnition m ay be
affe ct ed fo r some d ay s fol lowin g the u se of
MDM A . As p erhaps the m ajo rity of recreational
M DM A use rs t ak e t he d ru g a t th e w eek en d, but
do not take it a gain u ntil th e follo win g w ee kend,
it is i mp ort ant to as ses s th e d rug ’ s e ffec ts no t
on ly a cutely bu t also residually ov er subseq ue nt
da ys . Th is m a y b e especially imp ortant fo r t he
ma ny M D M A u se rs w ho a re a lso students (Pe r-
outka, 1987) for whom cognitive impairment
ma y a dv ers ely a ffe ct t heir le arnin g.
The present stu dy therefo re aim ed to asses s
bo th t he a cute and r esi du al e ffec ts o f M DMA on
co gnition and m o od in recreation al u sers. G iv en
tha t the illi cit status of th e drug p rec ludes c on -
tro lled laboratory s tu dies, th e present re sea rc h
wa s a `® e ld’ stud y, t ak in g place initia lly in a club
set tin g with f oll ow -up as sessm en ts o n sub-
seq ue nt d ays i n ea ch p arti cip ant’ s ho me. Som e
co nt rol for tes ting w as obtai ned in that t he clu b
pro vi ded a qu ie t roo m a wa y from the dan ce a rea
in w hich a ss es sme nt s to ok p lac e. T hi s a rra ng e-
ment was possible as the psychologist assessing
pa rtic ipants had p re vio us ly b een emp loyed a s a
pa rt- tim e disc jockey a t the cl ub . Vo lu nte ers w h o
rep or ted us e of M D M A o n th e S at urd ay n igh t
we re assessed on that ev en ing and th en thes e
sa me p eo ple were fo llo wed- up for repe at assess -
ments the next day and again 4 days later. As a
co mp ariso n group, w e assesse d peop le w ho re-
po rte d u se o f alcohol bu t no illicit dr ug s. Id ea lly ,
the aut ho rs w ou ld h av e us ed a d ru g-free grou p
as a co ntrol for rep eat testing but th ere we re n o
vo lun teers w ho w ere d ru g-free in t he en vi ron-
me nt fro m w hi ch the M DM A u ser s we re r e-
cru ite d. F urther, u se o f drug -fre e volu nteers
fro m a n on -c lub environmen t would have impli-
cat ed m an y non-speci® c factors in th e co mpari-
M oo d and co gni tiv e eff ec ts o f MD M A 823
so n. T he alcoho l users w ere sele cted p artly b e-
ca us e co gnitiv e effects o f al co hol a re w ell -
do cu me nt ed (Finnigan & H amm ersley, 1992 ).
Although, so me years ag o, a lcohol an d M D MA
were a ss oci ated with `c lub’ a nd `r ave ’ s ett ing s,
res pe ctively, n ow ad ay s restricti on on `ra ve s’ has
led to mo re o ve rla p of d ru g us e in c lub settings
so t ha t th ere were s uf® c ien t numbers o f vo lun-
tee rs a va ila ble w ho reported taking o nly MDM A
or o nly alc oh ol.
M et ho d
Pa rticipa nt s
Vo lu nte ers were recru ited in a club setting on
su cce ss ive S aturd ay n ig hts o ve r a p eri od of 4
months. T he clu b kin dly prov ided a q uiet roo m
in w hich the s tud y to ok p la ce o n da y 1 (Saturday
night). The s tud y had approval fro m the ins titu-
tio nal ethic al co m mi tte e and a ll p articipa nt s ga ve
writt en, inform ed c on se nt b oth o n t he Saturday
night an d ag ain the fol lo win g day. Recru itm en t
us ed a snowball technique (Solow ij, Hall & Lee,
1992) and volunteers who reported having taken
drugs oth er than MD M A o r alcohol, or a co mbi-
na tio n o f both, were not inclu ded in t he study .
In al l, 2 4 p eop le w h os e ag es r an ged from 20 to
27 years p ar tic ipa ted in the study an d they we re
all test ed o n each of t he t hree o ccasions. Tw el ve
of the sample reported that they had taken
MDM A on da y 1 ( i.e. Sa tu rda y n igh t); 12 re-
po rte d they had take n alcohol b ut no o th er p sy -
ch oa ctiv e d rug s (a pa rt fro m caffein e an d/or
nicot ine ) on d ay 1 . Th ere we re eigh t male s an d
fou r fe male s in each group. Of t he M D M A
gro up, six subjects were stud ents s tud ying fo r a
degre e, s ix w ere in e mplo ym en t (thre e w ith
GC S E a nd three w ith A-level quali® cati on s). O f
the alcohol group, seven were students studying
for a d eg ree , ® ve w ere in emplo ym en t (th ree wi th
GC S E a nd two w ith A -le vel quali ® c at ion s).
Pr oc edu r e
Vo lu nte ers were ta ke n in div idually to t he qui et
st ud y room where wa ter wa s avai lable t o th em
an d th ey w ere ask ed to rea d an inform ati on s hee t
ab out the 5 -d ay s tud y an d to d is cu ss th eir p ar-
tic ip atio n with t he experim enter. Indivi dua ls
who th en w ished to participat e were a sk ed to
giv e written , in forme d con sent. T hey then com-
ple te d th e tasks (question na ires and r at ing scales
described b elo w). Once the t as ks w er e c om -
ple te d, a rra ngem en ts w er e m ad e t o m eet up th e
fol low in g da y in order to c on du ct the d ay 1
tes tin g. Part icipants w ere as ked no t to t ak e an y
fur the r alco ho l or ill ici t su bst an ces be tw ee n d ay
1 an d day 2 testings. The pa rti cipant was then
shown back to the club.
Su bs equen t testing was ca rried o ut in the par-
tic ipa nt’ s home o n da y 2 (betw een 12 ;00 noon
an d 4.00 p.m.), a nd o n d ay 5 (between th e
ap pro xima te time s of 5 .30 p.m. and 8.30 p .m .).
Th e se tti ng wa s as quiet as p os sib le, gene ra lly a
roo m a wa y fro m d is tra ctio ns such as T V and
ot her peo pl e. O n day 2, partic ipa nt s we re ® rst
as ked if th ey s till wished t o ta ke p ar t in the s tud y
an d if so, to ag ain sign a n in forme d consen t
for m. A fter te st ing on d ay 2 , participan ts w ere
as ked to ® ll in a b rie f questionn aire d eta iling
the ir age, o cc up ation a nd f req uenc y of u se o f a
ran ge of d ifferent drugs . Participan ts ’ r etr os pec-
tiv e reports o f amount of a lco ho l an d other drug s
tak en the p rev io us n ight was a lso reco rd ed . On
da y 5, th e tes ts we re ru n fo r the t hir d tim e in the
sa me o rder us ing t he sam e instruct ion s. Again,
pre ca ution s were tak en to try to keep ea ch te st
the sam e, suc h as asking su bjects not to d rin k or
tak e illeg al s ub stances b etwee n d ay s 2 an d 5 .
As ses sm e nts
Pr os e re ca ll ta sk . This task parallels the para-
gra ph re ca ll ta sk f rom the W es chl er M em o ry
Sc ale u sed by K ry st al & Price (1 992). V ers io ns
us ed w ere f rom the R iv erm ea d B ehavioural
M em or y B at ter y (W i lso n, C o ckb ur n & B ad de-
ley , 19 85 ). Th e expe rim en te r re ad a pros e para -
gra ph alo ud and the participa nt reca lled it aloud
(i) im m ed iat ely and (ii) after a delay ® lled by a ll
ot her a ssess ments (approximate ly 15± 2 0 m in utes
lat er) . Re ca ll w as s co red in the standard way
wit h o ne po int b ei ng g iv en for each of the po ss -
ibl e 21 details rec alled p erfectly o r a c lo se s yn -
on ym ; ha lf a poin t for pa rti al reca ll o r pa rti al
sy no nym . O rder o f the th ree ve rsions used were
balanced across subjects and design.
Se ria l se ve ns . T his is a task tap ping concen -
tra tio n an d w or kin g mem ory. T he p ar tic ipa nt is
as ked to s erially subtract a s man y sevens fro m a
giv en thre e-dig it nu mber as th ey c an i n 12 0
sec on ds ( e.g . given 876, t he c orrect res po nses
wo uld beg in 869, 8 62, 855 , 848¼ ). The nu mber
of correct subtractions and the number of errors
ma de i n th e tim e al lot ted is rec ord ed . Three
824 H . V. C urr an & R. A. Tr av ill
ve rsi ons were used wit h o rder bala nce d a cro ss
su bje cts a nd d esign .
Be ck D ep ression I nv en to ry (Beck et a l. , 19 78) .
This s tanda rd d epr es sio n in vento ry was g ive n at
ea ch te sting p oint.
M oo d ra tin g sc al e. Th is c on sis ts o f 16 v isual
analogue scales each of 100 mm and anchored at
ea ch end w ith co ntras ting descriptors of p res en t
mood (Bond & Lader, 1974 ). S co re o n ea ch
sc ale i s measured in m m from th e le ft a nchor to
th e line m ar ked by th e participant as correspond-
in g to h is/her cu rren t m ood.
Bo di ly sy m pt om s s ca le. T his scale is o f sim ila r
co nstru ction, co ns isting of 14 v isu al a na logue
sc ale s an chore d at o ne e nd b y `no ph ys ical s ym p-
to m’ and at th e ot her b y `p hy sic al sy mp to m
se ver e’ .
Results
A na ly sis
A r epe at ed me as ure s ana lys is o f va ria nce w as
ca rrie d o ut o n al l va ria bles with g rou p (MD M A
ve rsu s al cohol) as a betw een-s ub jects fa cto r and
tes ti ng d ay as a within-s ub jec ts fac tor.
Pa rticipa nt s’ rep or ted drug u se
In t erm s o f fre qu en cy o f us e of d ifferent d ru gs,
th e M D M A gro up rep or ted m ore reg ul ar us e o f
a r an ge o f d rugs w ith alcohol, can na bis , M D MA
an d c oca ine (r esp ec tiv ely ) b ein g the m os t fre -
qu en tly use d. O the r d rugs listed in th e q ue sti on-
na ire i ncluded am ph etam ine, LSD, G HB
(ga m ma -h ydrox ybuty rate), `mu shroo ms ’ and
he roi n bu t few participan ts repo rte d th ey h ad
ever used these, and those that had only rarely.
In t he M D M A g rou p , two peo pl e rep ort ed usi ng
M DM A o nc e a we ek , s ix a pp rox ima te ly on ce p er
mo nth and fou r only occasiona lly. In the alco hol
gro up , t hr ee part ici pan ts sai d th ey to ok MD M A
ap pro xima tel y on ce p er m onth , fou r only
oc cas ion al ly an d ® v e ha d n ev er ta ke n th is d rug.
Re po rts give n o n day 2 o f drug us e th e pre-
vio us e ve nin g co n® r med that 12 p articipa nts be-
lie ved t he y ha d ta ken M D M A bu t se ven
pa rtic ipants said t hey ha d a lso t ak en b etween 1
an d 3 u ni ts (m ean 1 .8 u nits) of a lco hol. F or
mo st , this alcohol use wa s be fo re they arrived at
the club , althoug h fo r tw o p ar tic ipa nt s it w as a t
the club . Th e other 12 participan ts re po rte d no
illi cit d rug u se on day 1 and b etwee n 4 an d 14
un its ( mean 10.8 uni ts) of alco hol o n d ay 1 . T he
am ou nt o f a lc oh ol tak en b y 7 of th e MD M A
us ers w as sm all co mp ared w ith th e `alcoh ol ’
gro up , al tho ug h it m ay have had a n eff ect . The
gro up s wi ll sti ll be ref erre d t o as `M DM A ’ a nd
`alc oh ol’ . O nl y o ne s ub jec t rep ort ed d rin ki ng
alc oh ol (3 un its) betw een d ays 2 an d 5 ; n on e
sa id th ey ha d taken illic it drug s.
Pr os e re ca ll. T here was a trend (p,0.0 6) for
the M D M A g roup to ha ve l ow er s cores o n im -
me diate recall on all three as se ssment da ys. A
sig ni ® cant m ain effect o f test da y (p,0.001)
wit h n o signi® ca nt interact ion b etween gro up
and day re¯ ected improved performance over
da ys b y bo th g ro up s (T able 1 ). T he pattern of
res ults on de la yed reca ll w as bro ad ly s im ila r: a
tre nd fo r lo we r s co res i n the M D M A gr ou p
(p,0.0 6) a nd a ma in effect of t es t da y
(p,0.0 01) . A dd iti on ally , the int era ct ion o f
gro up with da y s ho we d a s lig ht t ren d (p50.092)
re¯ e cti ng bett er performan ce on d ay 5 by the
alc oh ol grou p.
Se ria l s ev ens. T he n umber o f co rrect s ub trac-
tio ns on t his t as k revea led a sign i® ca nt g ro up by
days interaction (p,0.05 ) a s we ll a s a m ai n
Table 1. Gro up m ean s (s tand ar d dev iati on s) ov er da ys f or ser ial s even s an d pr ose r ecal l tas ks
M DM A Alc o hol
Da y 1 Da y 2 Da y 5 Da y 1 D ay 2 Da y 5
Ser ial s ev ens : n2.7 (1.9) 14.2 (6.7) 25.1 (7.1) 6.3 (3.4) 26.6 (10.7) 31.1 (11.1)
Serial seven s: e rror 2.3 (2.8) 2.6 (2.9) 2.3 (1.9) 2.8 (1.5) 2.1 (2.4) 1.1 (1.4)
Recall: immediate 1.2 (1.5) 5.9 (2.8) 8 .5 (3.1) 3.5 (2.8) 9.0 (4.4) 10.2 (4.6)
Recall: delayed 1.1 (1.0) 4.0 (1.8) 6.4 (3.7) 2.0 (2.0) 7.5 (3.9) 6.9 (3.3)
0
10
1
Day
MDMA users Alcohol users
Serial seven s: N subtractions
5
15
20
25
30
35
2 5 1 2 5
M oo d and co gni tiv e eff ec ts o f MD M A 825
Fig ur e 1. M ea n n um ber corre ct on the ser ia l seve ns task f or the MD M A an d a lco hol g r oup s on d ay s 1, 2 a nd 5 .
effe ct of b ot h gr ou p (p,0.01) an d da ys
(p,0.0 01 ) ( Fi g. 1) . T he MD M A gro up ma de
few er sub tra cti ons tha n the a lco ho l gro up a t all
as ses sment po ints, b ut these gro up d ifferences
were m o re m arked on day 2 than d ays 1 a nd 5.
There were n o signi® ca nt gr ou p differen ces in
nu mber of errors m ad e.
Be ck D ep res sion Inv entory. Scores on this in -
ventory showed a very signi® cant interaction be-
tw een gro up a nd day of t estin g (p,0.001). A s
se en in F ig. 2, the t wo grou ps o f participan ts h ad
ve ry similar sco res on da y 2. O n day 1, M D M A
us ers scored low er t ha n alcohol u se rs. O n d ay 5,
th is pattern w as reversed su ch th at t he M D M A
us ers s co red a me an o f 11 .75 , whereas alc oh ol
us ers ’ s co res we re s imilar to t he ir in itial ratings
on d ay 1 . Scores of less than 9 on t he B DI are
co nsider ed w ith in th e n orm a l ran ge (Elkin ,
19 94) a nd th os e ab ove 1 6 a s indi cat iv e of clinical
depre ssion (Shapiro et a l., 1994). On day 5 , th e
va ria nce in BD I s co res o f th e M DM A gro up w as
hig he r th an o n t he p rev io us 2 test d ay s, s uch that
so me individ ua ls in thi s gro up were scoring
within th e no rm al ra ng e wh ereas others were
sc ori ng w ith in th e m ild to m od era te c lin ica l
depre ssion range.
M ood r ati ng sc ale. Visual analogue ratings
sh ow ed m ar ke d grou p differen ces ov er the 3 test
days, with 11 of the 16 scales showing signi® cant
group 3test -day inte ractio ns ( Ta ble 2). The
mo st sig ni® can t grou p 3day in terac tio ns
(p,0.0 01) were co nt ented± dis co ntente d;
ha pp y± s ad a nd int ere sted ± bored. Thus, as se en
in T ab le 2, th e M DMA gr ou p on da y 1 w ere
mo re con tented, happ y an d in te res ted than al-
co ho l users . MDMA users be came pro gress ively
mo re d is contented, s ad a nd bo red over the su b-
seq ue nt t est da ys w he rea s alco hol us ers s ho wed a
sli gh t `U-sh ap e’ cu rv e o ve r the 3 d ay s, rating
sli gh tly lo wer m oo d on day 2 c om pare d with
eit he r day 1 o r 5.
Five scales showed group 3d ay interactio ns a t
p,0.0 1. D ro wsin ess (alert ± drow sy ) ra tin gs were
hig h fo r bo th grou ps o n day 2 w ith the ma in
gro up differen ce s temm in g fro m h igh alertnes s
rat ing s by MD M A us ers on da y 1 . R a tin gs of
str on g± f eeb le s ho we d M D M A u ser s r ati ng th em -
sel ve s ver y stro ng o n d ay 1 , an d t hen more feeble
tha n a lco ho l us ers on d ay 2. `M uz zy clear-
hea d ed’ rat in gs a lso s ho we d M DM A us ers a s
mo re c lea r head ed o n d ay 1 b ut rat her more
mu zzy on da y 2 than alc oh ol u ser s. T his pattern
of gro up di ffer en ces ov er d ays was al so s een o n
0
4
1
Day
MDMA users Alcohol users
BDI sc ore
2
6
8
10
12
2 5 1 2 5
826 H . V. C urr an & R. A. Tr av ill
Fig ur e 2. M ea n s cor es on the Be ck Dep res sio n In ven tor y f or the MD M A an d a lcoh ol g ro ups o n da ys 1 , 2 an d 5 .
rat in gs o f `le thargic± en erget ic’ and `tro ubl ed ±
tra nq ui l’ w ith M DM A us ers ra tin g v ery h igh on
en erg y and tranquillity on d ay 1, b ut l ow er tha n
alc oh ol u se rs o n day 2. A s im ila r pa tte rn w as
ob taine d for sc ale s s ho wing a group 3d ay in te r-
ac tio n which reache d signi® cance at 0.05:
MDM A users rated th em se lves as m ore am i-
ca ble , mo re pro ® cient a nd l ess clums y th an a l-
cohol users on day 1.
Bo dil y S ym pt om s Sc al e. Three scales showed
gro up 3da y in teraction s at the 0.0 01 le vel. Pre-
di cta bl y, M D M A use rs had ve ry hig h `s we ati ng’
sc ore s on ly o n day 1. Th ey also ve ere d from
rel ati vely high e nergy a nd lack of tiredne ss o n
da y 1 to ma rked lack of energy a nd tire dn es s on
da y 2 which p ers isted somewhat to da y 5 (com-
pa red with alcohol u se rs) . Ra tings of a nxiety,
depre ssion an d agitatio n (a ll yielding
gro up 3da y inte ra ctio ns signi® cant at the
p,0.0 1 leve l) ea ch showed a p rogressi ve in -
cre as e over days fo r th e M D MA gro up , wh ile t he
alc oh ol g roup s ho wed le ss e xt rem e c hange s o ver
da ys w hich aga in follow ed a `U-shap ed’ curve.
Two scales revealed gro up 3da y interaction s at
th e 0.0 5 level, alth ough t hey s ho uld be inte r-
pre te d w ith ca ution given that the analy sis of 34
va ria ble s in t his stu dy wo ul d pro duce 1.7
sig ni ® can t res ults at 0.05 b y ch an ce. Irritability
rat ing s (p,0. 05) re ve ale d the same p att ern of
effe cts ov er day s; d ry mouth (p,0.0 5) h ad h igh
rat ing s by MD M A us ers on da y 1 . R a tin gs of
impaired co nc entratio n we re high est for alcohol
us ers o n d ay 1 , and h ighest for MDM A use rs o n
da y 2.
Discussion
Th e m ain re su lt of th is s tu dy ind ica te s th at u se
of M D M A at t he w ee ken d is ass oc iate d wi th a
low ering of m oo d m id-week . Score s on the Beck
De pre ssion I nv en tor y (B DI) , on several m oo d
rating scales (happy± sad; contented± discon-
ten te d; in te res ted ± bo red) a nd b od ily symptom s
sca le s (depress ed , an xious , ag ita ted ) all showed
ver y s ign i® cant gro u p d iffe ren ce s o ve r th e 5
da ys . O n all the se , M D M A use rs rat ed ele vat ed
mo od on day 1 which pro gr ess ively lo we red o ve r
su bs equ ent testi ng day s. I n c on trast, the alcohol
gro up sh ow ed a `U-sh ap ed’ c urve, with the l ow -
est point being d ay 2 , presum ab ly a han g-over
effe ct from day 1’ s co nsumption. On day 2, bo th
gro up s were bro ad ly simi lar in ra tin gs o n thes e
va ria bles , im pl yin g th at t he `d ay aft er’ effect s of
M DM A ( in clu din g la ck of s lee p) a re no t di ss imi-
lar in some res pe cts t o an alco hol hang-ov er.
Of partic ula r co ncern a re th e B DI sc ores of
M ood a nd c og niti v e ef fect s o f M D M A 827
Ta ble 2 . Gr oup mea ns (s tan da rd de viatio ns) o ver day s for sc ore s on th e Be ck Dep ress ion Inve nto ry an d in div idu al m oo d rat ings; AN O VA resu lts fo r eac h ra ting
AN OV A
MD M A Al co hol
Gr oup
Da y 1 Day 2 D ay 5 Da y 1 Da y 2 Da y 5 Gr oup Day 3d ay
BD I 3.5 ( 3.5 ) 8.7 ( 3.8 ) 11.8 ( 7.2 ) 6.4 ( 5.3 ) 8.3 ( 5.2 ) 6.9 ( 4.1 ) NS ** * ***
Mo od r atings (m m)
Dr owsy 19 .6 (2 7.1 ) 77.9 (14.5) 42.9 (23.8 ) 45.7 (27.0 ) 66.0 (1 4.1 ) 36 .8 (1 9.1 ) NS *** **
Ex cit ed 6 3.3 (37 .6) 14 .9 (9.4) 3 8. 9 (14 .8) 5 6. 8 (26 .3) 30.4 (15.1 ) 36.6 (1 4.9 ) NS *** NS
Feeble 17 .9 (1 6.4 ) 74.5 (15.0) 35.7 (16.6 ) 37.2 (17.7 ) 58.0 (9 .7) 38.8 (1 8.2 ) NS *** **
Cl ear -he ad ed 65 .1 (3 3.2 ) 24.1 (16.1) 58.1 (26.5 ) 34.2 (13.3 ) 37.3 (1 1.1 ) 63 .0 (1 6.2 ) NS *** **
Cl um sy 41 .4 (2 6.4 ) 67.6 (20.1) 35.6 (23.6 ) 62. 8 (12.6 ) 51.7 (1 5.2 ) 40 .0 (1 7.0 ) NS ** *
En erg etic 88 .3 (1 1.8 ) 17.8 (11.7) 46.8 (24.7 ) 61.0 (24.7 ) 31.8 (1 9.8 ) 49 .2 (1 4.8 ) NS *** **
Di sco ntente d 9 .4 ( 9.1 ) 3 8. 3 (24.0) 5 9. 4 (23 .3) 3 5. 4 (18 .5) 44.4 (19.5 ) 42 .5 (1 8.5 ) NS *** * **
Tr anq uil 75 .8 (1 5.7 ) 65.9 (24.5) 38.8 (19.1 ) 52.4 (12.6 ) 45.1 (1 7.9 ) 48 .2 (1 1.4 ) *** ** * *
Qu ick -w itted 51 .9 (3 1.6 ) 24.4 (16.6) 54.1 (21.9 ) 46.4 (22.8 ) 40.5 (1 9.7 ) 61 .3 (1 9.8 ) NS *** NS
Relax ed 71 .6 (1 5.2 ) 65.3 (24.6) 43.8 (30.3 ) 58.8 (22.6 ) 44.7 (2 0.9 ) 49 .4 (2 0.0 ) NS * N S
Dr eam y 44. 5 (37.3) 8 2. 8 (13 .1) 42 .6 (2 5.0 ) 49 .6 (2 2.3 ) 58 .2 (1 5.2) 38 .4 (17. 5) N S ** * N S
Pro ® ci en t 60 .8 (2 8.3 ) 35.8 (16.5) 65.6 (20.8 ) 48.8 (19.9 ) 49.8 (1 3.5 ) 64 .7 (2 0.3 ) NS *** *
Sad 7.0 (9. 9) 33. 5 (20.7 ) 5 4. 6 (27 .7) 2 6. 9 (21 .8) 41.6 (1 8.5 ) 35 .1 (1 6.9 ) NS *** * **
Am icable 82.8 ( 14. 5) 67. 4 (18 .7) 50 .5 (2 8.7 ) 60 .8 (2 5.1 ) 58 .2 (2 2.2) 60 .0 (14. 6) N S * *
Bo red 14 .4 (1 4.9 ) 49.6 (19.5) 62.8 (25.1 ) 41.9 (28.7 ) 55.9 (2 1.6 ) 39 .4 (1 0.7 ) NS *** * **
Gr ega rio us 68 .1 (1 9.3 ) 37.2 (18.4) 47.4 (22.8 ) 66.7 (18.8 ) 46.4 (1 8.3 ) 55 .5 (1 1.6 ) NS *** NS
***p,0 .00 1; ** p,0.0 1; * p,0. 05; N S n ot signi ® c ant.
828 H . V . C ur ra n & R. A . T ra vill
Ta bl e 3. G rou p m ean s (stand ar d deviat ion s) over d ays f or bo dily sym ptom s ra tin gs; A N OV A re su lts for each r atin g
AN O VA
M DM A Al co ho l
Gr oup
Da y 1 Day 2 Da y 5 Day 1 Da y 2 Day 5 G ro up Da y 3da y
Restle ssn es s 44.4 (3 2.1 ) 52.9 ( 28. 4) 58. 7 (17 .9) 37.8 (2 4.7) 58 .8 (14.7) 38.8 ( 16.8) N S N S NS
Irritab ilit y 17.6 ( 14 .1) 56. 0 (21 .1) 63 .6 (1 7.6) 33 .7 (2 5.7 ) 55 .7 (20.0) 44.1 (18.3) N S *** *
Physic al t iredne ss 15 .1 (1 8.7 ) 78.9 ( 11. 7) 60. 0 (21.3 ) 41. 9 (23.1) 64.5 (5 .9 ) 46 .1 (23 .1 ) NS *** * **
Lack of energ y 10. 6 (9 .7 ) 8 2.2 ( 11.4) 68.6 (1 5.1 ) 38.8 (22.5 ) 65.8 (8 .5 ) 48 .7 (23 .8 ) NS *** * **
Im pai red concen tra tion 47.3 ( 29 .9) 74. 2 (9.3) 62.1 (2 4.0 ) 67.3 (9 .5) 60.3 (1 6.2 ) 50 .3 (2 5.5 ) NS NS *
Heada ch e 18. 3 (18 .5 ) 5 8.3 ( 24.3) 37.6 (3 6.0 ) 21.8 (1 7.1 ) 50 .2 (3 1.7 ) 25 .8 (2 2.4 ) NS *** NS
Di f® cu lty b reath ing 3 3.7 ( 23 .2) 29. 7 (25.0) 19.8 ( 25. 2) 16.3 (17. 3) 24.0 ( 26 .4) 1 6.3 ( 15 .6) N S N S NS
Dr y m out h 73.2 ( 27 .3) 50. 1 (26.0) 23.8 (31. 0) 34.8 (21. 9) 43.8 ( 28 .6) 1 8.7 ( 22 .5) * *** *
Nausea 31. 1 (20 .5 ) 30.3 (26. 1) 9.3 (9. 2) 1 6.0 ( 14. 0) 3 0.7 ( 29 .1) 1 3.5 ( 15 .2) N S ** NS
Anxie ty 20. 8 (15 .6 ) 34.7 (23. 5) 52. 2 (21 .2) 18.7 (1 6.0 ) 40 .9 (2 1.4 ) 26 .9 (1 8.7) NS ** * **
Sweat ing 73. 6 (30 .7 ) 18.6 (15. 2) 8.6 (12 .0) 2 1.8 (21 .3) 33. 9 (22 .3 ) 14 .8 (18 .5 ) * * ** * **
Blu rre d visio n 55. 8 (28 .2 ) 21.3 (21.2) 12.4 (20 .5) 29.1 (2 3.9 ) 18 .5 (1 8.0 ) 8.8 ( 13 .4) * ** * N S
De pre ssi on 13 .3 (1 1.0 ) 45.2 ( 23. 1) 56. 3 (24 .4) 17. 4 (16 .5) 34 .7 (2 5.5 ) 20 .7 (1 3.6 ) * *** **
Ag itat ion 20.7 ( 20.7) 49. 1 (15 .6) 60 .8 (2 1.1 ) 30 .5 (2 7.1 ) 44 .5 (1 8.4 ) 24 .5 (15.4) * * * * *
***p,0.00 1; * *p,0 .01 ; *p,0 .05 ; NS not signi® can t.
M oo d and co gni tiv e eff ec ts o f MD M A 829
MDM A u se rs wh ich ind icate that some part ici -
pa nts are within the m ild to m od erate c lin ica l
ran ge for d ep res sio n. T he BD I incl ud es s ev era l
so ma tic item s referrin g to changes in s lee pi ng/
ea ting patterns. M D MA is k no wn to a ffect s leep
(A llen et a l., 1 993) and s ub ject iv e rep or ts of
decreased a pp eti te ar e co mmo n (Solowij et al.,
19 92; Liester et al., 1992). T o ex plore w he th er
hig h scores o n th ese s om at ic item s mi gh t ha ve
co ntributed to g roup d iffe ren ces in depression,
BD I s co res w ith th ese items o m itt ed were re-
an alyse d. H ow ev er, the p at ter n of sc ore s over
da ys and the s igni® cance o f the gro up 3da ys
in ter act ion (p,0.0 01) re ma ined. (Grou p m ea ns
for d ay s 1, 2 and 5, respecti ve ly, w er e: M D M A
2.2 5; 6 .91 ; 9.9 2; A LCO HOL 5.08; 6.83; 5.49).
T hus s om at ic effe cts o f MD M A we re no t ma in
co ntributory fa ctors t o group differenc es in de-
pre ss ion score s. T his also acco rds wi th t he re -
su lts o n v is ua l an alogue s cales. Our resu lt s are
co nsist ent w it h anecdo tal rep orts that MDM A
ca n lead to depression du rin g th e week afte r it is
ta ken (Barnes, 1988 ; S au nd ers , 19 95).
Lo w m ood d ay s after M DMA is ta ke n m ay
re¯ e ct s ero tonergic d ep let ion w hich m ight be
tem p orary foll ow ing acu te e levat ion of s ero tonin
in duced b y M DM A . If th is is the ca se, one
would ex pec t m oo d to lift over a longer time
co urs e. I f M DM A is se rot one rg ica lly n eu ro tox ic,
co mp lete re co very o f m oo d m ay n ot oc cur. It
co uld also be argued th at th e link b etwee n d e-
pre ss ion and MD M A m ay not b e a dire ct c on se -
qu en ce o f neurochem ical c ha ng es. T h e ap pa ren t
`low ’ exp er ien ce d in th e day s afte r M DM A u se
could be a psychological consequence of the
ac ut e `hig h’ follow in g M DMA. A s one M D MA
us er p ut it:
By dancing a ll n ight on E, a fee lin g o f to tal
bli ss an d utter ful® lm en t is achieved, a nd o f
cours e th e d ownside to t hi s is that no th ing else
bea ts that f eel ing , thus rea lit y can seem boring
(qu ot ed in Sa un de rs, 1995).
Th e present `® e ld ’ s tud y has cl ear lim ita tions
co mp ared w ith a do ub le- bli nd, con tro lled labo -
rat or y st udy. N eit he r ex perim en ter no r pa rtici-
pa nts ha d objective con ® rm ation o f what dru gs
or dosages w er e actu al ly taken by th e M D MA
group. Tablets sold as MDM A can contain
MDA ( 3,4 me th yle nedio xy-amphet am ine),
M DE A ( `Ev e’ -3 ,4 m et hy len edi oxy eth yla m-
ph eta mi ne ), o r various m ixtures o f a ra nge o f
co mp ou nd s (e.g. ampheta mine, ketam in e, L SD ,
caf fein e, ep he drine). It w as b ey on d th e sc op e of
the present s tud y to att em pt b io ch emi ca l as say s:
req uests t o t ak e bl oo d or o th er bod ily ¯ uids m ay
ha ve m itiga ted again st p eople v olunt ee ring for
the s tudy as wel l as pr es enting health/sa fet y
pro bl em s fo r th e in ves tig ato r in a clu b s etting. It
co uld b e a rgued t ha t a fu rt he r lim itation of t he
pre se nt s tud y w as the c on joint u se o f alcohol
rep or ted by s om e o f th e M DM A us ers o n d ay 1 .
Ho we ve r, this was a t lo w dose s, w ith th e
M DM A gr ou p con su mi ng les s tha n 17% o f the
av era ge d ose repo rted by the alc oh ol grou p.
Although w e cannot be sure th at t he table ts
tak en b y t he M DM A g ro up co nt ain ed p ure
M DM A , t he pro® l e o f m oo d e ffec ts rep ort ed on
the night acc ords w ith previous ® ndin gs from
stu dies o f a cute e ffec ts o f kno wn dos es o f p ure
M DM A carr ied ou t be for e go ve rn me nta l res tr ic-
tio ns ( Do w nin g, 1 98 6; G re er & Ta lb ot, 1 98 6).
Th is p rovid es some ev idenc e th at the p artici-
pa nt s in th e p res en t st ud y h ad tak en M DM A .
Fu rth er, our ® nd in gs a lso acco rd with m ore re-
cen t re tro spect ive stu dies wh ich c ou ld n ot
co n® rm t ha t M D M A wa s a ct ua lly ta ken ( Per-
ou tka e t al ., 19 88; So lowij e t al., 1992; Leist er et
al. , 19 92 ). T he p ro ® le of p hy sic al side-effects
ob ta ined in this st udy, in clu di ng h ig h le vel s of
en erg y, s eve re d ry m outh an d swea ting, a lso
acc or ds w ith rep orts in t ho se studies .
Cogn iti ve ef fect s were sa mp led by re la tiv ely
few tes ts, and fu tu re stud ies ma y ex plore a m ore
co mp rehen siv e ra ng e o f co gnitiv e fu nctio n. T he
pro se recall ta sk ( im mediate an d d elayed) w as
cho sen o n t he b as is o f ® ndin gs b y K rystal &
Pri ce (1992) im plyin g th at p erforma nc e on both
imme diate a nd de lay ed a sp ec ts of this task
sh ow ed s om e di sru pt ion in ch ron ic M D M A
us ers . T he p res en t st ud y fo un d th at M D M A
us ers g en era lly p erform e d poorer t ha n a lco hol
us ers o n thi s task, an d bo th grou ps im p roved
ov er the 3 tes t da ys . A n on -s igni® ca nt ( p,0.10)
ten dency em erged on delayed recal l re¯ ect ing
ma rg ina lly wo rs e perfo rm a nc e by MD M A use rs
on d ay 2. H ad the sa mp le s ize b ee n larger, t his
di ffere nce m ight have reached sign i® cance.
The s eri al se ve ns t ask wa s se lec ted pa rtly to
pro vi de a n in dex of a ttention /wo rk ing memory
an d pa rtly fol low in g Do wnin g et a l. (1986) w h o
rep orted a sma ll num be r of MDM A use rs having
pro bl em s ca rry in g out m athe ma tic al calc ula-
tio ns . MD M A us ers w ere im pa ire d on t his ta sk
(co mpared wi th a lco ho l us ers) on all 3 test ing
830 H . V. C urr an & R. A. Tr av ill
da ys a lthou gh imp airme nts we re m os t pro-
no un ced on da y 2. It is not clea r wh et her thi s is
a direc t d rug effect or wh eth er lack of sle ep,
rep or ted by m os t M DM A u se rs o n da y 2, a ls o
co ntributed to impairm en t. Imp aired atten tional
fun ct ion could i n tu rn a ffect perform ance on a
ran ge of t as ks, i nclud ing compre hension an d en-
co ding in the p rose r eca ll t as k. In de ed , it is
po ssible tha t ap pa ren t mem ory pr ob lem s link ed
to M DM A c ou ld be ex pl ain ed by t he co ntr ibu -
tio n of con ce nt rati on a nd link ed encoding
de® cits.
As f ar a s we are a wa re, the prese nt s tudy is the
® rst to investi gat e th e m oo d and c og nitive e ffec ts
of we ek en d M DM A u se in te rms o f bot h acu te
an d res idu al eff ect s ove r sub se que nt da ys . W e
are c urr en tly as se ssin g M D M A u se rs o ve r a
lo ng er ti me peri od . If t he m id -w eek lo w m oo d is
du e to a te mporary de pletio n in 5- HT , a s op -
po sed to 5- HT ne ur oto xicity, there w ou ld b e a
tim e course o ver w hic h moo d wo ul d lift.
In te rm s o f th e d ebate about the us e o f
MDM A as a n ad ju nc t to p sy choth era py, the
results of the present study would caution
ag ain st t he u se of a drug w hich in so me peop le
might co mp ou nd pro blems by ind uc ing a lo we r-
in g of mo od so me days after a t her ap y se ss io n.
The present ® ndings also add to the list of
ad verse c on se qu enc es o f M D MA u se, in that the
`hig h’ at the w ee ken d m ay le ad to a `low’ m id -
week and to atte ntional problems . T his may be
of p ar tic ular concern to th os e w ho se s tu di es or
job perf orm a nce may s uff er fr om imp aire d a tte n-
tio nal fun ct ion.
In summ ary, th e re su lt s of t his st ud y im ply
th at MD M A us e at the we ek en d is ass oc iate d
with s ub sequent lo w m ood m id -w eek and with
im pa ired at te ntional fu nc tio n. I t is n ot cle ar t o
what ext en t th is may re¯ ect a te mp orary sero-
to ne rgic dep le tio n, a m ore serio us s ero to nergic
neuroto xic ity or a psychologica l co ns equen ce of
th e acu te `high’ m ood in du ced by week en d
MDM A use.
Referen ce s
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(1993) Persistent effects of 3,4-m ethy lene-
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BARNES, D . M. (198 8) Ne w d ata inte nsi® e s t he agony
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