Many problems users encounter with MDMA are similar to those found with the use of amphetamines and cocaine. They are:

• Psychological difficulties, including confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia - during and sometimes weeks after taking MDMA (even psychotic episodes have been reported).
• Physical symptoms such as muscle tension, involuntary teeth-clenching, nausea, blurred vision, rapid eye movement, faintness, and chills or sweating.
• Increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease.

MDA, the parent drug of MDMA, is an amphetamine-like drug that has also been abused and is similar in chemical structure to MDMA. Research shows that MDA destroys serotonin-producing neurons, which play a direct role in regulating aggression, mood, sexual activity, sleep, and sensitivity to pain. It is probably this action on the serotonin system that gives MDA its purported properties of heightened sexual experience, tranquility, and conviviality.

MDMA also is related in structure and effects to methamphetamine, which has been shown to cause degeneration of neurons containing the neurotransmitter dopamine. Damage to these neurons is the underlying cause of the motor disturbances seen in Parkinson's disease.

Link to Brain Damage

Heavy users of ecstasy, a synthetic drug that is structurally similar to methamphetamine and the hallucinogen mescaline, may be risking brain damage that remains long after the high has worn off.

In a series of studies conducted with rats and nonhuman primates, Dr. George Ricaurte and his colleagues at Johns Hopkins Medical Institutions first determined that a single dose of MDMA (3,4-methylenedioxymethamphetamine), only slightly higher than the size of doses taken by humans, significantly damaged brain cells called neurons that produce serotonin. Serotonin is a major neurotransmitter, or chemical messenger, in the brain that is thought to influence mood, appetite, sleep, and other important functions. Then Dr. Ricaurte reported that 12 to 18 months after the brains of squirrel monkeys had been damaged by MDMA, serotonin-producing nerve fibers had regrown abnormally in some brain regions and failed to regrow at all in others.

Unlike methamphetamine, which damages brain neurons that produce both serotonin and another important chemical messenger called dopamine, "MDMA selectively damages serotonin neurons in virtually all species examined to date," Dr. Ricaurte says.

"With MDMA, the doses that people take very closely approach the doses known to produce neurotoxic effects in animals," Dr. Ricaurte says.

"At this point, the major question is whether the neuronal changes we see in animals from methamphetamine and MDMA exposure occur in human beings who use these drugs," he says.

To help answer that question, he is conducting separate clinical studies using brain imaging techniques to evaluate the possibility of long-term brain damage in humans who have previously used either methamphetamine or MDMA. These studies also are assessing the potential functional consequences of such neuronal damage on aspects of mood, movement, memory, impulse control, aggression, and sleep cycles.