The British Journal of Psychiatry (2008) 193: 289-296. doi: 10.1192/bjp.bp.106.035089
© 2008 The Royal College of Psychiatrists
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Neurotoxic effects of ecstasy on the thalamus

Maartje M. L. de Win, MD, PhD

Department of Radiology, Academic Medical Center, University of Amsterdam, and The Netherlands and Graduate School of Neurosciences, Amsterdam

Gerry Jager, PhD

Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht

Jan Booij, MD, PhD

Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam

Liesbeth Reneman, MD, PhD

Department of Radiology, Academic Medical Center, University of Amsterdam

Thelma Schilt, MSc

Amsterdam Institute for Addiction Research and Department of Psychiatry, Academic Medical Center, University of Amsterdam

Cristina Lavini, MPhil

Department of Radiology, Academic Medical Center, University of Amsterdam

Sílvia D. Olabarriaga, PhD

Informatics Institute, University of Amsterdam

Nick F. Ramsey, PhD

Rudolf Magnus Institute of Neuroscience, Department of Neurosurgery, University Medical Center, Utrecht

Gerard J. den Heeten, MD, PhD

Department of Radiology, Academic Medical Center, University of Amsterdam

Wim van den Brink, MD, PhD

Amsterdam Institute for Addiction Research and Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands

Correspondence: Maartje M.L. de Win, Department of Radiology, G1-229, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Email: m.m.dewin{at}amc.uva.nl

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

Neurotoxic effects of ecstasy have been reported, although it remains unclear whether effects can be attributed to ecstasy, other recreational drugs or a combination of these.

Aims

To assess specific/independent neurotoxic effects of heavy ecstasy use and contributions of amphetamine, cocaine and cannabis as part of The Netherlands XTC Toxicity (NeXT) study.

Method

Effects of ecstasy and other substances were assessed with 1H-magnetic resonance spectroscopy, diffusion tensor imaging, perfusion weighted imaging and [123I]2β-carbomethoxy-3β-(4-iodophenyl)-tropane ([123I]β-CIT) single photon emission computed tomography (serotonin transporters) in a sample (n=71) with broad variation in drug use, using multiple regression analyses.

Results

Ecstasy showed specific effects in the thalamus with decreased [123I]β-CIT binding, suggesting serotonergic axonal damage; decreased fractional anisotropy, suggesting axonal loss; and increased cerebral blood volume probably caused by serotonin depletion. Ecstasy had no effect on brain metabolites and apparent diffusion coefficients.

Conclusions

Converging evidence was found for a specific toxic effect of ecstasy on serotonergic axons in the thalamus.


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