Interview with a psychiatrist about psychiatric dangers of Ecstasy

I have always warned that the greatest danger of taking Ecstasy is
psychological. For my new book, I have interviewed Dr. Karl Jansen of The
Maudsley Hospital, one of the very few researchers in this field and a
psychiatrist who specialises in drug related psychiatric problems. Here is an
abbreviated version of my interview with him:

Is it true that Ecstasy can cause psychosis in some people?

It's unlikely that anyone without previous problems is susceptible. They may
already have had delusions, hallucinations or markedly abnormal behaviour,
although psychiatrists do come across cases of people with no apparent
preconditions. One of my patients who took about 100 Es had
depersonalisation/derealisation syndrome [a kind of neurotic syndrome where the
person lacks emotion and feels unreal, remote or automatised]. It's very
unpleasant and has lasted over 2 years. I couldn't find anything predisposing
in her history and she clearly attributed the problem to Ecstasy use. But,
amongst drugs, alcohol is by far the highest cause of psychosis. After alcohol,
probably cannabis in predisposed persons. But then lots more people drink
alcohol and smoke cannabis, so we would expect more consequences.

And speed too?

Oh yes, psychosis can be caused by amphetamine, that is very well recognised.

Are epileptic fits triggered by Ecstasy?

Yes, epilepsy would be a clear contra indication to taking a drug like Ecstasy
or any kind of amphetamine.

What about those with poor distinction between fantasy and reality?

Of course, if boundaries are gone, then you are more liable to psychosis.
Anyone who has a psychotic illness such as schizophrenia or manic depression
should not take any drugs including alcohol. They should live quietly and
peacefully. The major precipitant to psychotic relapse is not drug taking but
living in a family where everyone shouts and screams at each other. Anyone who
has an inner feeling that they have had difficulty distinguishing reality from
fantasy should realise that they are at higher risk. Persons who are very
anxious and prone to anxiety disorders, phobias, depression and panic attacks
are more likely to suffer adverse consequences from psychedelic and MDMA-like
drugs, although it is also true that some persons find these drugs have
psychotherapeutic value. In general, unless taken in a controlled
psychotherapeutic context, the former outcome is more likely.

Is the same true of LSD?

Yes, I would give the same advice, though I think LSD is much less physically
toxic because MDMA has a greater physical component.

Apart from psychosis, what other psychiatric problems may be caused by Ecstasy?

Anxiety disorders. These can be generalised, where you feel anxious all the
time, or chronic in the form of panic attacks.

What are panic attacks?

The person thinks he or she is going to die, but they are not. The feeling that
you are about to die is very strong, but it only lasts a few minutes. It's an
entirely psychological condition that responds to anti depressants and, in the
long term, to cognitive-behavioural therapy [A therapy where thoughts are shown
to effect the way we feel and behaviour is analysed]. Also sleep disturbances
are commonly reported, such as nightmares.

What about depression?

Depression and mania definitely can be triggered by Ecstasy if you are
predisposed. MDMA lowers serotonin, and low serotonin levels have been linked
with depression and suicide in some studies (not of MDMA users). The effect of
many antidepressants (e.g. Prozac) is to increase the action of serotonin. In
very simple terms, antidepressants have the opposite effect on serotonin action
to MDMA. There are thus theoretical reasons to propose that MDMA use will show
an association with depression and possibly suicidal thoughts, though this
association has not been established as yet.

Are people with strong self image more likely to have problems?

No. The more strong minded people are, the fewer problems they will have. Its
the neurotic, anxious people who have a lot of fantasy anyway; already have
sleep disturbances; have a very high imagery level; an unhappy family
background. . . these are the people who are likely to suffer adverse
consequences.

How should people deal with such problems?

If a person has anxiety or depressive disorder related to MDMA use, they should
seek treatment. The options are cognitive-behavioural therapy [where the goal
is to alter behaviour through finding underlying causes], psychodynamic
psychotherapy [an insight oriented Freudian-based therapy which aims to
understand what is going on] and anti depressants such as impramine and
fluoxetine [Prozac].

If they have delusions, their friends should take them to a GP who should be
asked to refer them to a psychiatrist. They will probably be treated with an
antipsychotic medicine such as haloperidol. This is a more pleasant route than
going directly to a General Hospital where a less sympathetic attitude may be
encountered.

copyright Nicholas Saunders April 1995