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Ecstasy More Harmful to Women's Brains

Scans show damage to users of club drug

THURSDAY, Nov. 29, 2001 (HealthDayNews) -- Women who seek thrills from the club drug ecstasy may suffer more brain damage from heavy use than do men, a new study suggests.

The finding, appearing in the Dec. 1 issue of The Lancet, adds to mounting evidence that ecstasy is bad for neurons, and it's the first to show the harm might be gender selective.

Lead study author Dr. Liesbeth Reneman, a radiologist at the Academic Medical Center, in Amsterdam, is cautious about the results, since the study involved only 69 subjects; however, she says it's the largest brain-imaging study of the drug to date.

Ecstasy, also known as MDMA or "ex," acts like both a stimulant and a hallucinogen, producing a euphoric high that makes it a favorite on the party scene. As many as 1.3 million Americans take the drug, which initially generates a rush of serotonin, a brain messenger molecule that helps regulate such things as mood, sexual appetites and pain.

But over time, ecstasy appears to cause sharply lower levels of serotonin. The likely result: memory problems and brain damage, says the National Institute on Drug Abuse.

Recruiting ecstasy users from "rave" parties, Reneman and her colleagues conducted positron emission tomography (PET) scans on male and female volunteers with varying histories with the drug. Twenty-three were heavy users, 15 took the drug occasionally, while 15 others said they'd never tried it. The researchers also studied 16 people who said they'd taken ecstasy but not for at least a year.

Reneman's group specifically looked at ecstasy's effects on serotonin transporters, which reabsorb the messaging molecule into the cells that release it. Without adequate transporters, serotonin signaling is like a telephone conversation made balky by static.

Reneman's group found that among women but not men, heavy ecstasy users had markedly less binding of serotonin than more moderate users or those who never took the drug. However, women who'd quit taking it had more serotonin transporters than those who continued heavy use, though not more than those who'd never tried the drug, suggesting the brain can recover somewhat from the damage.

Why ecstasy might be more harmful to women than men is a mystery, Reneman says. One explanation may lie with the female sex hormone estrogen, which has been shown to interact with the serotonin system and alter the number of the messenger molecule's transporters. "We know that estrogens have an effect on the serotonin system and in that way may modulate the effects of ecstasy on the human brain," she says.

But another possibility (one that undercuts a gender bias) is that the women in the study had brain architecture, including abnormal serotonin transporters, that made them especially receptive to ecstasy. In this scenario, ecstasy use is the "effect," rather than the "cause," of bad brain wiring.

Dr. George Ricaurte, a neurologist at Johns Hopkins University, in Baltimore, and co-author of an editorial accompanying the journal article, calls the work "timely and potentially important." But in an interview, Ricaurte says the study's size is "quite modest" and limits how much stock researchers can put in the work.

Ecstasy's harmful effects don't stop with the brain. In Europe, where ecstasy use is more common, about 20 to 30 cases of liver failure associated with the compound have been reported. Ecstasy also may damage other organs, including the kidneys and heart, researchers say.

And British scientists have found that pregnant women who use ecstasy put their unborn babies at a significantly higher risk of birth defects than mothers who don't take the drug.

The leader of that work, Patricia McElhatton of the Regional Drug and Therapeutics Center, in Newcastle upon Tyne, says the Dutch study is the first to show a gender difference in ecstasy's damage to the human brain. But some evidence in rodents has suggested such an effect might exist, she says.

What To Do

For more on the link between ecstasy and health problems, try the National Institute on Drug Abuse.

To get a graphic sense of how ecstasy works in the brain, try the University of Washington.

To learn more about drug use in America, check the Partnership for A Drug-Free America or the National Association of Drug Diversion Investigators.

SOURCES: Interviews with Liesbeth Reneman, M.D., Ph.D., radiology fellow, Academic Medical Center, Amsterdam, Netherlands; Patricia McElhatton, Ph.D., National Teratology Information Service, Regional Drug and Therapeutics Center, Newcastle upon Tyne, England; George A. Ricaurte, M.D., associate professor of neurology, Johns Hopkins University, Baltimore; Dec. 1, 2001, The Lancet
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