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Neuroimaging of chronic MDMA ("ecstasy") effects: A meta-analysis
Felix Müller1, Raphael Brändle1, Matthias E Liechti2
1University of Basel, Department of Psychiatry (UPK), Switzerland.
Abstract:
In this meta-analysis, we aimed to assess the evidence from neuroimaging studies for chronic alterations in the brains of MDMA users. The databases PubMed, Embase, and Web of Science were searched for studies published from inception to August 24, 2018, without any language restriction. Sixteen independent studies comprising 356 MDMA users and 311 controls were included. Of these, five studies investigated frontal and occipital N-acetylaspartate/creatine and myo-inositol/creatine ratios, three studies assessed basal ganglia blood flow and ten studies investigated serotonin transporter (SERT) density in various regions. We found significantly decreased SERT density in eight of 13 investigated regions. Meta-regression indicated a positive association with abstinence, but none with lifetime episodes of use. Therefore, other variables (such as doses taken per occasion) might be more important determinants. Positive associations between time of abstinence and SERT density might indicate that these alterations are reversible to some extent. Furthermore, there were no significant differences between user and control groups in terms of neurochemical ratios in the frontal and occipital lobes and blood flow in the basal ganglia. Overall, MDMA user groups showed heavy use patterns and study quality was poor.
Insights
This meta-analysis found chronic decreases in brain serotonin transporter (SERT) density in MDMA users, particularly in specific regions. Some evidence suggests these brain changes may be reversible with abstinence.
Area of Science:
- Neuroimaging
- Neuroscience
- Psychopharmacology
Background:
- 3,5-Methylenedioxymethamphetamine (MDMA) use is associated with potential neurotoxic effects.
- Previous neuroimaging studies have yielded mixed results regarding chronic brain alterations in MDMA users.
Purpose of the Study:
- To systematically review and meta-analyze neuroimaging evidence for chronic brain alterations in recreational MDMA users.
- To investigate the relationship between MDMA use patterns, abstinence duration, and neurochemical changes.
Main Methods:
- Systematic literature search of PubMed, Embase, and Web of Science up to August 24, 2018.
- Inclusion of 16 studies (356 MDMA users, 311 controls) examining neurochemical ratios, blood flow, and serotonin transporter (SERT) density.
- Meta-regression analysis to explore associations with abstinence and usage patterns.
Main Results:
- Significant reductions in SERT density were observed in 8 out of 13 brain regions examined in MDMA users compared to controls.
- No significant differences in frontal/occipital neurochemical ratios or basal ganglia blood flow between groups.
- Meta-regression suggested a positive association between abstinence duration and SERT density, indicating potential reversibility.
- No significant association found between SERT density and lifetime episodes of MDMA use.
Conclusions:
- MDMA use is associated with chronic, region-specific decreases in brain SERT density.
- These neurochemical alterations may be partially reversible with extended abstinence.
- Factors beyond cumulative use, such as dose per occasion, may influence the extent of brain changes.
- Limitations include heavy use patterns in user groups and overall poor study quality, necessitating cautious interpretation.