Gouzoulis-Mayfrank Euphrosyne, Daumann Jörg
Department of Psychiatry and Psychotherapy, University of Cologne, Germany.
J Psychopharmacol. 2006 Mar;20(2):188-93. doi: 10.1177/0269881106059939.
The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine -- MDMA) is neurotoxic upon central serotonergic neurons in laboratory animals and possibly also in humans. In recent years, several studies reported alterations of serotonergic transmission and neuropsychiatric abnormalities in ecstasy users which might be related to MDMA-induced neurotoxic brain damage. To date, the most consistent findings associate subtle cognitive, particularly memory, deficits with heavy ecstasy use. However, most studies have important inherent methodological problems. One of the most serious confounds is the widespread pattern of polydrug use which makes it dif.cult to relate the findings in user populations to one specific drug. The present paper represents a brief overview on this issue. The most commonly co-used substances are alcohol, cannabis and stimulants (amphetamines and cocaine). Stimulants are also neurotoxic upon both serotonergic and dopaminergic neurons. Hence, they may act synergistically with MDMA and enhance its long-term adverse effects. The interactions between MDMA and cannabis use may be more complex: cannabis use is a well-recognized risk factor for neuropsychiatric disorders and it was shown to contribute to psychological problems and cognitive failures in ecstasy users. However, at the cellular level, cannabinoids have neuroprotective actions and they were shown to (partially) block MDMA-induced neurotoxicity in laboratory animals. In future, longitudinal and prospective research designs should hopefully lead to a better understanding of the relation between drug use and subclinical psychological symptoms or neurocognitive failures and, also, of questions around interactions between the various substances of abuse.
流行的摇头丸（3,4-亚甲基二氧甲基苯丙胺——MDMA）对实验动物的中枢5-羟色胺能神经元具有神经毒性，对人类可能也有神经毒性。近年来，多项研究报告了摇头丸使用者的5-羟色胺能传递改变和神经精神异常，这可能与MDMA诱导的神经毒性脑损伤有关。迄今为止，最一致的发现是，大量使用摇头丸会导致细微的认知缺陷，尤其是记忆缺陷。然而，大多数研究存在重要的内在方法学问题。最严重的混淆因素之一是多药滥用的普遍模式，这使得很难将使用者群体的研究结果与一种特定药物联系起来。本文对这一问题进行简要概述。最常同时使用的物质是酒精、大麻和兴奋剂（苯丙胺和可卡因）。兴奋剂对5-羟色胺能和多巴胺能神经元也具有神经毒性。因此，它们可能与MDMA协同作用，增强其长期不良影响。MDMA与大麻使用之间的相互作用可能更为复杂：大麻使用是公认的神经精神疾病风险因素，并且已证明它会导致摇头丸使用者出现心理问题和认知障碍。然而，在细胞水平上，大麻素具有神经保护作用，并且已证明它们在实验动物中可（部分）阻断MDMA诱导的神经毒性。未来，纵向和前瞻性研究设计有望更好地理解药物使用与亚临床心理症状或神经认知障碍之间的关系，以及围绕各种滥用物质之间相互作用的问题。
