Blasted with ennui.

Ecstasy has been much in the news in Britain during recent months. Such a statement does not imply an epidemic outbreak of transcendental joy among a phlegmatic people but rather the arrival of yet another drug of misuse-ecstasy. The pharmacological name for this substance is 3,4methylenedioxyamphetamine (or MDMA). It is a "designer drug" with both psychomimetic and stimulant properties.' As so often happens with British drug fashions, MDMA achieved earlier notoriety in America: in perhaps 1985 it was beginning to be encountered as a recreational drug on that side of the Atlantic, and in 1987 a survey suggested that two fifths of 369 Stanford undergraduates had used it at least once.' There was the usual phase of therapeutic enthusiasm for the drug,54 and it was advocated as adjunct to psychotherapy-providing echoes of lysergide (LSD). Allegedly it helped people to get in touch with their feelings and form close relationships. It was then shown that the drug could induce dependence,5 which was not surprising given the chemical kinship to methylamphetamine. Next came the news that a man aged 22 had taken the drug, climbed a pylon, and died from electrocution6-an incident that might be expected with a psychomimetic substance. Possibly MDMA may also cause cardiac arrhythmias, at least in susceptible people.6 There is a sense of tired sameness as yet another drug fashion emerges with the familiar cycle of complacency followed by alarm and probable exaggeration. It was Ophelia who used the phrase "blasted with ecstasy" in relation to Hamlet's sad overthrow of mind; with current drug fashions we are perhaps in danger of being blasted with ennui. But what is new about MDMA and its congeners is the evidence that they cause damage to nerve endings concerned with serotonergic transmission in a few animal species." There is an almost biblical vengeance about this finding: the price of ecstasy shall be damage to the capacity to feel pleasure. We seem to be dealing with a subtle and nasty neurotoxin, and whether such changes are reversible in all circumstances is still open. There must be the usual provision about extrapolating from animals to man, and the dosage equivalence also deserves scrutiny-but the comforting deception that this is just an innocent Californian fun drug no longer carries conviction. Drugs often acquire euphemistic labels: "crack" for cocaine base, "speed" for amphetamine, "angel dust" for the highly dangerous phencylidine hydrochloride, and whisky, usquebaugh, or the spirit of life for ethanol. We should resist complicity and refer to this particular drug only as MDMA rather than giving it the benefit of the further advertising that goes so perniciously with the popular soubriquet.