[3,4-methylenedioxymethamphetamine ('ecstasy'): its long-term emotional and cognitive effects, and serotonin depletion].

AIMS The main objective of this study is to describe the different neuropsychological deficits associated to the consumption of 3,4-methylenedioxymethamphetamine (MDMA or 'ecstasy'), as well as the growing evidence that attributes these deficits to the selective axonal damage to serotoninergic cells brought about by this substance. DEVELOPMENT MDMA is an amphetamine derivative that, like its precursor, has properties as a stimulant. Part of its chemical structure is similar to that of the hallucinogen mescaline with which it shares the capacity to alter perception. Nevertheless, the primary pharmacological effect of this substance, which is what usually leads to its use and abuse, is chiefly linked to an intense positive emotional state. This effect on the individual's mood is also usually accompanied by numerous feelings of empathy, sociability and closeness, which turn this drug into a powerful entactogenic agent (a term used in psychotherapy to describe a state of wellbeing, closeness and emotional self-awareness produced by certain compounds). The antidepressant and entactogenic effects induced by an acute dose of MDMA can be accounted for by the notable increase in serotonin bioavailability triggered by the drug. Repeated consumption of MDMA, however, ends up affecting many functions that have been related to the serotoninergic systems, such as sleep, appetite, attention and memory, or one's emotional state. CONCLUSIONS Most of the neuropsychological disorders found in individuals who take ecstasy on a regular basis can be explained by the selective neurodegeneration processes that the drug appears to produce in the serotonin terminals of the brain in the long run.