Obsessive-compulsive disorder followed by psychotic episode in long-term ecstasy misuse.

Two young people developed obsessive-compulsive disorder during heavy ecstasy use. After stopping the drug for several months, one developed major depression with psychotic features and the other a psychotic disorder. Neither had any prior mental disorder. One had a family and personality vulnerability for mental illness; the other did not. Physical exams, lab tests, and brain scans were normal in both. Treatment with a serotoninergic medication plus an antipsychotic led to remission of OCD and the depressive or psychotic episode. Heavy long-term ecstasy use may alter the brain's serotonin-dopamine balance, possibly triggering obsessive-compulsive, depressive, and psychotic symptoms. The drug likely interacted with a pre-existing vulnerability in one subject, while the other may have developed an entirely new disorder from ecstasy.

Study at a glance

Abstract

We report the case of two young subjects who developed an obsessive-compulsive disorder (OCD) during a heavy use of ecstasy. After several months of discontinuation of the drug, major depression with psychotic features developed in one subject and a psychotic disorder in the other individual. No mental disorder preceded the use of ecstasy in any subject. A familial and personality vulnerability for mental disorder was revealed in one subject, but not in the other, and all physical, laboratory and cerebral NMR evaluations showed normal results in both patients. Remission of OCD and depressive episode or psychotic disorder was achieved after treatment with a serotoninergic medication associated with an antipsychotic. The heavy long-term use of ecstasy may induce an alteration in the brain balance between serotonin and dopamine, which might constitute a pathophysiological mechanism underlying the onset of obsessive-compulsive, depressive and psychotic symptoms. The heavy use of ecstasy probably interacted with a vulnerability to psychiatric disorder in one subject, whereas we cannot exclude that an "ecstasy disorder" ex novo affected the other individual.