Obsessive-compulsive disorder followed by psychotic episode in long-term ecstasy misuse.
Carlo Marchesi, Matteo Tonna, Carlo Maggini
The World Journal of Biological Psychiatry 2009 DOI: 10.1080/15622970701459828 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 2 |
| Population | Two young subjects who used ecstasy heavily |
| Interventions | serotoninergic medication antipsychotic |
| Topics | MDMA |
| Key findings | Heavy long-term ecstasy use may induce obsessive-compulsive, depressive, and psychotic symptoms, possibly through altered serotonin-dopamine balance. |
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.
Comparable studies
Other case reports and case series on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| 'Eve' and 'Ecstasy'. A report of five deaths associated with the use of MDEA and MDMA Individuals whose deaths were associated with MDMA or MDEA use | 1987 | Case series | n = 5 |
| Pathology of deaths associated with "ecstasy" and "eve" misuse. Young white men aged 20 to 25 who died after using ring-substituted amphetamines (MDMA... | 1996 | Case series | n = 7 |
| 'Eve' and 'Ecstasy' Individuals who died after using MDMA or MDEA | 1987 | Case series | n = 5 |
| A Method of Conducting Therapeutic Sessions with MDMA Clients with clear therapeutic purpose, excluding those with serious functional... | 1998 | Case study | n = 2 |
| Diversity of Psychopathology Associated with use of 3,4-Methylenedioxymethamphetamine (‘Ecstasy’) Psychiatric patients presenting between 1990 and 1992 whose symptoms developed in the... | 1994 | Case series | n = 13 |
Citations in the library
Cited by 5
- MDMA and MDMA-Assisted Therapy. American Journal of Psychiatry 2025
- Psychedelics for the Treatment of Obsessive–Compulsive Disorder: Efficacy and Proposed Mechanisms The International Journal of Neuropsychopharmacology November 29, 2024
- Treatment approaches and efficacy in psychedelic-induced psychosis: A systematic review. Asian Journal of Psychiatry June 26, 2025
- New‐Onset Obsessive–Compulsive Symptoms After MDMA‐Assisted Psychotherapy in a Patient With Refractory PTSD: A Case Report Case Reports in Psychiatry 2026
- Hippocampal remodelling after MDMA neurotoxicity: a single case study. The World Journal of Biological Psychiatry 2009
Cites 8
- Positron emission tomographic evidence of toxic effect of MDMA (“Ecstasy”) on brain serotonin neurons in human beings The Lancet October 1, 1998
- Neurotoxicity of methylenedioxyamphetamines (MDMA; ecstasy) in humans: how strong is the evidence for persistent brain damage? Addiction February 27, 2006
- Diversity of Psychopathology Associated with use of 3,4-Methylenedioxymethamphetamine (‘Ecstasy’) The British Journal of Psychiatry September 1, 1994
- Is MDMA (‘Ecstasy’) Neurotoxic in Humans? An Overview of Evidence and of Methodological Problems in Research Neuropsychobiology 2000
- Striatal serotonin is depleted in brain of a human MDMA (Ecstasy) user Neurology July 25, 2000
and 3 more in the library