Ecstasy use and serotonin syndrome: a neglected danger to adolescents and young adults prescribed selective serotonin reuptake inhibitors.
Yuriy Dobry, Timothy Rice, Leo Sher
International journal of adolescent medicine and health 2013 DOI: 10.1515/ijamh-2013-0052 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Population | Adolescents and young adults prescribed SSRIs who concurrently use ecstasy (MDMA) |
| Topics | MDMA Serotonin |
| Key findings | The authors argue that combining MDMA with SSRIs can produce a rapid, synergistic rise in central nervous system serotonin, leading to serotonin syndrome, a life-threatening acute medical emergency. They contend that scarce clinical and laboratory data, alongside increasing ecstasy use and SSRI prescribing among adolescents, make this an overlooked public health danger requiring further research and regulatory attention. |
Abstract
At present, there are scarce clinical and basic lab data concerning the risk of acute serotonin toxicity from selective serotonin reuptake inhibitors (SSRIs) and 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) co-administration. The health care community can strongly benefit from efforts to address the high risks associated with serotonin syndrome from this specific drug combination. The aim of this work is to review the risk of serotonin syndrome in adolescents and young adults prescribed with SSRIs and are concurrently using ecstasy. An electronic search of the major behavioral science bibliographic databases (Pubmed, PsycINFO, Medline) was conducted to retrieve peer-reviewed articles, which detail the clinical characteristics, biological mechanisms and social implications of SSRIs, MDMA, and their potential synergism in causing serotonin syndrome in the pediatric and young adult population. Search terms included "serotonin syndrome", "ecstasy", "MDMA", "pediatric", and "SSRI". Additional references were incorporated from the bibliographies of these retrieved articles. MDMA, in combination with the widely-prescribed SSRI antidepressant class, can lead to rapid, synergistic rise of serotonin (5-HT) concentration in the central nervous system, leading to the acute medical emergency known as serotonin syndrome. This review addresses such complication through an exploration of the theoretical mechanisms and clinical manifestations of this life-threatening pharmacological interaction. The increasing incidences of recreational ecstasy use and SSRI pharmacotherapy among multiple psychiatric disorders in the adolescent population have made this an overlooked yet increasingly relevant danger, which poses a threat to public health. This can be curbed through further research, as well as greater health care provision and attention from a regulatory body owing.
Comparable studies
Other narrative reviews on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Human Pharmacology of MDMA | 2004 | Review | |
| Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research | 2001 | Review | |
| 3,4‐Methylenedioxymethamphetamine (MDMA, “Ecstasy”): pharmacology and toxicology in animals and humans | 1994 | Review | |
| (±)3,4-Methylenedioxymethamphetamine (‘Ecstasy’)-Induced Serotonin Neurotoxicity: Studies in Animals | 2000 | Review | |
| Amphetamine toxicities | 2010 | Review |
Citations in the library
Cited by 10
- Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review Psychopharmacology March 7, 2022
- Reported Cases of Serotonin Syndrome in MDMA Users in FAERS Database Frontiers in Psychiatry January 24, 2022
- First drug-checking study at an electronic festival and fentanyl detection in the central region of Mexico Harm Reduction Journal December 10, 2023
- Perioperative Considerations for Patients Exposed to Psychostimulants. Anesthesia & Analgesia September 1, 2023
- Case of Cardiac Arrest Treated with Extra-Corporeal Life Support after MDMA Intoxication Case Reports in Critical Care January 26, 2020
and 5 more in the library
Cites 14
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- An Exploration of the History and Controversies Surrounding MDMA and MDA Journal of Psychoactive Drugs September 1, 2001
- Ecstasy Intoxication: An Overlap Between Serotonin Syndrome and Neuroleptic Malignant Syndrome Clinical Neuropharmacology April 1, 1996
and 9 more in the library