MDMA Studies at the Maudsley Hospital and London Inst. of Psychiatry MDMA (Ecstasy) Studies at the Maudsley Hospital and London Institute of Psychiatry Karl L.R. Jansen, M.D., Ph.D.
J.C.R., The Maudsley Hospital
Denmark Hill
London SE5 8AZ
England

This research focuses upon the outcome in humans of self-administering very high doses of MDMA over prolonged periods. While this avenue has been previously explored, the present study generally has subjects who have taken considerable higher doses than in most previous studies. For example, the Maudsley project includes a person who injected an average of 250 mg of pure MDMA powder four times per day for six months, sometimes taking up to four grams in 24 hours (by injection) which is a level of use approaching some of the animal administration paradigms.

d-fenfluramine challenge tests

Central serotonergic functioning has been assessed using a d-fenfluramine challenge test. The d-fenfluramine is swallowed by the subject. It causes a release of serotonin which binds to the appropriate receptors and in turn triggers a release of the hormones cortisol and prolactin. The release is monitored throughout a morning and generally increases on a known curve. The hypothesis is that this curve will be blunted if there is serotonergic hypofunction. Such blunting is seen in some forms of depression. This test was pioneered at the Maudsley, and the lab thus has considerable experience with the method and its interpretation. Neuroendocrine tests have already been used to investigate MDMA users, but the results were generally inconclusive. While the present study certainly has its weaknesses, the overall design is such that if the results indicate normal function amongst the relevant portion of the serotonergic system which is tested, this could be accepted as reasonably conclusive. However, if the results show that there is an underactive response to d-fenfluramine, then further studies will be required. The correct interpretation of the results will then be less clear due to several confounding factors which it has been difficult to eliminate from neuroendocrine tests in this area. These studies also involve questionnaires and rating scales. Some of these are focused upon key issues such as long-term effects on sleep, sex drive, appetite, weight, dreams, mood (with a particular focus on depression, mania and anxiety), aggression and also positive changes in psychological state. It must be stressed that the study is wholly focused upon long-term effects of very high use patterns - acute effects, of either a positive or a negative nature, are not dealt with at all. MAPS has contributed $1,875 to this study to cover payment of volunteers' travel expenses and a small stipend.

Functional MRI study

The Maudsley Hospital Ethical Committee approved a protocol in which subjects are given 1.4 mg/kg MDMA and assessed using functional magnetic resonance imaging (fMRI) of the brain, before taking the drug and during the period of peak effect. Brain scans which assess function of particular areas are leading to huge and exciting advances in psychiatry. In this paradigm, the brain is activated by wearing goggles which flash colored lights, and wearing headphones through which an emotional book passage is read to activate the emotional brain by auditory means. This is thus called a 'vis-aud' study.

Application has yet to be made to the Home Office for a licence to carry out this study, but we are hopeful that the study will be supported as it has local ethical approval, and the public pressure (principally from concerned parents) for research in this area has become intense. MDMA use is regarded as a major public health issue in the UK. All of the subjects will already have self-administered MDMA without undue consequence. The study involves comparing persons who have taken MDMA less than 5 times with persons who have taken MDMA more than 1,500 times.

Consideration is also being given to possible studies involving ketamine. Karl Jansen is currently writing a book about ketamine and would be interested in hearing from any person who has a view or knowledge concerning ketamine.

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