Making use of all medical case reports of psychiatric symptoms after ecstasy published up to 2001, and also using some studies of non-patient samples, the authors try to characterize the nature and manner of association between ecstasy use and subsequent psychiatric symptoms. Of 38 cases examined, 24% of those reporting psychiatric symptoms after ecstasy had a history of previous mental disorders and 34% reported mental illness in a first-degree family member, leaving 42% of the cases with apparently no predisposing factors. 29% involved psychotic symptoms, 26% involved anxiety disorders or panic attacks, and 16% involved depression. The authors note the range of ecstasy use, but appear not to have calculated an average for the cases (the mode appears to be regular ecstasy use for at least a year prior to reporting symptoms). The range of doses per use is presented, with some suggestion that larger doses are more likely to produce psychiatric problems than smaller doses. Further conclusions are based on findings from 3 surveys, with only one of them currently published in a peer-reviewed journal. These surveys found that higher levels of psychiatric symptoms were reported by polydrug users with heavy ecstasy use. However, despite concluding that there is an association between ecstasy use and psychiatric symptoms that is related to serotonergic neurotoxicity, the authors recognize the limitations of relying on anecdotal evidence (medical cases), and acknowledge that there is a correlation between heavy use of ecstasy and heavy use of other drugs. They also discuss the effects produced by fake pills, such as dextromethorphan. The conclusions of this review may need to be re-examined in the light of other recently published studies (Daumann et al. 2001; Dughiero et al. 2001) suggesting that polydrug use or use of specific other substances, and not ecstasy, are associated with use of psychiatric symptoms.