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Ricaurte's 1998 Neurotoxicity Study
A Letter to the Editor in response
by Julie Holland, M.D.

Positron emission tomographic evidence of toxic effect of MDMA ('Ecstasy') on brain serotonin neurons in human beings,
by U. D. McCann; Z Szabo; U Scheffel; R.F. Dannals; G. A. Ricaurte
The Lancet Vol 352, Oct 31, 1998, 1437

To the editor:

Regarding "Nerve Damage to Brain Linked To Heavy Use of Ecstasy Drug," by Erica Goode (10/30/98), it is important to distinguish drug abuse from therapeutic use. Many potent medicines have toxic doses--even Tylenol can be fatal, for example, as can lithium. But that does not exclude them as therapeutic agents. MDMA, an extraordinarily valuable drug when used as an adjunct to psychotherapy, should be considered in this context.

Ricaurte's research subjects averaged more than two hundred doses of "ecstasy" within four to five years, at 386 milligrams per dose. This does not represent the dosage and frequency of MDMA as it was safely used in psychotherapy for many years, which is 125 mg in a single oral dose, perhaps repeated once several months after the initial session. Dr. Ricaurte himself gave monkeys single oral doses of MDMA every two weeks, and failed to produce any adverse effects.

Further, equating a loss in the number of serotonin reuptake sites with "brain damage" is presumptive. There are many psychiatric medications, such as Prozac and Zoloft, which essentially decrease the number of these receptors by their blockade. This is the mechanism of action in antidepressant therapy. In general, the brain responds to repeated doses of chemicals by changing the number of receptors it creates, so this could be interpreted as an adaptive respose as opposed to a toxic or "damaged" response.

Julie Holland, MD