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De Win MM, Reneman L, Reitsma JB, Den Heeten GJ, Booij J, Van Den Brink W. 
“Mood disorders and serotonin transporter density in ecstasy users-the influence of long-term abstention, dose, and gender”. 
Psychopharmacology (Berl). 2004 Jan 15;Epub ahead of print(Online).
RATIONALE. Neurotoxic effects of 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') on the serotonin (5-HT) system have been described in animals and humans, but little is known about long-term effects of ecstasy use on mood. OBJECTIVES. To investigate short-term and long-term effects of ecstasy use on mood and its association with 5-HT neurotoxicity, dose, and gender in humans. METHODS. Fifteen moderate ecstasy users, 23 heavy ecstasy users, 16 former heavy ecstasy users and 15 drug-using, but ecstasy-naive controls were included. Mood was assessed using the Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory (BDI). Outcomes were correlated with 5-HT transporter (SERT) density, assessed with [(123)I]beta-CIT single photon emission computed tomography (SPECT). RESULTS. The prevalence of mood disorders assessed by CIDI did not differ between all groups. The overall test for differences in BDI scores between groups was near significance ( P=0.056), with BDI scores higher in former heavy ecstasy users than in ecstasy-naive controls ( P=0.045). BDI scores were correlated with the total number of ecstasy tablets used ( r=0.310; P=0.021). No associations between CIDI or BDI outcomes and SERT density or gender were observed. CONCLUSIONS. These results suggest that ecstasy use is not associated with clinical depression (CIDI). However, the number of ecstasy tablets taken lifetime was associated with higher BDI scores for depressive mood, and this relationship seemed to persist after ecstasy use had stopped. We did not find that depressed mood in ecstasy users was associated with decrease in SERT density. Prospective studies are needed to establish the causal relationship between ecstasy use and depressed mood.
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