Ecstasy refers to a morbid mental condition, associated with an extreme sense of wellbeing, with a feeling of rapture, and temporary loss of self-control. It often presents as a form of religious obsession, with a feeling of direct communication with God, saintly voices and images being perceived. In milder cases the patient may preach as though with a divine mission to help others. Ecstasy may occur in happiness PSYCHOSIS, SCHIZOPHRENIA, certain forms of EPILEPSY, and abnormal personalities.
The term is also a street drug name for an amphetamine derivative, 3, 4-methylenedioxymethamphetamine or MDMA, increasingly used as a ‘recreational’ drug. It is classiﬁed as a class A drug under the Misuse of Drugs Act 1971. MDMA is structurally similar to endogenous CATECHOLAMINES and produces central and peripheral sympathetic stimulation of alpha and beta ADRENERGIC RECEPTORS. It is taken into nerve terminals by the serotonin transporter and causes release of the NEUROTRANSMITTER substances serotonin and dopamine. Following this, SEROTONIN depletion is prolonged. As serotonin plays a major part in mood control, this leads to the characteristic ‘midweek depression’ experienced by MDMA users.
Several fatalities in young people have been attributed to adverse reactions resulting from MDMA use/abuse and possibly accompanying alcohol consumption. The principal eﬀects are increase in pulse, blood pressure, temperature and respiratory rate. Additional complications such as cardiac ARRHYTHMIA, heatstroke-type syndrome, HYPONATRAEMIA and brain haemorrhage may occur. There is also concern over possible eﬀects on the mental concentration and memory of those using ecstasy.
Management of patients who get to hospital is largely symptomatic and supportive but may include gastric decontamination, and use of DIAZEPAM as the ﬁrst line of treatment as it reduces central stimulation which may also reduce TACHYCARDIA, HYPERTENSION and PYREXIA.