Mental Health Problems in Ecstasy Users: Was It Actually the Cannabis? | Research

The takeaway

A study combining cross-sectional and longitudinal data found that psychological symptoms in ecstasy users were predominantly attributable to concurrent cannabis use, not ecstasy itself.

Read this if you use multiple substances and want to understand which one is most likely affecting your mental health.

Cannabis abstinence, not ecstasy abstinence, predicted symptom remission

What the researchers found

At baseline, ecstasy users reported significantly more psychological complaints than controls. However, when the analysis accounted for concurrent drug use, self-reported psychopathology was mainly associated with regular cannabis use rather than ecstasy use.

The 18-month follow-up strengthened this finding: subjects who had stopped using ecstasy showed no different symptom levels from those who continued, while subjects who regularly used cannabis during the follow-up period reported more anxiety, interpersonal sensitivity, and obsessive-compulsive behavior than cannabis-abstinent users. Higher levels of depression, anxiety, phobic anxiety, paranoid ideation, and obsessive-compulsive behavior were all significantly correlated with the duration of regular cannabis use during the follow-up period.

Why it matters

Much of the research attributing psychiatric symptoms to ecstasy use had not adequately controlled for concurrent cannabis use. This study demonstrated that cannabis, not ecstasy, was the primary driver of psychological complaints in this population. This has implications for both drug policy messaging and clinical assessment of polydrug users.

The numbers in context

Sixty ecstasy users and 30 controls at baseline. 38 ecstasy users at 18-month follow-up. Anxiety, interpersonal sensitivity, obsessive-compulsive behavior, depression, phobic anxiety, and paranoid ideation all correlated with cannabis use duration.

How the study worked

This study combined cross-sectional and longitudinal designs. At baseline, 60 recreational ecstasy users and 30 matched controls completed self-rating scales for impulsivity, sensation seeking, and psychological complaints. At 18-month follow-up, 38 of the original ecstasy users were re-examined.

What this study cannot tell us

The sample was relatively small and self-selected. Self-reported symptom measures may not capture clinical diagnoses. Cannabis users may differ from non-users in ways not captured by the study, introducing confounding. The 18-month follow-up had some attrition.

How to read the evidence

This is a study combining cross-sectional and 18-month longitudinal data with appropriate controls, providing moderate-level evidence.

When this study was published

Published in 2004. The importance of controlling for cannabis use in polydrug research has been increasingly recognized since.

The bigger picture

This finding that cannabis rather than ecstasy drove psychiatric symptoms in polydrug users added to concerns about cannabis and mental health. It also highlighted the importance of controlling for polydrug use in substance abuse research, a methodological point that applies broadly across the field.

Questions still open

Are the psychiatric effects of cannabis reversible after cessation in polydrug users? How much ecstasy research has been confounded by uncontrolled cannabis use?

Common questions

Do ecstasy users have more mental health problems?

They often report more symptoms, but this study found those symptoms were mainly associated with concurrent cannabis use, not ecstasy itself. When cannabis use was accounted for, ecstasy use had little additional impact on psychological complaints.

Can stopping cannabis improve mental health symptoms in polydrug users?

In this study, abstinence from cannabis during the 18-month follow-up predicted improvement in psychological symptoms, while continuing or stopping ecstasy made no significant difference.

Read the original research

Self-reported psychopathological symptoms in recreational ecstasy (MDMA) users are mainly associated with regular cannabis use: further evidence from a combined cross-sectional/longitudinal investigation.

Psychopharmacology, 173(3-4), 398-404

View on PubMed ↗

Citation

Daumann, Jörg; Hensen, Gernot; Thimm, Bastian; Rezk, Markus; Till, Bianca; Gouzoulis-Mayfrank, Euphrosyne. (2004). Self-reported psychopathological symptoms in recreational ecstasy (MDMA) users are mainly associated with regular cannabis use: further evidence from a combined cross-sectional/longitudinal investigation.. Psychopharmacology, 173(3-4), 398-404.