Depressed but still raving

I T is almost exactly 25 years since I took my first LSD trip, at the end of my first term at university. Thinking I had discovered the secret of life, four more followed in quick succession.

They culminated in a real stinker of a "bad trip", a severe attack of the hee-bie-geebies, which pretty much ended my drug career at the tender age of 20.

On medical rather than aesthetic or experiential grounds, I consider myself fortunate to have been in an age-cohort where LSD rather than Ecstasy was the most dangerous drug likely to be encountered. While LSD can trigger psychoses (ie total madness - I was lucky only to suffer panic attacks for a few years afterwards), it does not cause any permanent brain damage. The same is true of heroin, the next big drug craze to come along, in the late 1970s. Its damaging consequences are legion, but none of them entails irreversible changes to the structure of the brain as a result of one dose. Furthermore, most people who take LSD or heroin begin to realise that it is harming them in a rather obvious, cause-and-effect kind of way. Going barking mad soon after taking a pill or finding that you cannot get by for 12 hours without a fix tends to lead even the most stupid or self-destructive person to realise that the drug they are taking is a problem. By contrast, Ecstasy is insidious. While a few people suffer dangerous dehydration and a few have panicky bad trips, most do not. During the experience and its immediate aftermath there are no clues that the drug may be permanently destroying key bits of brain. LSD or heroin damage software that can always be replaced just wipe the program and reinstall the Wordstar or Loco-script - but it now seems very likely that Ecstasy is much worse. It looks as if it causes irreversible damage to the hard disc, the brain's hardware. Until last month's publication of an article in the doctor's journal The Lancet, direct evidence that methyl- lenedioxymethamphetamine (MDMA - the chemical name for Ecstasy) kills crucial bits of brain was limited to studies of animals. Whether it was guinea pigs, rats or monkeys, administering MDMA caused a decrease in the number of "receptors" for processing serotonin, a brain-chemical that is crucial for mental health in humans and levels of which are raised by modern antidepressants such as Prozac. Serotonin carries messages that damp down and inhibit our animal selves - sex, hunger, anger. As well as depressives, people who are impulsive, aggressive, obsessive, alcoholic or suffer eating disorders have been found to have abnormal levels. That serotonin is so critical to our wellbeing made the finding that MDMA kills receptors in our closest animal relatives extremely worrying. Was what was true of animals true of us? Reduced levels of serotonin in the spinal fluid of human Ecstasy users was demonstrated several times. Other studies measuring the behaviour of Ecstasy users showed that they were at risk of midweek blues after a weekend session and of losing mental agility and memory. But none of these studies looked directly at the brain. While the evidence caused widespread alarm in medical circles, it was only when Professor Una McCann of the US National Institute of Mental Health published the results of her study in last month's Lancet that the fears were confirmed. Using direct images of the brain, she compared the brains of 15 Ecstasy users with 15 people who had never taken the drug. Her results were unequivocal. Not only did the Ecstasy users have significantly less of the crucial serotonin structures than the nonusers, the more Ecstasy they had taken during their lives, the worse the damage. McCann's conclusion was bleak: "Our data suggest that people who use MDMA as a recreational drug are putting themselves at risk of developing brain injury." This is made all the worse when you realise that as we get older, the number of sero-tonin receptors in our brain drops naturally. The destruction caused by Ecstasy could increase many kinds of psychiatric and neurological problems in old age. We do not yet know for sure if the damage in humans is irreversible, so it is possible that the brain could repair itself. Nor do we know in any detail whether it matters what size of doses have been taken, or their frequency. It is also possible, although unlikely, that the findings in all the studies of humans reflect damage which preexisted the MDMA use. Ecstasy users could be a self-selected group of people who, compared to nonusers, were more prone to have serotonin damage, low levels in spinal fluid, a tendency to depression and so on. But, all in all, it is beginning to look as if Ecstasy is another of those grim medical time-bombs already ticking away. As we ponder the potential damage done to our brains by mobile phones and beef, a significant slice of under-40-year-olds will have to add Ecstasy to the list. How very cruel. It seems so random that I could have got away with unprotected sex and taking the most dangerous drug around in the early 1970s whereas people who were young just a few years later are now threatened with a legacy of death or brain damage for doing just the same. * Oliver James is author of Britain on the Couch - A Treatment for The Low Serotonin Society, published by Arrow Psychologist Oliver James

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