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Interaction between MDMA and psychotropic meds???

Discussion in 'Medical Students - DO' started by MSW2DO, Dec 7, 2000.

  1. MSW2DO

    MSW2DO Member 10+ Year Member

    Dec 18, 1999
    San Francisco, CA 94118
    Hello everyone!

    I am a social worker in San Francisco, and I work with a lot of teenagers who are into the "rave scene" and all of the drugs that go along with that scene.

    Some of my teens are on psychotropic meds for depression, yet they continue to use ecstasy (MDMA) on a regular basis. I know that MDMA can be a dangerous drug, and that chronic use can lead to depression. However, I do not know how MDMA interacts with anti-depressants. I know it can't be good. I was wondering if you all could provide me with some information about how MDMA interacts with common anti-depressants like Paxil, Effexor, Prozac, etc.

    Some of these kids can be SO hard headed! Luckily, none of them have died yet. Should I tell them that if they feel the MUST take MDMA, then they should stop taking their meds? Please help. Thanks in advance.
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  3. together

    together Senior Member 10+ Year Member

    Oct 27, 2000
    Boston, MA
    Dear "MSW2DO,"

    The simple answer is that anti-depressants, or selective serotonin reuptake inhibitors (SSRIs) -- Prozac, Paxil, & Zoloft among others -- may actually reduce the effects of MDMA.

    To make a complicated mechanism simple, MDMA enters serotonergic neurons and triggers a massive release of serotonin. This may prompt one to ask the following question: Could it be possible to prolong the effect of MDMA by new selective serotonin reuptake
    inhibitors like citalopram? Probably not. One of the ways (if not THE way) MDMA enters the 5-HT (serotonin) neuron is through the serotonin reuptake transporter. By blocking 5-HT reuptake, you also seem to significantly block MDMA's entry into the cell, thus reducing its effects. I haven't seen any reports from humans about this, but I have seen microdilysis data wherein an SSRI stopped the fenfluramine-caused increase in extracellular 5-HT. On the other hand, Dave Nichols' group reported that rats who were pretreated with an SSRI and then given MDMA still responded as if they had been given MDMA. However, Nichols has more recently concluded that the rats do not experience/respond to MDMA the way humans do, since several substances which have no MDMA-like effect in humans will substitute for MDMA in rats. Thus, I would not draw strong conclusions from his SSRI+MDMA data.

    Some people take SSRIs (selective serotonin reuptake inhibitors) several hours after taking MDMA. Thus is not to prolong or potentiate the MDMA trip but to prevent the possibility of a neurotoxin entering the 5-HT cell and damaging the cell's axons. This has been shown to happen in animals after relatively high or repeated doses.

    Chronic use of SSRIs, as is done in the treatment of depression, seems to reduce the effects of MDMA. That is, a higher dose of MDMA is required to achieve the entactogenic effect.

    Go here for more info:

    Hope this helps!



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