3,4-Methylenedioxymethamphetamine (MDMA), or "ecstasy," is commonly taken in an oral dose of 75-120 mg as a recreational drug within the dance culture or "rave" scene for its central stimulant and psychedelic effects (Table 11) (52). The effects last for 4-6 hours, with tolerance developing to the acute effects. However, physical and psychological dependence do not occur.

Adverse effects such as a polydipsia, hyponatremia, and catatonic stupor have been reported (53,54). An acute rise in antidiuretic hormone (arginine vasopressin) accompanied by a small fall in plasma sodium has been shown after MDMA ingestion. Therefore, in view of the risk of hyponatremia, individuals who take such drugs should avoid drinking fluid in excess of the body's requirement. This may be difficult because MDMA reduces the perception of thirst and impairs judgment (55), and people tend to overcompensate and consciously overdrink.

Regular users may habitually use chewing gum to overcome the effects on the jaw muscles. The clenching of teeth in the acidic environment caused by carbonated (fizzy) drinks will result in an increased likelihood of tooth wear on the back teeth (56). Other adverse effects have been described, including jaundice and hepatotoxicity (57); flashbacks and psychosis (58); pneumomediastinum (59); urinary retention (60); hyperthermia; coagulopathy (61); rhabdo-myolysis; and cardiovascular complications resulting in death (62-64). Development of chronic paranoid psychosis has been described after heavy misuse of the drug (65), and the serotonin syndrome (66) (altered mental state, hyper-thermia, and autonomic dysfunction) has also been reported following MDMA ingestion (67). Evidence is emerging of possible long-term damage to the brain in the form of serotonin neural injury, which may result in depression, anxiety, and memory disorders (68). However, there are other factors, such as other concomitant drug use, that complicate the issue.

3,4-Methylenedioxyamphetamine is an analog of MDMA with similar effects. 3,4-Methylenedioxyamphetamine and paramethoxyamphetamine may also be used as recreational drugs. Overdose may result in severe sympathetic stimulation and death (69).

Getting to Know Anxiety

Getting to Know Anxiety

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