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The normal process of neuron functioning is that a "message" travels down an axon (transmitter), across a tiny space called a synapse, and into the next neuron's dendrite (receiver). The synapse is the transfer point for neurotransmitters, like seratonin and dopamine, from one neuron to another. These chemicals are stored in tiny vesicles in the axons, and their flow across the synapses to receptors in the dendrites is regulated in part by reuptake transporters (think of them as cogs on gears that "catch" some of the serotonin and put it back into the axons' vesicles for storage). The serotonin that makes it across the synapses attaches to specific sites on the dendrites, resulting in a transfer of the "message" from one neuron to the next. The dendrites have different receptors for different neurochemicals, and when enough of one kind of neurotransmitter is attached to enough receptor sites, the "message" is then transferred up the dendrite of the neuron and down that neuron's axon to the next synapse. This is how messages travel through the brain.

An increase of serotonin is generally associated with an elevated mood, which is why drugs like Prozac (selective serotonin reuptake inhibitors, or SSRIs) are designed to essentially "clog" the reuptake transporters. These drugs do not cause more serotonin to be sent out of the vesicles; rather, they make it so that the serotonin that is sent out does not come back into the axons through the reuptake transporters. In this way, there is more serotonin in the synapses, and more of the serotonin receptors in the dendrites will absorb the serotonin that is there.

Unlike Prozac, ecstacy does not clog the reuptake transporters. Instead, it makes more of the serotonin vesicles send their serotonin across synapses to the serotonin receptors in the dendrites. The result is euphoria--the brain is buzzing like mad with the "happy chemical" serotonin. Ecstacy causes more dopamine and norepinephrine to be released, as well. Remember, those reuptake transporters are also working to put some of that serotonin back into the axons. That is why eventually, when enough serotonin detaches from the dendrites and floats back into the synapses to be taken back into the axon through these reuptake transporters, you will come down from your ecstacy high.

Another part of this equation is monoamine oxidase (MAO), which breaks down serotonin. Before there were SSRIs, there were MAO inhibitors (and they are still in use today, but not to the extent that SSRIs are being used). Instead of blocking the reuptake of serotonin (like SSRIs do), MAO inhibitors make it so that serotonin is no longer broken down, thus increasing serotonin levels in the synapse. Bear in mind that taking ecstacy and MAO inhibitors can be especially dangerous because the brain can no longer control the vast amounts of serotonin being pumped into the synapses, except through reuptake, which takes considerable time. The results of this serotonin overload can be fatal.

Now, in about 4 hours into your ecstacy high (you should be coming down at this point, but not completely down for another couple of hours), the serotonin is basically all pumped out of your axons (serotonin takes a while to replenish, and you only have so much. Ecstacy does not cause the neurons to create more serotonin; instead, it causes more than the usual amount of the serotonin that is already there to be released, rather than kept in storage for future use), but remember that dopamine is also being pumped into the synapses and binding with its own receptors on the dendrites. Dopamine replenishes itself faster than serotonin, and the result is that your synapses gradually contain more dopamine than serotonin.

One thing the serotonin overload can do (over time)is "downregulate" the receptor sites for serotonin on the dendrites, thus making serotonin less likely to have its desired effect in normal circumstances. I don't think they know yet whether this "downregulation" is permanent (I suspect that over time it will get back to normal if the person stops taking ecstacy, but it may take a long time. If the brain adjusts itself one way, it likely will also reverse its adjustments once it realizes it needs to).

But that is not the main danger of ecstacy use. The main danger is the dopamine that MDMA has caused to be pumped out along with the serotonin. Remember those reuptake transporters? Well, the theory is that when there is little more serotonin to reuptake, they take up dopamine instead. This theory has been supported by several different studies. The problem with dopamine reuptake is that the serotonin neurons aren't equipped for dopamine--especially since these neurons contain MAO, which works fine for breaking down serotonin, but metabolizes dopamine into hydrogen peroxide. The dopamine and hydrogen peroxide can permanently damage the axon terminals (which store and release the serotonin).

So, where does Prozac (or some other SSRI) come into the picture? Well, the same chemicals that block the reuptake transporters from taking up serotonin also block them from taking up dopamine. Studies have shown that, at least in animals, those animals that are given an SSRI within six hours after taking ecstacy suffer no neurotoxic damage. Those given SSRIs after six hours suffered neurotoxicity, and to greater degrees as the time extended from the 6 hour mark.

The moral: if you take ecstacy, make sure you can get hold of some Prozac to take within six hours after taking the ecstacy.

By the way, don't take Prozac before you take ecstacy, as it will diminish your high. I won't get into that here. If you want to know more, visit DanceSafe at http://www.dancesafe.org

Facing ostracism and loss of research funding,
scientists are, in practical terms, prevented from
making safety-oriented recommendations.

If the numbers of 15-17 yr old white kids arrested and given stiff prison sentences, then the CIA will start selling a super-strength derivative of Ecstasy in the inner cities and take the political heat off by putting more blacks and latinos in prison for Ecstasy use than whites. Can't endanger that gravy train!

When I discuss such items with reporters, I emphasize a few points:

1) There are always risks attendant with drug usage, but efforts should be made to minimize them. Education is the answer, not repression.

2) Current prohibition does not work, so it is absolutely pointless to add Salvia divinorum or other plants/chemicals to the list. Such approaches only exacerbate the problem.

The only reasonable approach to illegal drugs is one of harm reduction. Use the term, however, and the prohibitionists will instantly and irrevocably relegate you to the great unwashed of drug users or "legalizers." Such is the poor quality of the opposition's arguments. We actually have the moral high ground on this issue.