Obsessive-compulsive disorder followed by psychotic episode in long-term ecstasy misuse

World J Biol Psychiatry. 2009;10(4 Pt 2):599-602. doi: 10.1080/15622970701459828.

Abstract

Aim: We report the case of two young subjects who developed an obsessive-compulsive disorder (OCD) during a heavy use of ecstasy. After several months of discontinuation of the drug, major depression with psychotic features developed in one subject and a psychotic disorder in the other individual. No mental disorder preceded the use of ecstasy in any subject.

Findings: A familial and personality vulnerability for mental disorder was revealed in one subject, but not in the other, and all physical, laboratory and cerebral NMR evaluations showed normal results in both patients. Remission of OCD and depressive episode or psychotic disorder was achieved after treatment with a serotoninergic medication associated with an antipsychotic.

Conclusions: The heavy long-term use of ecstasy may induce an alteration in the brain balance between serotonin and dopamine, which might constitute a pathophysiological mechanism underlying the onset of obsessive-compulsive, depressive and psychotic symptoms. The heavy use of ecstasy probably interacted with a vulnerability to psychiatric disorder in one subject, whereas we cannot exclude that an "ecstasy disorder" ex novo affected the other individual.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Amphetamine-Related Disorders / diagnosis*
  • Amphetamine-Related Disorders / psychology*
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Benzodiazepines / therapeutic use
  • Borderline Personality Disorder / diagnosis
  • Borderline Personality Disorder / psychology
  • Brain / drug effects
  • Clomipramine / therapeutic use
  • Comorbidity
  • Depressive Disorder, Major / chemically induced
  • Depressive Disorder, Major / diagnosis
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / genetics
  • Depressive Disorder, Major / psychology
  • Dopamine / metabolism
  • Female
  • Genetic Predisposition to Disease / genetics
  • Hallucinogens / toxicity*
  • Humans
  • Male
  • N-Methyl-3,4-methylenedioxyamphetamine / toxicity*
  • Obsessive-Compulsive Disorder / chemically induced*
  • Obsessive-Compulsive Disorder / diagnosis
  • Obsessive-Compulsive Disorder / drug therapy
  • Obsessive-Compulsive Disorder / genetics
  • Obsessive-Compulsive Disorder / psychology
  • Olanzapine
  • Psychoses, Substance-Induced / diagnosis*
  • Psychoses, Substance-Induced / drug therapy
  • Psychoses, Substance-Induced / genetics
  • Psychoses, Substance-Induced / psychology
  • Risk Factors
  • Risperidone / therapeutic use
  • Serotonin / metabolism
  • Substance Withdrawal Syndrome / diagnosis
  • Substance Withdrawal Syndrome / drug therapy
  • Substance Withdrawal Syndrome / psychology
  • Young Adult

Substances

  • Antidepressive Agents, Tricyclic
  • Antipsychotic Agents
  • Hallucinogens
  • Benzodiazepines
  • Serotonin
  • N-Methyl-3,4-methylenedioxyamphetamine
  • Risperidone
  • Olanzapine
  • Clomipramine
  • Dopamine