Q. I’ve tried ecstasy several times. Lately I seem to be having difficulty concentrating. I’m having memory lapses, too. Has it changed my brain some way?

A. I receive more questions about ecstasy (also called MDMA or simply "e") on my website than any other street drug. First of all, I have a bias. I believe that the brain changes any time we subject it to a mind-altering substance. Whether or not those changes are permanent (to say nothing of desirable) is the million-dollar question.

What does ecstasy do in the brain? For one thing, it forces nerve cells to release all the serotonin stored at the ends of the axons. This process not only floods the brain with serotonin but can damage the cells, as well, sometimes irreparably. In addition, it interferes with the reuptake (the reabsorption of serotonin from the synaptic gap). It’s primarily this serotonin rush and related brain-function consequences that users seek.

A common short-term side effect is overheating. That is, ecstasy can interfere with the brain’s ability to control body temperature. Deaths have occurred post-ecstasy when body temperatures climbed to more than 108 degrees F. Because the drug tends to inhibit sweating, as well, ingestion can easily contribute to heatstroke. Scary!

The second most common short-term side effect relates to something called psychological trauma. For example, a few users have had a serious mental breakdown after using the drug. Many others have experienced depression. Depression is associated with a decrease in serotonin levels and the forced release of this substance in the brain can result in a down day that users sometimes refer to as Terrible Tuesdays.

Because serotonin can induce feelings of empathy, as well as euphoria, users are at risk for engaging in activities they might not otherwise choose (e.g., lowered sexual inhibitions). Some studies have shown that ecstasy users fared worse on memory tests when compared to individuals who said they’d never taken the drug. Again, some researchers hypothesize that the damage may be irreversible.

A major concern from my point of view is that one never knows exactly how one’s brain will respond to any given substance. Furthermore, no one really knows what the long-term implications might be in terms of brain function. Will side effects show up in ten or twenty years after ingestion of the substance?

In addition, one never knows what other substances might be mixed with ecstasy in order to increase its profitability. Some samples have been shown to contain aspirin, caffeine, DXM (a cough suppressant that can cause hallucinations), or PMA (an hallucinogenic and hyperthermic substance).

Added together, taking ecstasy is a bit like playing Russian roulette. For some individuals, it may be relatively harmless. For others, one dose may be life threatening. One never knows! Since we are first and foremost our “brains,” my position is that ingesting mind-altering substances constitutes an unacceptable risk.