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Striatal iron deposition in recreational 3,4-methylendioxymethamphetamine (MDMA, “Ecstasy”) users

  • Rebecca, C Coray
    Corresponding author: Rebecca Coray, M.Sc. Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of, Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland,
    Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Switzerland

    Neuroscience Center Zurich, ETH Zurich and University of Zurich, Zurich, Switzerland
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  • Jatta Berberat
    Geriatric Psychiatry, Department of Psychiatry, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland

    Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
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  • Josua Zimmermann
    Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Switzerland

    Neuroscience Center Zurich, ETH Zurich and University of Zurich, Zurich, Switzerland
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  • Erich Seifritz
    Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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  • Ann-Kathrin Stock
    Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
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  • Christian Beste
    Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
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  • David, M. Cole
    Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Switzerland

    Neuroscience Center Zurich, ETH Zurich and University of Zurich, Zurich, Switzerland
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  • Paul, G. Unschuld
    Geriatric Psychiatry, Department of Psychiatry, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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  • Boris, B. Quednow
    Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Switzerland

    Neuroscience Center Zurich, ETH Zurich and University of Zurich, Zurich, Switzerland
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Published:February 25, 2023DOI:



      The common club drug 3,4-methylendioxymethamphetamine (MDMA, “Ecstasy”) enhances mood, sensory perception, energy, sociability, and euphoria. While MDMA has been shown to produce neurotoxicity in animal models, research on its potential neurotoxic effects in humans is inconclusive and has focused primarily on the serotonin system.


      We investigated 34 regular, largely pure MDMA users for signs of premature neurodegenerative processes in the form of increased iron load in comparison to a group of 36 age-, sex-, and education-matched MDMA-naïve controls. We employed quantitative susceptibility mapping (QSM), a novel tool able to detect even small tissue (non-heme) iron accumulations. Cortical and relevant subcortical gray matter structures were grouped into eight regions-of-interest (ROIs) and analyzed.


      Significantly increased iron deposition in the striatum was evident in the MDMA user group. The effect survived correction for multiple comparisons and remained after controlling for relevant confounding factors, including age, smoking and stimulant co-use. Although no significant linear relationship between measurements of the amounts of MDMA intake (hair analysis and self-reports) and QSM values could be observed, increased striatal iron deposition might nevertheless point to MDMA-induced neurotoxic processes. Additional factors (hyperthermia, simultaneous co-use of other substances) that possibly amplify neurotoxic effects of MDMA during the state of acute intoxication are discussed.


      The demonstrated increased striatal iron accumulation may indicate that regular MDMA users have an increased risk potential for neurodegenerative diseases with progressing age.


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