Childhood depression and anxiety precedes ecstasy use

Individuals with childhood symptoms of anxiety and depression may have an increased tendency to use ecstasy in adolescence or as a young adult, say researchers.

"Its effects are supposed to include enhanced feelings of bonding with other people, euphoria, or relaxation," note Anja Huizink and colleagues from Erasmus Medical Center in Rotterdam, The Netherlands.

"Especially individuals with symptoms of anxiety or depression may be susceptible to these positive effects," they say.

The use of ecstasy, or 3,4-methylenedioxymethamphetamine (MDMA), is known to be associated with emotional health problems, such as depression and anxiety, but whether these problems are a consequence of ecstasy use or a cause is unclear.

To investigate, the researchers assessed ecstasy use in 1580 individuals from The Netherlands over a 14-year period.

The first assessment took place in 1983 when the participants were aged an average of 9.9 years, and before MDMA appeared as a recreational drug in the country. The child behavior checklist was used to obtain parents' reports of their children's behavioral and emotional problems. Use of ecstasy was then determined 14 years later.

In 1997, data were available for 76% of the original cohort, and showed that 98 (47%) of participants reported using MDMA on at least five occasions.

Correlating MDMA use with eight syndrome scales of childhood behavior, the team found that only scores in the deviant range for the anxious or depressed subscale were significantly associated with MDMA use.

Indeed, after taking into account age, gender, and socioeconomic status, childhood anxiety and depression increased the risk of later MDMA use 2.22-fold.

"Our findings give evidence for a temporal pathway, in which childhood symptoms of anxiety and depression may precede use of MDMA," Huizink and team write in the British Medical Journal.

"Focusing on the children with symptoms of anxiety and depression as vulnerable individuals in future studies will increase our insight into the potential harmful effects of MDMA."

They add that reward mechanisms involved in the plausible "self medication" attempts of vulnerable individuals need to be examined to prevent children and adolescents from using MDMA regularly.

BMJ 2006; Early online publication