Is Ecstasy an “Empathogen”? Effects of ±3,4-Methylenedioxymethamphetamine on Prosocial Feelings and Identification of Emotional States in Others

This within-subjects, placebo-controlled study (n=21) found that MDMA (52.5-105mg/70kg) may be more accurately characterized as increasing social approach behaviour rather than empathy as such.

Abstract

“Background: Users of ±3,4-methylenedioxymethamphetamine (MDMA), “ecstasy,” report that the drug produces unusual psychological effects, including increased empathy and prosocial feelings. These “empathogenic” effects are cited as reasons for recreational ecstasy use and also form the basis for the proposed use of MDMA in psychotherapy. However, they have yet to be characterized in controlled studies. Here, we investigate effects of MDMA on an important social cognitive capacity, the identification of emotional expression in others, and on socially relevant mood states.

Methods: Over four sessions, healthy ecstasy-using volunteers (n = 21) received MDMA (.75, 1.5 mg/kg), methamphetamine (METH) (20 mg), and placebo under double-blind, randomized conditions. They completed self-report ratings of relevant affective states and undertook tasks in which they identified emotions from images of faces, pictures of eyes, and vocal cues.

Results: MDMA (1.5 mg/kg) significantly increased ratings of feeling “loving” and “friendly”, and MDMA (.75 mg/kg) increased “loneliness”. Both MDMA (1.5 mg/kg) and METH increased “playfulness”; only METH increased “sociability”. MDMA (1.5 mg/kg) robustly decreased accuracy of facial fear recognition relative to placebo.

Conclusions: The drug MDMA increased “empathogenic” feelings but reduced accurate identification of threat-related facial emotional signals in others, findings consistent with increased social approach behaviour rather than empathy. This effect of MDMA on social cognition has implications for both recreational and therapeutic use. In recreational users, acute drug effects might alter social risk-taking while intoxicated. Socioemotional processing alterations such as those documented here might underlie possible psychotherapeutic benefits of this drug; further investigation of such mechanisms could inform treatment design to maximize active components of MDMA-assisted psychotherapy.”

Authors: Gillinder Bedi, David Hyman & Harriet de Wit

Is ecstasy an ‘empathogen’? Effects of MDMA on prosocial feelings and identification of emotional states in others

MDMA (ecstasy) users report unusual psychological effects, including increased empathy and prosocial feelings. These effects have yet to be characterized in controlled studies.

MDMA increased social approach behavior and reduced accurate identification of threat-related facial emotional signals in others, suggesting that it may alter social cognition in recreational and therapeutic users.

INTRODUCTION

MDMA (ecstasy) has unusual, so-called ’empathogenic’ effects, which are cited as a motivation to use ecstasy recreationally and as a rationale for the use of the drug as a psychotherapeutic adjunct.

Only a small number of controlled laboratory studies have assessed subjective experiences after MDMA, and there have been no published reports in humans of the effect of MDMA on behaviors related to empathy and sociability. MDMA altered brain response to social material, but did not alter the behavioral response to the stimuli. This suggests that emotion recognition may play a role in the drug’s effects, but the methods used were not optimal to detect a behavioral effect.

We used more sensitive methods to investigate the behavioral effects of MDMA on social cognition using emotional identification paradigms, and included a comparison drug, methamphetamine, to determine the specificity of these effects to MDMA.

We hypothesized that MDMA would affect emotion recognition, and that this would result in increased empathy, or decreased sensitivity to threat-related emotions, and hence increased social approach behavior (sociability).

Healthy volunteers aged 18-38 who reported using MDMA or ecstasy on at least two occasions were recruited with internet advertisements and word-of-mouth. They underwent extensive screening and provided written informed consent.

Experimental Protocol

A 4-session, within-participants, double-blind design was employed. Participants received a capsule containing MDMA, methamphetamine or placebo, and were required to abstain from cannabis, alcohol and medications for 24 hours and all other recreational drugs for 48 hours prior to sessions.

We selected a methamphetamine dose (20mg) that is safe and induces robust stimulant and euphoric effects, in amphetamine-naive volunteers. The dose produced overlapping reinforcing and subjective effects of MDMA and d-amphetamine, although in many cases MDMA produced higher ratings.

After baseline measures, participants ingested an opaque gelatin capsule containing MDMA or methamphetamine with lactose or dextrose, or placebo. They remained in the laboratory for at least 4.5 hours, undergoing regular cardiovascular checks and subjective state questionnaires.

Assessment Measures

Subjective measures included Visual Analogue Scales and the Profile of Mood States. The VAS and POMS were administered at 0, 30, 60, 90, 120, 150, 210 and 240 minutes post capsule, with the middle time point designed to occur during peak drug effects.

Two facial affect identification tasks and a vocal affect task were completed once in each session, during the period of anticipated peak drug effects. The Facial Emotional Recognition task (FER) is sensitive to serotonin and norepinephrine reuptake inhibition.

The Reading the Mind in the Eyes – Revised test (Eyes test) was used to identify complex emotions. It is sensitive to oxytocin administration.

The DANVA-2 Adult Paralanguage Test is a vocal affect recognition task that comprises 24 audio clips of professional actors saying a single neutral phrase in a happy, sad, angry, or fearful tone.

Statistical Analyses

Subjective outcomes were assessed using repeated measures ANOVA, and interactions between drug and emotion type were assessed using two-way repeated measures ANOVA. A total Eyes score was assessed using an ANOVA, and the effect of drug on this score was assessed using an ANOVA. We assessed for normality of the data and univariate outliers prior to analysis. Four outcome measures were nonnormal, and non-parametric analysis yielded the same results except VAS Lonely, for which parametric statistics are reported.

Participants’ mean age was 24.4 years, 9 were female, and 17 identified as Caucasian, 2 were Asian, 1 was African-American, and 1 was of mixed race. All had used cannabis at some time in their lives.

The drugs increased ratings on all five subjective state measures. MDMA1.5 increased loving feelings, POMS friendliness ratings, VAS loneliness ratings, and VAS playfulness ratings.

There was a significant interaction between drug condition and emotion on the FER accuracy of emotion identification, with MDMA1.5 decreasing accuracy of fear recognition relative to placebo.

To explore the possible mechanisms of the effect of MDMA1.5 on facial fear recognition, we examined whether subjects’ apparent expectancies of receiving MDMA affected their responses during sessions.

DISCUSSION

We found that MDMA (1.5mg/kg only) decreased recognition of fearful faces, without changing recognition of other emotions from facial or vocal cues. This suggests that MDMA may facilitate social interactions by reducing the impact of others’ negative emotions.

Methamphetamine increased subjective effects measured, including self-rated sociability and loving feelings and friendliness. However, these effects were not significantly different from ratings on methamphetamine, suggesting that expectancies play a minor role in these results.

MDMA affected social cognition only when participants had to identify emotions from facial expressions, and had no effect on recognition of affective cues from the eye region or from voices.

The findings may not generalize to MDMA-naive individuals, because the behavioral tasks we used may not have been sensitive to all of the unusual social effects attributed to MDMA, and because participants had prior experience with ecstasy or MDMA.

MDMA increases prosocial behavior in rodents and humans, and increases plasma oxytocin levels. Further studies are needed to examine the role of oxytocin in the social cognitive, affective and behavioral effects of MDMA in humans.

These findings may have implications for both recreational and therapeutic MDMA use. For example, modifying users’ expectations about positive social effects of MDMA may alter ecstasy-use behavior, and reducing sensitivity to subtle signs of negative emotions in others may facilitate expression of thoughts and feelings during therapy.

Figure 1.

Drug effects on self-reported loving, friendly, and lonely feelings were examined. Asterisks denote difference from placebo, MDMA, and methamphetamine.

Figure 2.

Drug effects on self-reported playfulness and sociability. Asterisk denotes difference from placebo, % denotes difference from MDMA.