MDMA enhances emotional empathy and prosocial behavior

This placebo-controlled, double-blind study (n=32) investigated the acute effects of MDMA on empathogenic and prosocial feelings and found that MDMA sex-specifically altered the recognition of emotions, emotional empathy, and prosociality.

Abstract

“3,4-Methylenedioxymethamphetamine (MDMA, ‘ecstasy’) releases serotonin and norepinephrine. MDMA is reported to produce empathogenic and prosocial feelings. It is unknown whether MDMA in fact alters empathic concern and prosocial behaviour. We investigated the acute effects of MDMA using the Multifaceted Empathy Test (MET), dynamic Face Emotion Recognition Task (FERT) and Social Value Orientation (SVO) test. We also assessed effects of MDMA on plasma levels of hormones involved in social behaviour using a placebo-controlled, double-blind, random-order, cross-over design in 32 healthy volunteers (16 women). MDMA enhanced explicit and implicit emotional empathy in the MET and increased prosocial behaviour in the SVO test in men. MDMA did not alter cognitive empathy in the MET but impaired the identification of negative emotions, including fearful, angry and sad faces, in the FERT, particularly in women. MDMA increased plasma levels of cortisol and prolactin, which are markers of serotonergic and noradrenergic activity, and of oxytocin, which has been associated with prosocial behaviour. In summary, MDMA sex-specifically altered the recognition of emotions, emotional empathy and prosociality. These effects likely enhance sociability when MDMA is used recreationally and may be useful when MDMA is administered in conjunction with psychotherapy in patients with social dysfunction or post-traumatic stress disorder.”

Authors: Cédric M. Hysek, Yasmin Schmid, Linda D. Simmler, Gregor Domes, Markus Heinrichs, Christoph Eisenegger, Katrin H. Preller, Boris B. Quednow & Matthias E. Liechti

Summary

Introduction

3,4-Methylenedioxymethamphetamine (MDMA, ‘ecstasy’) releases brain serotonin and norepinephrine and is classified as an ‘entactogen’ or ’empathogen’. It is unknown whether MDMA increases empathy or prosocial behavior when measured objectively.

The effects of MDMA on emotion recognition were assessed using the Face Emotion Recognition Task (FERT) and the Reading the Mind in the Eyes Test (RMET). MDMA did not improve emotion recognition overall, but enhanced the identification of positive emotions in the RMET.

This study investigated the effects of MDMA on empathy, emotion recognition, prosocial behavior and the levels of several neuropeptides and steroid hormones in the blood before and after MDMA or placebo administration.

Experimental protocol

We used a double-blind, placebo-controlled, cross-over design with a washout period of at least 10 days to study the effects of MDMA on cognition.

Measures

Subjective effects

Visual analog scales and the Adjective Mood Rating Scale were used to assess subjective effects related to prosociality.

Multifaceted empathy test

The MET was used to assess the cognitive and emotional aspects of empathy. It consisted of 40 photographs that showed people in emotionally charged situations and the subjects were required to infer the mental state of the subject in each scene and indicate the correct one from a list of four responses.

Social Value Orientation test

The paper-based SVO measure was used to assess social behavior. Participants chose their most preferred joint distribution between themselves and another person and received real value.

The SVO index was calculated by calculating the ratio of self and other allocations, and the inequality-aversion index was calculated to differentiate between two prosocial motivations, inequality aversion and joint gain maximization.

Facial affect recognition

Facial affect recognition was tested 2 h after MDMA or placebo administration. The emotion recognition accuracy was assessed as the percentage of correctly identified emotions.

Endocrine measures and pharmacokinetics of MDMA

Plasma levels of oxytocin, copeptin, cortisol, prolactin and testosterone were determined before and 2 h after drug administration. MDMA concentrations were determined using HPLC-tandem mass spectrometry.

Empathy

MDMA increased explicit and implicit emotional empathy ratings for all stimuli, but was most significant for positive valence stimuli. MDMA influenced emotional empathy differently in male and female subjects. MDMA increased explicit and implicit emotional empathy ratings only in men, and no effect of treatment was found on cognitive empathy scores. Trait empathy in the IRI did not moderate the state empathy response to MDMA in the MET.

Facial emotion recognition

MDMA increased detection threshold for fearful faces compared to placebo, and overall emotion recognition accuracy correlated with MET accuracy after placebo treatment.

Endocrine effects and pharmacokinetics of MDMA

MDMA significantly increased the levels of oxytocin, cortisol and prolactin compared with placebo, but did not alter the concentrations of copeptin or testosterone.

Discussion

This study showed that MDMA increased emotional empathy and prosocial behavior in men. Men showed more empathic concern and less competitive behavior, and exhibited a more prosocial orientation after MDMA treatment, equal to that observed in women with placebo.

MDMA did not alter cognitive empathy in the MET or FERT, but impaired emotion recognition of basic emotions in the FERT especially in women, consistent with impaired cognitive empathy with regard to decoding of basic emotions. MDMA also reduced affect recognition accuracy particularly in women.

The findings indicate that MDMA enhances the emotional but not cognitive components of empathy and reduces the recognition of negative but not positive emotions in others. These effects likely enhance sociability when MDMA is used as a club drug.

Women are generally more susceptible to the effects of MDMA compared with men, and are also more likely to develop hyponatremia in association with ecstasy use. Women are also less able to detect and process negative emotional information compared with men.

In this study, we documented increased levels of oxytocin, cortisol and prolactin along with alterations in emotional cognition, but we found no correlations between MDMA-induced endocrine and emotional changes. This may be due to several reasons, including the fact that the blood drawings were done before the computer tasks.

MDMA releases serotonin and norepinephrine in the brain, which mediates most of the acute psychotropic effects of MDMA. Serotonin and norepinephrine release also likely mediates the effects of MDMA on emotional processing, including the recognition of fearful faces. MDMA increases aspects of prosocial behavior, and tryptophan depletion decreases cooperative behavior. These effects are consistent with other pharmacological manipulations of serotonin and norepinephrine neurotransmitters. MDMA increases plasma levels of oxytocin in parallel with its empathogenic and prosocial effects. Oxytocin is a key candidate for the mediation of the empathic and prosocial effects of MDMA. MDMA and oxytocin have similar empathogenic effects in the MET and RMET, and both enhance emotional but not cognitive empathy. MDMA improves emotion recognition in the RMET, although only for positive stimuli. Oxytocin has been shown to increase generosity and trust, and is similar to MDMA in its emotional-cognitive effects. This could implicate oxytocin as a crucial mediator of the effects of MDMA on empathy and social behavior. MDMA increased cortisol and prolactin levels, which are markers of hypothalamic – pituitary – adrenal, serotonergic and noradrenergic activity. Cortisol levels are also associated with social cognition.

We used a high dose of MDMA to study social cognition in healthy subjects and found that it increased emotional empathy and prosocial behavior. This may explain its popularity as a recreational drug and potential beneficial effects of MDMA in the treatment of ‘social disorders’ and post-traumatic stress disorder.