Is ecstasy an "empathogen"? Effects of ±3,4-methylenedioxymethamphetamine on prosocial feelings and identification of emotional states in others

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 behavior 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.

Figure 1

Drug effects on self-reported loving, friendly, and lonely feelings. Top: Visual Analogue Scale (VAS) Loving. Middle: Profile of Mood states (POMS) Friendly. Bottom: VAS Lonely. Data are mean change from pre-drug baseline (± S.E.M.) as a function of minutes post-capsule. Asterisk denotes difference (peak change from baseline) from placebo (p< 0.05, with Bonferroni correction); % denotes difference from MDMA (0.75mg/kg; p< 0.05, with Bonferroni correction); ! denotes difference from methamphetamine (20mg; p< 0.05, with Bonferroni correction). N = 20 due to missing data.

Figure 2

Drug effects on self-reported playfulness and sociability. Top: Visual Analogue Scale (VAS) Playful. Bottom: VAS Sociable. Data are mean change from pre-drug baseline (± S.E.M.) as a function of minutes post-capsule. Asterisk denotes difference (peak change from baseline) from placebo (p< 0.05, with Bonferroni correction); % denotes difference from MDMA (0.75mg/kg; p< 0.05, with Bonferroni correction). N = 20 due to missing data.