|Beitragstitel||Direct comparison of autonomic, subjective, emotional, and endocrine effects of MDMA, methylphenidate, and modafinil: A cross-over study in healthy subjects|
Background: 3,4-methylenedioxymethamphetamine (MDMA) is used recreationally and investigated as an adjunct to psychotherapy for post-traumatic stress disorder. Methylphenidate and modafinil are psychostimulants used in the treatment of attention deficit hyperactivity disorder and narcolepsy, respectively, but also as cognitive enhancers by healthy subjects to stay awake and concentrate. Little is known about differences in the acute subjective, emotional and endocrine effects of these substances when compared directly within the same healthy subjects.
Methods: We investigated the acute autonomic, subjective, endocrine and emotional effects of MDMA (125 mg), methylphenidate (60 mg), modafinil (600mg) and placebo in a in a double-blind cross-over study in 24 healthy participants. Acute subjective effects were tested using Visual Analog Scales (VASs), the Adjective Mood Rating Scale (AMRS), the State-Trait Anxiety Inventory (STAI), the Addiction Research Center Inventory (ARCI), and the 5 Dimensions Altered States of Consciousness Scale (5D-ASC). Acute effects on emotion processing were investigated using the Facial Emotion Recognition Task (FERT). Effects on sexual arousal and desire were assessed using the Sexual Arousal and Desire Inventory (SADI).
Results: All active treatments produced comparable hemodynamic stimulation and adverse effects. MDMA produced greater pupil dilation and a reduced response to light compared with all other treatments. MDMA produced greater subjective drug effects than all other treatments including greater good drug effects, drug liking, happiness and trust on the VASs, greater well-being on the AMRS, and greater alterations in consciousness on the 5D-ASC. MDMA reduced anxiety on the STAI and impaired fear recognition on the FERT. MDMA also increased misclassifications of emotions as happy compared with placebo. Methylphenidate increased anxiety on the STAI and methylphenidate and modafinil increased misclassifications of emotions as angry. Modafinil had no subjective drug effects. After MDMA, subjects scored higher on the motivational, and physiological scores of the SADI compared with placebo, methylphenidate and modafinil. Further subjects had a higher “motivational” score after MDMA expressing a higher motivation to engage in sexual activity. Only MDMA produced relevant increases in cortisol, prolactin, and oxytocin.
Conclusion: MDMA produced acute subjective, emotional, and endocrine effects that were distinct from those of the stimulants methylphenidate and modafinil. Modafinil produced comparable acute sympathomimetic stimulation and adverse effects to methylphenidate and MDMA in the absence of subjective effects.