Thus , the current state of research does not allow for the conclusion that long-term use of MDMA affects decision-making behavior in general .
Different cognitive impairments have been reported as a result of long-term MDMA/ecstasy use .
Increased impulsivity and altered decision-making have been shown to be associated with the development and maintenance of addictive disorders pointing toward the necessity to underst and a potential impairment of decision-making due to MDMA use .
Thus , assessing the long-term effects of MDMA is crucial in order to evaluate its controversially discussed therapeutic use .
The aim of this systematic review was to summarize the scientific literature on potential effects of chronic MDMA use on higher order decision-making processes in humans .
Serotonin Neurotoxicity after (±)3,4-Methylenedioxymethamphetamine (MDMA; “Ecstasy”): A Controlled Study in Humans
(±)3,4-Methylenedioxymethamphetamine ( MDMA ; “ Ecstasy ” ) , an increasingly popular recreational drug , is known to damage brain serotonin 5-hydroxytryptamine ( 5-HT ) neurons in experimental animals . Whether MDMA is neurotoxic in humans has not been established . Thirty MDMA users and 28 controls were admitted to a controlled inpatient setting for measurement of biologic and behavioral indexes of central 5-HT function . Outcome measures obtained after at least 2 weeks of drug abstinence included concentrations of monoamine metabolites in cerebrospinal fluid ( CSF ) , prolactin responses to L-tryptophan , nociceptive responses to ischemic pain , and personality characteristics in which 5-HT has been implicated ( i.e. , impulsivity and aggression ) . Subjects with a history of MDMA exposure had lower levels of CSF 5-hydroxyindoleacetic acid ( the major metabolite of 5-HT ) than controls ( p = .002 ) . Although they resembled controls in their prolactin response to L-tryptophan and their response to ischemic pain ,  MDMA  users had lower scores on personality measures of impulsivity ( p = . 004 ) and indirect hostility ( p = .009 ) . The CSF findings suggest that 5-HT neurotoxicity may be a potential complication of MDMA use . Further , differences in personality support the view that 5-HT systems are involved in modulating impulsive and aggressive personality traits . Additional studies of  MDMA-exposed individuals are needed to confirm and extend the present findings . Such studies could help eluci date the role of 5-HT in normal brain function as well as in neuropsychiatric disease states
Thus , the current state of research does not allow for the conclusion that long-term use of MDMA affects decision-making behavior in general .
Different cognitive impairments have been reported as a result of long-term MDMA/ecstasy use .
Increased impulsivity and altered decision-making have been shown to be associated with the development and maintenance of addictive disorders pointing toward the necessity to underst and a potential impairment of decision-making due to MDMA use .
Thus , assessing the long-term effects of MDMA is crucial in order to evaluate its controversially discussed therapeutic use .
The aim of this systematic review was to summarize the scientific literature on potential effects of chronic MDMA use on higher order decision-making processes in humans .