Striatal Iron Deposition in Recreational MDMA (Ecstasy) Users

Research output: Contribution to journalResearch articleContributedpeer-review


  • Rebecca C. Coray - , University of Zurich, ETH Zurich (Author)
  • Jatta Berberat - , University of Geneva, Cantonal Hospital Aarau (Author)
  • Josua Zimmermann - , University of Zurich, ETH Zurich (Author)
  • Erich Seifritz - , University of Zurich (Author)
  • Ann Kathrin Stock - , Department of Child and Adolescent Psychiatry and Psychotherapy, Chair of Biopsychology, Department of Child and Adolescent Psychiatry and Psychotherapy (Author)
  • Christian Beste - , Department of Child and Adolescent Psychiatry and Psychotherapy, Department of Child and Adolescent Psychiatry and Psychotherapy (Author)
  • David M. Cole - , University of Zurich, ETH Zurich, University of Basel (Author)
  • Paul G. Unschuld - , University of Geneva (Author)
  • Boris B. Quednow - , University of Zurich, ETH Zurich (Author)


Background: The common club drug MDMA (also known as ecstasy) enhances mood, sensory perception, energy, sociability, and euphoria. While MDMA has been shown to produce neurotoxicity in animal models, research on its potential neurotoxic effects in humans is inconclusive and has focused primarily on the serotonin system. Methods: We investigated 34 regular, largely pure MDMA users for signs of premature neurodegenerative processes in the form of increased iron load in comparison to a group of 36 age-, sex-, and education-matched MDMA-naïve control subjects. We used quantitative susceptibility mapping, a novel tool able to detect even small tissue (nonheme) iron accumulations. Cortical and relevant subcortical gray matter structures were grouped into 8 regions of interest and analyzed. Results: Significantly increased iron deposition in the striatum was evident in the MDMA user group. The effect survived correction for multiple comparisons and remained after controlling for relevant confounding factors, including age, smoking, and stimulant co-use. Although no significant linear relationship between measurements of the amounts of MDMA intake (hair analysis and self-reports) and quantitative susceptibility mapping values was observed, increased striatal iron deposition might nevertheless point to MDMA-induced neurotoxic processes. Additional factors (hyperthermia and simultaneous co-use of other substances) that possibly amplify neurotoxic effects of MDMA during the state of acute intoxication are discussed. Conclusions: The demonstrated increased striatal iron accumulation may indicate that regular MDMA users have an increased risk potential for neurodegenerative diseases with progressing age.


Original languageEnglish
Pages (from-to)956-966
Number of pages11
JournalBiological Psychiatry: Cognitive Neuroscience and Neuroimaging
Issue number9
Publication statusPublished - Sept 2023

External IDs

PubMed 36848948
ORCID /0000-0002-2989-9561/work/146788799
WOS 001073803700001



  • Addiction, Empathogens, Imaging, Iron load, Neurotoxicity, Quantitative susceptibility mapping, Stimulants, Substance use, Drugs, Brain, Oxidative stress, Lipid-peroxidation, Methamphetamine, Inflammation, Accumulation, Parkinsonism, 3,4-methylenedioxymethamphetamine mdma, Serotonin neurotoxicity, Hallucinogens/pharmacology, Serotonin, Humans, Iron, Illicit Drugs/adverse effects, N-Methyl-3,4-methylenedioxyamphetamine/toxicity