What happens if the drugs really don't work?

New research is likely to reveal a disturbing link between Ecstasy use and long-term depression and psychosis. So are the good times over? Tony Naylor reports

IT'S OFFICIAL: the drugs don't work. A new sobriety is settling in, according to style-watchers in The Face, i-D and The Big Issue, and The Verve are being canonised for articulating a generation's collective come-down.

While the taste-makers give their nasal membranes a rest, a little belated attention is beginning to be paid to the disturbing tales filtering through clubland about what happens when the drugs really don't work. As Britain's unregulated drugs experiment rolls on, and the numbers involved increase (or simply remain massive), it appears that a significant minority of clubbers may be experiencing harrowing psychological side-effects. It's a sensitive subject. Friends who flip out and leave the scene are clubland's great taboo and are all too quickly forgotten about - when they're not being sniggeringly dismissed as lightweights.

"Most drug users will suffer mild side effects in one form or another," reports Liz Skelton, coordinator of Edinburgh drug agency Crew 2000. "And of those, a small number will go on to develop a significant problem." For that minority, however, the side-effects can be devastating. All-consuming depression, anxiety - to the extent where the simplest social situations leave you rigid with fear - paranoia, hallucinations, psychosis and "panic attacks" have all been reported by drugs helplines, surveys and GPs. These aren't simple cases of the mid-week blues.

Amassing scientific data to try to establish a cause-and-effect link between E and mental health problems is problematic. Clubbers take impure drugs, they take cocktails of drugs that may include amphetamines (amphetamine psychosis is already widely recognised) and they hide other factors, such as relationship troubles, that may predispose them to problems. Consequently, as John Ramsey, Head of Toxicology at Tooting's St George's Medical School and a consultant to the Health Education Authority, readily admits, current thinking is largely an amalgam of "medical intuition", animal research and anecdotal evidence from clubbers. (Though, significantly, most clubbers would have an anecdote or two.) Indeed, of 469 long term E-users questioned for Radio 5's The E Generation, broadcast in July last year, six out of ten said that they had been affected by depression and/or loss of memory.

This month, Dr David Semple, of the Royal Edinburgh Hospital publishes new research into the effects of MDMA on the brain's serotonin and dopamine functions. Although the connection is far from fully understood, low serotonin levels have been linked with depression in some studies. Dr Semple conducted brain scans and psychological tests on a group of volunteers who'd all used ecstasy for at least one year, and who had taken at least 50 tablets (although most had taken many more). "Does E, in the long term, cause effects on the brain? Yes, you could say that we've found something," says Dr Semple. "But you could also say that it poses more questions than it answers."

Results published in November last year by American scientist George Ricaurte, Assistant Professor of Neurology at John Hopkin's University, were similarly equivocal. In his study E-users certainly showed deficiencies in serotonin - the so called "happiness chemical" and this may be a factor in the problems E-users are currently experiencing. But, if even this is far from clear cut, the long-term effects are even more hotly disputed. As David Concar, deputy editor of New Scientist, explained in the Independent: "The really tricky point about this is whether you call these changes "damage", or whether they are "chemical responses" to the drug which would in time reverse themselves."

Does MDMA lower serotonin to an extent that it will cause problems for the majority of users? Or, is it the case that E causes problems in specific types of people, who, due to their chemical make-up or mental state, are unusually susceptible? Moreover, does any change or damage last, or will the brain revert back to normal after use has ceased?

The pessimists predict a bleak future that suggests those currently with problems are merely experiencing the calm before the storm. Animal testing suggests that E may permanently reduce users' serotonin levels and damage the nerve terminals from which serotonin is released, leaving a substantial section of our generation potentially "amotivational" - a psychiatric condition that completely disables the sufferer. Quoted in Mixmag last year, Dr John Henry of the National Poisons Unit at London's Guy's Hospital, said: "I'm convinced people taking Ecstasy every week will be more liable to mental illness in the long term. Four doses in animals causes permanent brain damage and people take it time and time again."

Dr Karl Jansen, a specialist in drug related psychiatric problems and formerly of the Maudsley Hospital in London, is more cautious, although he also calls for rigorous scientific testing to assess the long-term risks. In Nicholas Saunders' Ecstasy and the Dance Culture, Jansen readily admits that mental problems, particularly among those with previous psychiatric problems such as anxiety disorders, phobias and depression, can be triggered by small doses of Ecstasy: "It's the neurotic, anxious people who already have sleep disturbances, a very high imagery level, or an unhappy family background... these are the people who are likely to suffer adverse consequences." He argues that rather than being caused by E's own "neurotoxicity", problems may be triggered by "psychological events" that are themselves brought to a head or exaggerated by often quite small doses of E. Jansen has also posited the idea of E as a "Pandora's box" which will bring buried psychiatric problems to the fore. It was, after all, designed to reduce inhibitions during controlled psychiatric counselling.

The average clubber, predisposed to problems (be it by chemical make- up or family history) or not, are groping around in the dark, unsure of what they can do to protect themselves. Most drugs agencies, however, are increasingly aware of, and better equipped to deal with, psychological side-effects. Even from cannabis. "Up until a few years ago, if anybody went to a drugs project and said they had a problem with cannabis then they wouldn't be taken seriously," explains Liz Skelton. "This has changed quite a bit. People are recognising there are side-effects, particularly for people who've got any sort of mental illness."

Assessing the number of people affected is virtually impossible. Some argue that an informal survey of GPs is needed to ascertain the scale of the problem. Certainly, the artificial paradise created by house music and Ecstasy doesn't come for free. Which, when the advice fails, leaves agencies like Crew 2000 picking up the pieces. "There is a bottom line with it," says Liz Skelton."Ultimately, there are some people who shouldn't take drugs. But, most people find that out the hard way."

If you'd like to talk to someone about drugs, call the National Drugs Helpline on 0800 776600. A version of this piece appears in this month's "Club On" magazine.