Ecstasy Citalopram

Liechti, M.E. and Vollenweider, F.X., The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine ( Ecstasy ) in healthy volunteers, J. Psychopharmacol. 14(3), 269-274, 2000. 

Treatment of psychiatric complications should generally be along standard lines for the respective conditions. Some syndromes appear to be brief and self-limiting once ecstasy use stops, but a more chronic course may also be seen, with cases in the literature of psychoses which prove resistant to treatment (Vecellio et al. 2003). Whichever psychiatric syndrome occurs, there is possibly a theoretical indication for specific serotonergic re-uptake inhibitors such as fluoxetine, sertraline or citalopram, given the effect of ecstasy in reducing serotonin transmission. This would purely be a pragmatic approach which has not yet been properly tested, and it may be that the transmission abnormalities are not amenable to this kind of enhancement. 

It was considered that his symptoms could be directly due to ecstasy, but also that some secondary anxiety and depression were likely. For short-term symptom relief he was prescribed diazepam 2 mg tablets up to four per day for one week. He was also given citalopram 20mg per day, and the need to avoid ecstasy or any illicit drugs was reinforced. 

Methylenedioxymethamphetamine (MDMA) The psychological effects of MDMA ( Ecstasy ) are markedly reduced by the concurrent use of citalopram. It seems likely that other SSRIs will also reduce or block the effects of MDMA. An isolated report describes a neurotoxic reaction in a man on citalopram when he took unknown amounts of MDMA. 

When a man taking citalopram 60 mg daily additionally took unknown amounts of ecstasy he became aggressive, agitated, severely grandiose, restless and performed compulsive movements in a peculiar and joyless dance-like marmer. He lacked normal movement control and said he could see little bugs. He was treated with haloperidol and chlordiazepoxide, and improved within 2 days of replacing the citalopram with promazine. ... 

The study of ecstasy with citalopram was primarily undertaken to find out how eestasy works, but on the basis of these results and animal studies it seems likely that patients already taking citalopram may not be able to get as high on usual doses of ecstasy, and some adverse effects may also be redueed. Furthermore, if the proposed mechanism of interaction is correct, the same is also likely to be true if they are taking any other SSRI and some cases have been reported. However, be aware of possible pharmaeokinetie interaetions with some SSRIs that are potent CYP2D6 inhibitors (e.g. fluoxetine, paroxetine), which may increase ecstasy levels. There is also a risk of increased serotonergic activity and there have been a few reports of interaetions involving other sympathomimetics and SSRIs or related drugs, see Phentermine + Fluoxetine , p.205. 

Liechti ME, Baumann C, Gamma A, Vollenweider FX. Acute psychological effects of 3,4-metltylenedioxymethamphetamine (MDMA, "Ecstasy") are attenuated by me serotonin uptake inhibitor citalopram. Neuropsychophcumacology (2000) 22, 513-21. 

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