title: Basal functioning of the hypothalamic-pituitary-adrenal (HPA) axis and psychological distress in recreational ecstasy polydrug users.
abstract: BACKGROUND
  Ecstasy (MDMA) is a psychostimulant drug which is increasingly associated with psychobiological dysfunction. While some recent studies suggest acute changes in neuroendocrine function, less is known about long-term changes in HPA functionality in recreational users.
  
  
  OBJECTIVE
  The current study is the first to explore the effects of ecstasy-polydrug use on psychological distress and basal functioning of the HPA axis through assessing the secretion of cortisol across the diurnal period.
  
  
  METHODS
  Seventy-six participants (21 nonusers, 29 light ecstasy-polydrug users, 26 heavy ecstasy-polydrug users) completed a substance use inventory and measures of psychological distress at baseline, then two consecutive days of cortisol sampling (on awakening, 30 min post awakening, between 1400 and 1600 hours and pre bedtime). On day 2, participants also attended the laboratory to complete a 20-min multitasking stressor.
  
  
  RESULTS
  Both user groups exhibited significantly greater levels of anxiety and depression than nonusers. On day 1, all participants exhibited a typical cortisol profile, though light users had significantly elevated levels pre-bed. On day 2, heavy users demonstrated elevated levels upon awakening and all ecstasy-polydrug users demonstrated elevated pre-bed levels compared to non-users. Significant between group differences were also observed in afternoon cortisol levels and in overall cortisol secretion across the day.
  
  
  CONCLUSIONS
  The increases in anxiety and depression are in line with previous observations in recreational ecstasy-polydrug users. Dysregulated diurnal cortisol may be indicative of inappropriate anticipation of forthcoming demands and hypersecretion may lead to the increased psychological and physical morbidity associated with heavy recreational use of ecstasy.
authors.affiliation: Health in Action Stress Research Group, Department of Psychology, University of Northumbria, Newcastle-upon-Tyne, UK, mark.wetherell@northumbria.ac.uk.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Wetherell
authors.forename: Catharine
authors.initials: C
authors.lastname: Montgomery
mesh_terms: D001007:Anxiety / Q000139:chemically induced / Q000378:metabolism; D016022:Case-Control Studies; D002940:Circadian Rhythm; D003863:Depression / Q000139:chemically induced / Q000378:metabolism; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D013287:Illicit Drugs / Q000009:adverse effects; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D012463:Saliva / Q000378:metabolism; D019966:Substance-Related Disorders / Q000378:metabolism / Q000523:psychology; D055815:Young Adult
chemical_list: D013287:Illicit Drugs; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D006854:Hydrocortisone