3,4-Methylenedioxymethamphetamine (MDMA)-induced anxiety disorder in a young female

Substance abuse is a growing concern among today's youth in India. The most commonly used substances are alcohol, tobacco, and cannabis but it may also include a wider range of substances like methamphetamine (MDMA), heroin, and cocaine.1 Women have been affected both as partners of substance users as well as substance users themselves. Problems associated with substance use in women, as a result of social adversities, unavailability of resources, negative attitude, or methodological inadequacy have been less acknowledged.2 Earlier, Indian epidemiological studies showed negligible rates of substance use among women,3 but more recent studies have reported prevalence varying from 2 to 8%.4 A 26-year-old, divorced female, of lower socioeconomic status, and a dancer in private parties by profession was brought to the casualty by her aunt with complaints of sudden onset apprehension and palpitation, fear of impending doom, restlessness, and pacing around for two days and reduced sleep and appetite since eight days. She was consuming MDMA, around 2–3 g each day for the past 8 days via snorting, by crushing MDMA crystals. There was a history of consumption of MDMA two years back on and off with transient psychotic symptoms. She is a known case of hypothyroidism but off treatment for the past 8 days. Her parents had separated because of interpersonal issues, and after a few years, her mother was rendered bedridden after an attack of stroke. Due to financial constraints, she dropped out of school. Such harsh conditions compelled the patient to look for other means of livelihood instead of pursuing further studies at the age of 14 years. After doing unskilled labor work for the next couple of years, she started working as a dancer in pubs and private parties where she got access to multiple illicit substances with the help of one of her male colleagues. On physical examination, the pulse was 120 beats/min. Mental Status Examination revealed an ill-kempt female, who was restless in the ward, with increased motor activity, increased rate, tone and volume of speech, and distressed affect. A urine drug assay detected the presence of MDMA. With a diagnosis of stimulant-induced anxiety disorder, she was treated with benzodiazepines and low-dose antipsychotics with improvement in her clinical status. Up until recently, the use of psychoactive substances was primarily seen as a male problem, which led to research that was largely androcentric and insensitive to gender differences. Psychological and social factors play a vital role when it comes to substance use in women. Women with substance use have reported greater rates of childhood or adult trauma and are more likely to be introduced to substance use by their sexual partners. Stressful experiences in childhood, relationships, and lifestyle changes are a few of the common causes of maintenance of substance use in such women.5 It is hypothesized that three possible pathways contribute to substance use in women, namely, predisposition and modeling, social disadvantage and social isolation, and role transition and lifestyle changes. Such models are a useful tool in understanding the causative factors as well as issues related to treatment and support.6 Worldwide, alcohol use in women has received the widest attention,7 and stimulant use in them has gone largely under the radar. Current interventions are largely focused on males,8 but the increasing prevalence of substance use in women4 makes an appropriate understanding of female psychosocial factors necessary to help us in formulating gender-specific approaches. Declaration of patient consent The patient has given his consent to be included in the case report. The patient has agreed to provide his clinical details and for the same to be reported in the journal. The patient understands that his name and personal details will not be divulged, and his identity will be concealed; however, absolute anonymity was not guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.