MDMA (Ecstasy, Molly) Short-term and Long-term Effects

Ecstasy is a popular name for the illicit synthetic drug 3,4-methylenedioxymethamphetamine (MDMA). The chemical structure of MDMA is similar to those of some hallucinogens (mescaline) and some stimulants (methamphetamine), but they are pharmacologically distinct compounds. The psychoactive effects of MDMA on the brain are profound and complex and cause a transient (three to six hours) sense of euphoria and intense pleasure associated with enhanced sensory perception and enjoyment.

A critical but often overlooked component of ecstasy’s risks and addictive potential is that it can only be purchased through risky “street” transactions due to its classification as a Schedule I drug. A 2018 study surveyed 351 ecstasy users in New York City and found that over half of the participants suspected they had purchased adulterated pills. Of the pills subsequently tested for purity, 49.2% contained methamphetamine or amphetamines. Other contaminants were cocaine, “bath salts” and heroin.

Notably, the drugs most commonly found in MDMA are associated with a substantial risk for dangerous side effects and addiction. In addition, most ecstasy users take other drugs or alcohol simultaneously. Consequently, the true profile of MDMA as a drug of abuse is difficult to assess honestly.

MDMA Effects on the Brain

MDMA exerts its hallucinogenic effects because of its activity in the brain. Specifically, MDMA increases the activity of the brain’s neurotransmitters serotonin, dopamine and norepinephrine, causing them to stick around longer than usual. This can lead to short-term mood elevation, followed by a crash as the brain depletes these neurotransmitters and struggles to catch up.

Short-term Side Effects of MDMA

MDMA is used for its ability to produce feelings of euphoria, exhilaration, enhanced emotional clarity, inner peace, intense pleasure from physical touch and increased empathy. However, many negative short-term side effects are often reported, including:

• Nausea
• Muscle tension
• Increased body temperature
• Chills and sweating
• Feelings of depersonalization
• Faintness
• Tremors
• Involuntary teeth clenching
• Anxiety
• Inability to concentrate
• Blurred vision
• High blood pressure

In addition, many people report feelings of depression, lethargy and mental fogginess the day after ecstasy use.

Long-term Side Effects of MDMA

Regular MDMA use can cause dependence in some people over the long term. Ecstasy has been linked to persistent serotonin neurotoxicity that may affect dopamine regulation of the “reward pathway,” which is a key regulator of addiction. Regular ecstasy use also leads to the development of tolerance, meaning ever-increasing doses are required to achieve the desired effect. 

Additional health consequences of long-term MDMA use include possibly permanent problems with learning and memory.

MDMA Comedown

An MDMA comedown follows a person’s use of the drug to get high. MDMA increases the brain’s serotonin, norepinephrine and dopamine levels to abnormally high amounts and prevents the brain from removing the neurotransmitters. Eventually, the brain cannot produce enough of these neurotransmitters any longer, so the high ends and a comedown occurs.

MDMA comedown effects include:

• Concentration problems
• Blurred vision
• Memory problems
• Dizziness or balance problems
• Low mood

Dangers of MDMA

As a Schedule I controlled substance, MDMA carries dangers, including health risks. This includes the risk of unintentionally ingesting other substances that may be lacing the illicit MDMA, like fentanyl. But even on its own, MDMA may increase your chances of dangerous complications, including serotonin syndrome, risky behaviors, cardiac effects and overdose.

Serotonin Syndrome

Serotonin syndrome is a life-threatening condition that can occur when there is too much serotonin in the brain. As MDMA increases serotonin in the brain, serotonin syndrome is a risk with this drug, especially when combined with other agents that also increase serotonin in the brain, like some antidepressants, stimulants and opioids. More than 20 cases of serotonin syndrome on MDMA have occurred.

Serotonin syndrome symptoms include:

• Agitation
• Abnormal eye movements
• Diarrhea
• Rapid heartbeat 
• High blood pressure
• Hallucinations
• Fever
• Coordination problems
• Nausea and vomiting
• Overactive reflexes

Risky Behavior

An increase in risky behavior like unprotected sex is strongly linked to MDMA use. Further, MDMA is linked to sexual activity before age 14 and having multiple partners in a two-month timeframe. Unprotected sex can lead to many complications, including unplanned pregnancies and sexually transmitted diseases.

MDMA Effects on the Heart

MDMA can negatively impact heart health for multiple reasons. First, the drug can cause side effects like high blood pressure, which strains the entire cardiovascular system. Further, MDMA has been linked to heart disease, including valvular heart disease. This condition occurs when the heart valves do not close completely when the heart pumps out blood, meaning some blood flows backward into the heart instead of into the rest of the body.

MDMA Overdose

An MDMA overdose is possible and can include symptoms like:

• High blood pressure 
• Faintness
• Panic attacks
• Loss of consciousness 
• Seizures

Because an MDMA overdose can be dangerous, you should call 911 if you suspect someone has taken too much MDMA.

How Is MDMA Abused?

The most common route of MDMA administration is swallowing pills, but it may also be snorted, smoked or injected. Regular users may consume multiple doses at once (“stacking”) or take additional tablets later in a session (“boosting”) to maintain the drug-induced effects.

Why Do People Abuse MDMA?

The primary reason people take ecstasy (MDMA) is for the intensely pleasurable effects it produces. Researchers compiled commonly cited reasons for ecstasy use:

• Changed outlook on life
• Enhanced self-understanding
• Improved relationships
• Increased sociability
• Elevated self-confidence/self-worth
• Improved psychological functioning
• Healthiness
• Enhancement of sex
• Increased enjoyment of music and/or dancing
• Becoming closer to nature
• Experiencing an altered state of consciousness
• Increased introspection
• Improved capacity for communication
• Enhanced intimacy with a partner
• Lessening the grip of negative or traumatic emotions
• Coping with emotional stressors or negative relationships
• Coping with the loss of a loved one

MDMA Abuse Statistics

Data collected for the 2020 National Survey on Drug Use and Health indicate that:

• Around 1% of Americans aged 12 years and older used ecstasy within the past year.
• Those aged 18–25 years were more likely to have used hallucinogens like ecstasy within the past year than other age groups.
• About 632,000 Americans aged 12 and older used ecstasy for the first time in 2020.

Signs of MDMA Abuse

Defining the characteristic signs of MDMA abuse is complicated by two factors. First, most MDMA users co-use other drugs (polysubstance use). Second, most recreationally used MDMA has been adulterated with stimulants, sedatives or both. However, some key signs can help identify MDMA use.

Someone who is on MDMA may exhibit activities or reactions such as:

• High sensitivity to sensory stimulation
• Abnormal intimacy or friendliness
• High energy
• Prolonged wakefulness
• Newfound appreciation for music, dancing or lights
• Exaggerated pleasure from touch
• Reduced pain sensitivity

Someone who is on MDMA may display physical signs including:

• Nausea
• Elevated body temperature
• Chills and sweating
• Dilated pupils
• Muscle tension or cramps
• Tight, clenched jaw/grinding teeth
• Collapsing

Someone who has recently come off an MDMA high may exhibit behavioral signs that can include:

• Dramatic mood swings
• Depression
• Unusual drowsiness or lethargy
• Lack of interest
• Changes in sleep patterns
• Memory deficits

How Addictive Is MDMA?

Whether ecstasy is addictive is a controversial issue, but most published data does not support that MDMA meets the criteria for dependence or addiction as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Statistical Classification of Diseases (ICD-10).

Rigorous studies into the effects of ecstasy have been hampered by strict government regulations that classify MDMA as a drug with no medicinal value and a high potential for abuse. Despite its federal classification, ecstasy was a common addition to psychotherapy in the 1970s and 1980s and was successfully used to facilitate individual, couple and group therapy sessions. By some estimates, half a million doses were distributed in clinics to people with PTSD, depression or other conditions.

In 1985, the U.S. Drug Enforcement Administration placed an emergency ban on MDMA, which forced a near-complete halt on researching MDMA use as a therapeutic agent. However, in 2017, the Food and Drug Administration granted MDMA “Breakthrough Therapy Designation” after strictly regulated research demonstrated that MDMA offers a clinically relevant substantial improvement over existing therapies for people with post-traumatic stress disorder (PTSD). Additional research supports the possible use of MDMA for PTSD in the future.

Getting Help for MDMA Addiction in Ohio

If you or someone you love struggles with MDMA, The Recovery Village Columbus can help. The first step towards recovery is to undergo an evaluation with one of our high-quality addiction specialists who is familiar with MDMA abuse and treatment and can recommend an appropriate rehab program. We have several rehab programs and levels of care, including:

• Medical detox program: Under the care of doctors and nurses, our medical detox program can wean you off ecstasy and cleanse your system of the drug in an inpatient environment. 
• Residential rehab programs: For some people, rehab may start with our residential program that offers a safe environment where they can achieve early success in recovery without the challenges of avoiding triggers and resisting relapse.
• Outpatient programs: Our outpatient programs provide regular therapy for people who maintain home and work lives. Outpatient can be very beneficial for people who have solid support systems and are fully committed to recovery.

If you or a loved one is struggling with MDMA use, The Recovery Village Columbus can help. Call us today to speak with a representative about how professional addiction treatment can get you on the path to recovery.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more