MDMA is a recreational drug of abuse that is broadly known as Ecstasy when diluted. It has a wide range of psychoactive effects including an intense feeling of excitement, increased energy, enhanced mood, and increased sociability. Continue reading this article to learn about the health effects of MDMA.

Disclaimer: By writing this post, we are not recommending the use of this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the clinical and scientific literature. MDMA is specifically a drug that we at SelfHacked would recommend against. MDMA converts to MDA, which is neurotoxic. This is not a drug anyone should take on a long-term basis, if at all. It has some benefits, but Selfhacked thinks the negatives outweigh the benefits if you take it out of a clinical setting or at all if you have an addictive personality or the drug is not certified as pure. No one should take any drug without consulting with their physician.

What is MDMA?

3,4-methylenedioxymethamphetamine (MDMA) is a well known synthetic drug that has psychoactive properties [1].

It is chemically similar to the amphetamine group of drugs like methamphetamine and MDA (3,4-methylenedioxy-amphetamine, a breakdown product of MDMA) [2].

The drug was originally developed by the German pharmaceutical company Merck in 1912 [3].

Initially, MDMA was meant to be used for psychotherapeutic reasons [4]. However, due to its widespread use for recreational purposes in the 1980s, the drug was banned from medical use in 1985.

Notwithstanding, the drug is sold illegally around the world. According to a United Nations report, around 18.8 million people had used MDMA in the year 2015 [5].

MDMA is mostly sold in the form of pills, which is largely combined with other substances such as caffeine, ephedrine, ketamine, and Tylenol [6].

The drug is primarily consumed by young adults in highly social situations such as festivals and dance parties. MDMA is usually taken orally as a tablet or capsule, although some people prefer to store it in powder form [7].

A pure form of MDMA is available in a crystal powder, with a number of street names including Molly, Adam, or Mandy.

Mechanism of Action

When administered orally, MDMA absorbs rapidly into the bloodstream and reaches the brain to initiate its actions. Effects start within 30-45 minutes following oral ingestion, peaks in 70-120 minutes, and can last for 3-3.4 hours [89].

Once in the brain, MDMA increases the release of the neurotransmitters serotoninnorepinephrine, and dopamine. The serotonin effects seem to be more significant than for the other neurotransmitters [10].

The large and rapid release of these neurotransmitters in the brain causes psychoactive changes in the body, including emotional excitation, positive mood, increased social behaviors, and self-confidence [11].

MDMA increases neurotransmitter levels by acting as a VMAT2 (DAT, NET, and SERT) inhibitor [12].

VMAT2’s are neurotransmitter reuptake transporters and their inhibition by MDMA results in increased concentrations of the associated neurotransmitter (serotonin, norepinephrine, or dopamine) in the neuron [12].

MDMA and its byproducts also have some activity on postsynaptic serotonin receptors 5-HT1 and 5-HT2 receptors [13].


The desired short-term psychoactive effects of MDMA have been reported to include [14]:

  • Euphoria – a sense of general well-being and happiness
  • Increased sociability and feelings of communication being easy or simple
  • Entactogenic effects – increased empathy or feelings of closeness with others
  • A sense of inner peace
  • Mild hallucination
  • Enhanced sensation, perception, or sexuality
  • Altered sense of time

Setting Dependent Effects

The experience elicited by MDMA depends on the setting.

For example, MDMA used at parties is associated with high physical activity, reduced sense of self-identity, and poor awareness of one’s background surroundings.

Use of MDMA individually or in small groups in a quiet environment and when concentrating is described with increased lucidity, the capability of concentration, the sensitivity of aesthetic aspects of the background and emotions, as well as a greater capability of communication with others [13].

In psychotherapeutic settings, MDMA effects have been described by infantile ideas, alternating phases of temper, sometimes memories and moods connected with childhood experiences [13].

My Experience With MDMA and Takeaway From Psychoactive Drugs

A while back I experimented with this drug.  I really enjoyed the experience.  It gave me most of the effects that it’s supposed to give – euphoria, emotionality, increased socialness, and an increased sense of spirituality.

Given that I knew it increases vasopressin and that I was sweating, I took salt as soon as I started getting a slight headache the next day – and it nipped it in the bud.

My cognitive performance did decline in the following days by a bit, but nothing too dramatic.

I probably would’ve taken it again if I wasn’t worried about the purity of what I was getting.  Also, I didn’t like the decreased cognitive performance and productivity for a few days after.

Probably the only takeaway that stuck with me, is a similar takeaway that I get from other psychoactive agents: that we are products of biology.

Throughout my life, I’ve noticed profound changes in my biology, and I was able to see how my personality changes when my brain chemistry is altered in hundreds of different ways.

Changes included going from sick to healthy over a period.  It included the many hundreds of supplements and herbs that I’ve taken and the many diets that I’ve tried.

My experience with LSD hammered this point home even more than anything else.

MDMA likewise has its own psychoactive wrinkles that allow you to see how much you change based on a change in neurochemistry.

The sum of these experiences left me more fatalistic, which solidified the Zen and Taoist path that I was already on.

4 Potential Benefits

1) May Promote Pro-social Behaviors

The use of MDMA is linked to increased pro-social behaviors [15].

Moderate doses (75 mg) have been shown to encourage closeness and strengthen the bond between people [16].

Exposure to MDMA enhances the level of a chemical known as oxytocin, which plays a key role in social behaviors [17].

Owing to the pro-social behaviors, many therapists considered it to be a useful approach for couple’s therapy and family therapy [18].

A placebo-controlled study in 15 human volunteers found that the amount of oxytocin increase in the blood was correlated with the subjective social effects of MDMA [17].

2) Promising Treatment Option for Posttraumatic Stress  Disorder (PTSD)

Recently, MDMA has been shown as a novel approach for the treatment of PTSD [19].

In two clinical trials, the intake of MDMA markedly improved symptoms associated with PTSD [2021].

Research on an animal model of PTSD has shown that MDMA exposure may improve some of the brain abnormalities linked to PTSD [22].

MDMA has been indicated as possibly useful in psychotherapy, facilitating self-examination with reduced fear.

3) Possible Treatment Approach for Neurodegenerative Diseases

The use of MDMA been proposed as a new strategy for treating Neurodegenerative diseases such as Schizophrenia [23and Parkinson’s disease [24].

Research on an animal model of Parkinson’s disease has suggested that MDMA exposure can improve the uncontrollable arm and leg movements, common motor symptoms in people with Parkinson’s disease [25].

Similarly, some people diagnosed with Schizophrenia had reported that they have experienced a remarkable improvement in their mental behavior after using MDMA [26].

4) May Be Anti-Inflammatory

MDMA is an anti-inflammatory and people with Th1 dominance would benefit from the immune effects of this drug.  People with a Th2 dominant immune system would do worse with this drug.

In animals, MDMA inhibits the inflammatory cytokines IL-12, IL-1b, and TNF-alpha [27, 28].

MDMA suppresses neutrophil activity and increases the production of the anti-inflammatory cytokine IL-10 [28].

MDMA also suppresses circulating lymphocyte numbers and skews the immune system in a Th2 direction [28].

IgG2a levels were decreased following MDMA administration, possibly by reducing the production of the Th1 cytokine, IFNy [28].

In a few human trials, MDMA profoundly suppressed the number of circulating CD4+ T cells and increased the number of circulating natural killer cells.  However, natural killer cell numbers in MDMA users were reduced to 33% of that seen in control subjects [28].

It was also reported that MDMA promoted a switch to a Th2-type cytokine profile, as indicated by reduced IFNy and IL-2 production, with a concomitant increase in the Th2 cytokines, IL-4, and IL-6, and the T-regulatory (TREG) cytokines, IL-10 and transforming growth factor-β1 (TGF-β1) [28].

These immunosuppressive effects of MDMA were maximal 3–6 hr following drug administration, and in some cases were evident 24 hr later. In some instances, the co-administration of alcohol further enhanced the immunosuppressive effects of MDMA [28].

In humans, repeated administration of MDMA with both a short and a long time interval between doses increases both the magnitude and duration of MDMA-induced immunosuppression [28].

The total number of lymphocytes, CD4+ T cells, and CD19+ B lymphocytes were all significantly reduced even years later in MDMA abusers compared to control subjects [28].

However, it is not possible to ascertain if the suppression of immune parameters observed in the MDMA users is a result of MDMA abuse per se. For instance, the subjects enrolled in the clinical trials were all habitual users of cannabis, with prior experience of cocaine or methamphetamine. As it is well established that cannabis, cocaine, and methamphetamine all have significant immune suppressive properties in their own right [28].

Most of these immune suppressive effects are not the result of a direct action of the drug on immune cells, but rather caused by the release of chemicals that MDMA releases [28].

Many of the physiological changes elicited by MDMA closely resemble those induced by acute stress [28].

Negative Effects

Clinical studies on human and animal reveal that exposure to MDMA alone or in combination with other drugs (e.g., cocaine, cannabis) causes damage to the heart, brain, liver, and kidneys. These abnormalities may potentially lead to death [29, 30, 31, 32].

How MDMA Causes its Toxic Effects

Laboratory research on animals has elucidated the adverse effects of MDMA at the cellular level [33].

Inside the cell, MDMA has been shown to disrupt the structural and functional integrity of mitochondria, which are the major energy-producing machines in the cell. Consequently, the energy crisis develops in the cell [34].

MDMA also leads its toxic effects by producing an increased level of oxidative stress in the cell [35].

The increased level of oxidative stress can cause severe damage to all components of the cell including proteins, lipids and nucleic acids [36].

Side Effects

Adverse effects of MDMA use include addiction, memory problems, paranoia, difficulty sleeping, teeth grinding, blurred vision, sweating, and a rapid heartbeat. Use may also lead to depression and fatigue. Deaths have been reported due to increased body temperature and dehydration [37].

1) Can Cause Anxiety and Depression

Exposure to MDMA can cause mood disorders [38].

Research on mice and humans have shown that MDMA users are significantly prone to develop anxiety [39and depression [40].

2) Has Negative Effects on the Body

The use of MDMA can cause moderate effects on the body such as muscle aches/headache, sweating, numbness, dizziness, and dry mouth. In some cases, it may also cause vomiting [41].

Since MDMA increases vasopressin [42], it will cause electrolyte abnormalities – particularly low sodium. Sweating makes the situation worse, which is why many people have issues.

Two major syndromes are most commonly reported as the immediate cause of death in fatal cases: hyperthermia and hyponatremia (low sodium) [43].

3) Increases Heart Rate and Blood Pressure

Intake of MDMA is also associated with increased heart rate and blood pressure [44].

Modest oral dose (1.5 mg/kg) of MDMA has been reported to increase heart rate, blood pressure, and oxygen consumption in the heart [45].

4) Harms Sexual Performance

The use of MDMA may cause adverse effects on sexual performance [46].

A study conducted on MDMA users (both men and women) has shown that MDMA exposure results in sexual arousal and the perception of greater satisfaction, even though orgasm were delayed erections were impaired in 40% of the men [47].

5) Negatively Effects Cognitive Function

The use of MDMA in higher doses or for a longer period of time creates negative effects on cognitive functions of the brain. A study conducted on abstinent MDMA users revealed that excessive use of MDMA causes impairment in verbal and visual memory [48].

The use of MDMA has also been reported to cause severe short-term memory impairment. In one clinical study, a 21-year-old man, who had a history of taking one or two pills a day of MDMA for 4 months, was reported to develop a sudden memory loss after intake of two pills of MDMA [49].

I knew someone who took ecstasy and couldn’t remember anything that happened the prior night.

Administration of MDMA can cause an uncontrolled secretion of the antidiuretic hormone (ADH), which is involved in a condition called hyponatremia (low-level of sodium/salt in the body) [50].

Hyponatremia under severe condition may lead to drowsiness, seizures, coma, and death [51].

Small but significant deficits for ecstasy users compared to controls were reported in areas relating to attention, memory, psychomotor speed, executive systems functioning, and self-reported depressive symptoms [43].

Ecstasy users performed worse than controls on common measures of immediate and delayed verbal recall (RAVLT, RBMT, digit span). No difference was seen in IQ (NART).

Ecstasy users performed significantly worse than controls in 13/16 cognitive domains (immediate and delayed verbal and visual memory, working memory, two measures of attention, three measures of executive function, perceptual organization, self-rated depression, memory and anxiety, and impulsivity measured objectively and subjectively) [43].

The largest, most consistent exposure effects were seen in meta-analyses of memory (especially verbal and working memory, with less marked effects seen in visual memory). Former ecstasy users frequently showed deficits that matched or exceeded those seen amongst current users.

Former ecstasy users frequently showed deficits that matched or exceeded those seen among current users.

There are many confounding variables with these studies, so it’s hard to say if MDMA causes these effects or that people who take MDMA are of a certain nature that other behaviors cause these effects (maybe staying out all night and abusing other drugs).

MDMA Harm Compared to Other Drugs

The UK Science and Technology Select Committee published a 2006 report which suggested that the current system of recreational drug classification in the UK was arbitrary and unscientific and that a more scientific measure of harm should be used for classifying drugs.

The new classification system suggested that heroin, cocaine, alcohol, benzodiazepines, methamphetamine, and tobacco have a high or a very high risk of harm or abuse potential, while cannabis, LSD, and Ecstasy were all below the two legal drugs in harm or abuse potential.

A 2007 report by The Lancet, in the UK, published a journal about researchers having introduced an alternative method for drug classification.

This new system uses a “nine category matrix of harm, with an expert Delphic procedure, to assess the harms of a range of illicit drugs in an evidence-based fashion.” The new classification system suggested that alcohol and tobacco were in the mid-range of harm, while cannabis, LSD, and MDMA were all less harmful than the two legal drugs [52].

The study ranked MDMA 18th in harmfulness out of 20 recreational drugs. Rankings for each drug were based on the risk of acute physical harm, the propensity for physical and psychological dependency on the drug, and the negative familial and societal impacts of the drug. The authors did not evaluate or rate the negative impact of ‘ecstasy’ on the cognitive health of ecstasy users, e.g., impaired memory and concentration [52].

What to Take If You Consume MDMA

5-HTP two days later to prevent serotonin crash and grapefruit juice to inhibit the enzymes that break down MDMA into MDA.

Overdose Symptoms

MDMA overdose symptoms vary widely due to the involvement of multiple organ systems. Some of the more overt overdose symptoms are listed in the table below (from Wiki).

Symptoms of overdose
SystemMinor or moderate overdoseSevere overdose
  • Disseminated intravascular coagulation
  • Intracranial hemorrhage
  • Severe hypertension or hypotension
Central nervous
  • Abnormally fast reflexes
  • Agitation
  • Mental confusion
  • Paranoia
  • Stimulant psychosis
  • Cognitive and memory impairment potentially to the point of retrograde or anterograde amnesia 
  • Coma 
  • Convulsions 
  • Hallucinations 
  • Loss of consciousness 
  • Serotonin syndrome
  • Muscle rigidity
  • Rhabdomyolysis (i.e., rapid muscle breakdown)
  • Acute respiratory distress syndrome
  • Renal failure
  • Cerebral edema
  • Hepatitis
  • Hyperpyrexia (a life-threatening elevation of body temperature)
  • Hyponatremia (Syndrome of inappropriate antidiuretic hormone)


These break down MDMA into the more toxic MDA:

These focus on receptors and transporters affected by MDMA:

Want Better Ways to Improve Your Mood?

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