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.

NOTE: 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 more than once or twice or at all if you have an addictive personality.

Introduction

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

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

The drug was originally developed by the German pharmaceutical company Merck in 1912 (R).

Initially, MDMA was meant to be used for psychotherapeutic reasons (R). 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 (R).

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

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 (R).

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

How MDMA Works

When administered orally, MDMA absorbs rapidly into the bloodstream and reaches the brain to initiate its actions (R).

Once in the brain, MDMA increases the activity of the neurochemicals SerotoninDopamine, and Norepinephrine (R).

The large and rapid release of these chemicals (known as neurotransmitters) in the brain causes psychoactive changes in the body, including emotional excitation, positive mood, increased social behaviors, and self-confidence (R).

Effects start within 30-45 min following oral consumption and peak in 70-120 minutes, which can last for 3-3.4 hours (R).

Effects of MDMA

The desired short-term psychoactive effects of MDMA have been reported to include (R):

  • 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 setting.

For example, MDMA used at parties are associated with high physical activity, reduced sense of self-identity as well as poor awareness of the background surroundings.

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

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

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 Health Benefits of MDMA

1) MDMA Promotes Prosocial Behaviors

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The use of MDMA is linked to increased pro-social behaviors (R).

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

Exposure to MDMA enhances the level of a chemical known as Oxytocin, which plays a key role in social behaviors (R).

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

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 (R).

2) MDMA as a Promising Treatment Option for Posttraumatic Stress  Disorder (PTSD)

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Recently, MDMA has been shown as a novel approach for the treatment of PTSD (R).

In two clinical trials, the intake of MDMA markedly improved symptoms associated with PTSD (RR).

Research on an animal model of PTSD has shown that MDMA exposure may improve some of the brain abnormalities linked to PTSD (R).

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

3) MDMA as a Possible Treatment Approach for Neurodegenerative Diseases

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The use of MDMA been proposed as a new strategy for treating Neurodegenerative diseases such as Schizophrenia (Rand Parkinson’s disease (R).

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 (R).

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

4) MDMA is an Anti-Inflammatory

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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 (R, R2).

MDMA suppresses neutrophil activity and increases production of the anti-inflammatory cytokine IL-10 (R).

MDMA also suppresses circulating lymphocyte numbers, and skews the immune system in a Th2 direction (R).

IgG2a levels were decreased following MDMA administration, possibly by reducing production of the Th1 cytokine, IFNy (R).

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 (R).

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) (R).

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 (R).

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 (R).

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 (R).

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 (R).

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 (R).

Many of the physiological changes elicited by MDMA closely resemble those induced by acute stress (R).

Negative Effects of MDMA

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 (R), brain (R), liver (R), and kidneys (R). These abnormalities may potentially lead to death.

How MDMA Causes its Toxic Effects

Laboratory research on animals has elucidated the adverse effects of MDMA at the cellular level (R).

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 (R).

MDMA also leads its toxic effects by producing increased level of Oxidative stress in the cell (R).

The increased level of oxidative stress can cause severe damage to all components of the cell including proteins, lipids and nucleic acids (R).

MDMA 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 (R).

1) MDMA Can Cause Anxiety and Depression

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Exposure to MDMA can cause mood disorders (R).

Research on mice and humans have shown that MDMA users are significantly prone to develop anxiety (Rand depression (R).

2) MDMA 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 (R).

Since MDMA increases vasopressin (R), it will cause a electrolyte abnormalities – particularly low sodium.  The 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 hyponatraemia (low sodium) (R).

3) MDMA Increases Heart Rate and Blood Pressure

Intake of MDMA is also associated with increased heart rate and blood pressure (R).

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

4) MDMA Harms Sexual Performance

The use of MDMA may cause adverse effects on sexual performance (R).

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 (R).

5) MDMA 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 (R).

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 (R).

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) (R).

Hyponatremia under severe condition may lead to drowsiness, seizures, coma, and death (R).

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 (R).

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) (R).

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’s 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 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 (R).

The study ranked MDMA 18th in harmfulness out of 20 recreational drugs. Rankings for each drug were based on the risk for 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 (R).

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
System Minor or moderate overdose Severe overdose
Cardiovascular
  • Disseminated intravascular coagulation
  • Intracranial hemorrhage
  • Severe hypertension or hypotension
Central nervous
system
  • Abnormally fast reflexes[64]
  • Agitation[11][63]
  • Mental confusion[11]
  • Paranoia[11][63]
  • Stimulant psychosis[5]
  • Cognitive and memory impairment[11] potentially to the point of retrograde oranterograde amnesia[65]
  • Coma[5][63]
  • Convulsions[11][63]
  • Hallucinations[11][63]
  • Loss of consciousness[5]
  • Serotonin syndrome[5][11][37]
Musculoskeletal
  • Muscle rigidity[11]
  • Rhabdomyolysis (i.e., rapid muscle breakdown)[11][37]
Respiratory
  • Acute respiratory distress syndrome[11]
Urinary
  • Renal failure[11]
Other
  • Cerebral edema[5]
  • Hepatitis=
  • Hyperpyrexia (a life-threatening elevation of body temperature)[11][37]
  • Hyponatremia (Syndrome of inappropriate antidiuretic hormone)[11][36][37]

MDMA Mechanisms of Action

MDMA acts as a releasing agent of serotonin, norepinephrine, and dopamine, which arises from its activity as a TAAR1 agonist and VMAT2 inhibitor.  The serotonin effects are much more significant than for the other neurotransmitters.

VMAT2 was nicknamed The God Gene because a variation in the VMAT2 gene supposedly plays a role in one’s openness to spiritual experiences, but this association has not been confirmed in scientific studies [R].

The VMAT2 gene will have an important impact on how you respond to MDMA.

Inhibition of VMAT2 by MDMA results in increased concentrations of the associated neurotransmitter (serotonin, norepinephrine, or dopamine) in the neuron.

Activation of TAAR1 by MDMA increases monoamine transporters – DAT, NET, or SERT – of the neuron.

MDMA and its byproducts have some agonist activity at postsynaptic serotonin receptors 5-HT1 and 5-HT2 receptors (R).

Genes That Affect The Response to MDMA

These break down MDMA into the more toxic MDA, so you want to inhibit them:

If these enzymes are working well, it can be more problematic.

These focus on receptors and transporters affected by MDMA:

SelfDecode has a variety of SNPs that determines how you will respond to a drug like MDMA.

FDA Compliance

The information on this website has not been evaluated by the Food & Drug Administration or any other medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is shared for educational purposes only. You must consult your doctor before acting on any content on this website, especially if you are pregnant, nursing, taking medication, or have a medical condition.

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7 COMMENTS

  • LIZEL

    I only have posite things to say about this “drug”. I have been through severe traumas throughout my life including being raped, my house burning down with my wailing pets inside, a high-jacking at gunpoint, a boyfriend commiting suicide and a pshyciatric condition of crying the entire day since I was a little girl. I’ve been on various anti-depressants, clinics, herbal and whatnots which all had different effects but never cured all the symptoms. My chronic meds costs a huge amount every month. Since I have used a little amount of MDMA every few days I am a changed person. I can finally get out of bed, smile at people, do my job effieciently, have a normal relationship with someone and generally have a reason to live. My mind is sharper, I have no more outburst, as I have bipolar depression, I make the people around me happy. I am very clued up with my body and do not feel it ‘starting to actally work’ a certain time after I have taken it. I do not feel depressed a day or two afterwards and have absolutely no side-effects to report. There is no down afterwards, I am not dependant on it or addicted and I have a new appreciation for everything around me. I hate that it is illegal because it changed my life .around

  • John Stalks

    Like everything else…be moderate in your usage. If you use it like a party drug, you will feel like you do after you party…hungover and like shit. I always take it alone. I do not take it often (2-3 times a year). I have never felt “bad” the next day. Ever. I get up and work out and continue my normal life. Drugs like shrooms, LCD, and MD ought to be treated with the utmost respect. Their are amazing “party” contexts in which to use these drugs, but respect their power. I cannot tell you how many people overdid it when they were 17-21 and cannot take these drugs 20 years later. These drugs get BETTER with age. The older you are, the more positive the experiences, because your life is generally richer anyway. No one should do any psychedelic drug until they have achieved a degree of self actualization, and they should be done rarely. There is nothing worse than someone who has abused the drug and cannot enjoy the benefits later in life. Just be smart and informed, and do it right.

  • Carenician

    Molly Long Term Effects
    Craving
    Feeling of paranoid
    Hallucination
    Agitation
    Violent
    High blood pressure
    Increased respiratory rate
    Palpitations
    Headache

  • Brett

    Yeah, I second the experience of MDMA having severe serotonin depleting effects. Some people can tolerate it, but others seem to be neurochemically imbalanced in a terrible, debilitating way. I have observed some people suffering months of severe clinical depression following a single dose of pure product. Therefore, I do not recommend this particular drug – it has a well-known dark side.

  • James

    As a once-heavy MDMA user, I just thought I’d throw in a few thoughts.

    A common side effect reported by almost all heavy MDMA users is the “midweek blues”, a feeling of moderate to severe depression for a few days following MDMA use, caused by depleted levels of serotonin in the brain. Serotonin take several days to weeks to restore following depletion.

    I took a medium dose of MDMA with my girlfriend once. The next evening, she was watching Shark Tank and just burst in to tears for no apparent reason – completely out of character for her.

    I mention this because I’ve been able to consume extreme quantities of MDMA for up to 24-hour long binges. We’re talking 1 – 2 grams worth over an entire day. (Terrible, I know – I completely regret it and would never do it again knowing what I know now).

    After those binges, I felt nothing but a bit tired the next day. No after-effects whatsoever in the following days. This seems to go completely against the crowd. I’ve never heard about anyone doing anything like that without days of comedown afterwards. Friends of mine could barely function at all following these binges, despite us all taking similar amounts and having similar tolerances.

    I started researching the genetics responsible for MDMA metabolism. There’s some very interesting research available on Reddit which explains it far better than I could: https://www.reddit.com/r/DrugNerds/comments/13lp0b/mdma_neurotoxicity_part_1_metabolites/

    It seems there are a few enzymes, CYP2D6, CYP450, and CYP3A4, primarily responsible for the metabolism of MDMA. Specifically, CYP3A4 metabolises MDMA in to MDA, which is more neurotoxic than MDMA alone (and also produces more hallucinogenic, psychedelic effects).

    All this leads me on to the fact that grapefruit juice is a CYP3A4 inhibitor. This means, consuming a healthy amount of grapefruit juice prior to and during an MDMA session, prevents more of the MDMA metabolising in to MDA, thus leading to lower neurotoxicity risks.

    A final point, if you want to take MDMA responsibility (a bit rich coming from me, I know), there is an excellent guide available at lists a wide variety of supplements (including grapefruit juice) to help reduce neurotoxicity.

    Sorry for the ramble but just wanted to share these thoughts!

    1. Joseph M. Cohen

      Thanks!

    2. oh oh oh

      Thanks

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