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Ecstasy (MDMA, or 3,4-methylenedioxymethamphetamine) is an amphetamine analogue with both stimulant and hallucinogenic effects. Ecstasy is most commonly taken tablet or capsule form; however, some people will snort a powder or swallow the drug in a liquid form.1
In addition to ecstasy, other historically used street names for MDMA include:2
While in the past ecstasy was associated primarily with the rave or club scene, the use of MDMA has become more widespread in recent years.3 Among teens surveyed in 2018, more than 4% of 12th graders in the U.S. reported using ecstasy at some point in their lives. Even some very young teens are experimenting with the drug. More than 1.5% of 8th graders reported ever having used the drug.4
Despite evidence to the contrary, the myth that ecstasy is a “safe” drug continues.5
Ecstasy increases the activity of three neurotransmitters: serotonin, dopamine, and norepinephrine.1
While serotonin is released in abundance during ecstasy use, after use the brain becomes temporarily depleted of this neurotransmitter. This relative dip in serotonin activity could contribute to the feelings of anxiety, fatigue, and depression often associated with an ecstasy comedown.7 Chronically decreased active serotonin levels may contribute to the following symptoms often seen in regular ecstasy users:6
Like many drugs, many of MDMA’s effects are dose-dependent, which is to say that the amount of MDMA taken can have a significant impact on how the drug affects the body. Though substance purity and total dose are likely to vary wildly, previous estimates have been made that place many tablets at between 50 mg and 150 mg; however, short of analyzing the contents in a lab, the dose contained in such an illicit product is anyone’s guess. 6 An unexpectedly high dose can cause significant adverse effects. Adding to the danger, people using the drug often take a follow-up dose to prolong the comedown, further risking their health. 6
Many ecstasy tablets, especially those sold online on the “dark net” are more potent than ever before, as well. According to one European study, while tablets in the 90s and early 2000s average about 50-80 mg, the average dose of an ecstasy tablet on the current market is now 125 mg. Some “super pills” have been marketed, with doses ranging between 270 and 340 mg.8
Side effects that may occur from MDMA use, which may be more intense and likely to occur with higher doses, include: 6
Many mistakenly view ecstasy as a benign recreational drug or a nonaddictive, feel-good substance. However, there have been several reports of MDMA-related deaths.
One particular danger to ecstasy users is hyponatremia, an abnormally low level of sodium in the blood.9 Because people often dance for long periods in warm conditions like a club or party while using ecstasy, dehydration is common. Ecstasy users tend to combat dehydration by drinking a lot of water. Though there are several potential underlying physiological mechanisms at play, excessive water consumption coupled with drug-induced alterations in free water excretion by the kidneys results in a dilutional effect on serum sodium levels; in severe cases, the subsequent shifts of water from the serum compartment to intracellular spaces can result in brain swelling, mental status changes, seizure, coma, and death.10
Milder symptoms of hyponatremia may include:9
Adding to the dangers of altered fluid balance and hyponatremia is the risk of severe increases in body temperature (hyperthermia). Animal studies suggest that ecstasy may impair thermoregulation, or the body’s ability to regulate its temperature. MDMA use is commonly associated with increased physical activity for extended durations in particularly hot environments such as a packed dance club—a perfect formula for a dangerous spike in body temperature. 6 Untreated hyperthermia may lead to a life-threatening condition called rhabdomyolysis, wherein muscles begin to break down and spill their protein contents into the bloodstream.6 Hyperthermia may also further contribute to electrolyte imbalances and fluid shifts, which can lead to kidney failure or swelling of the brain.6
People who take selective serotonin reuptake inhibitors (SSRIs)—for example Prozac—and use ecstasy, may be at increased risk of a serious condition called serotonin syndrome.11 Serotonin syndrome symptoms include:12
When treated quickly, the prognosis is good. However, untreated serotonin syndrome may progress in severity and could potentially lead to marked agitation, hyperthermia, muscle breakdown, renal damage, and death.12
Illicit samples of ecstasy commonly contain other adulterant drugs and may even be completely devoid of MDMA. Other drugs that have been found in products sold as MDMA include:2
The truth is that no one buying ecstasy will know with certainty what drug or drugs they are consuming, so anyone seeking the desirable effects of MDMA is truly putting their health—sometimes their life—at risk.
A person using ecstasy may think that their use will never be problematic because they view the substance as safe to use in moderation. Though typical patterns of use differ somewhat from more conventionally addictive substances such as cocaine and heroin, there is evidence of addiction-related phenomenon in association with ecstasy use, including tolerance, withdrawal, and drug cravings. 6
There are warning signs to look for in someone who uses ecstasy. Such signs may be somewhat indicative of a tipping point when occasional recreational use has escalated to a more problematic, compulsive pattern of drug taking. Problematic ecstasy use may include some of the following signs or changes in behavior:13
Some individuals who use this drug may exhibit outward symptoms of psychiatric problems, such as paranoia and extreme anxiety that causes panic attacks.6
Professional treatment for problematic ecstasy use or an MDMA use disorder may take place in various settings. Such a treatment regimen will consist entirely of therapy and behavioral interventions since there are no approved medications to treat MDMA dependence.1 Someone abusing ecstasy on occasion without any other significant mental/physical health issues or risks for treatment complications may fare well in an outpatient rehabilitation program.
Someone frequently using ecstasy in combination with other drugs or someone who suffers from co-occurring mental health issues may need a higher level of care. By agreeing to a period of inpatient or residential treatment, the individual can separate themselves from stressors and other triggers to use in their home environment to better focus on recovery and planning ways to avoid relapse.14 Such relatively intensive levels of treatment may continue for just a few weeks or up to a year.
Individual distinctions and situational needs—including a person’s symptoms, stressors, and available support—should always dictate the type of treatment received.14 Engaging in treatment methods that aren’t a good fit for the person’s current needs may not create the needed change.
In some cases, people who complete some duration of treatment in an inpatient or residential setting will step down to outpatient care to continue receiving therapy involving mental health symptoms, self-care, education, vocational needs, and communication issues.14 Those in recovery from ecstasy or other drug use often attend support groups/meetings during (and after) their professional treatments as a way to complement their treatment efforts as well as to build and maintain a network of healthy, recovery-focused peers.
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