The MDMA effect
For Family Guy enthusiasts, there is an episode in which Peter takes ecstasy. He is overtaken with how soft and amazing everything is, especially Brian’s ears. Although hilarious, it is familiar and not too exaggerated.
In my early 20’s, I had a friend over who had taken ecstasy. She too, was overcome with how soft everything was. She laid on my living room floor and proclaimed I had the “best carpet ever.” I can assure you I had no such thing; I had gross, cheap apartment carpet.
Being sober and observing this otherwise reasonable person proclaim her love for everything from my carpet to her own socks was amusing. Her irritable and depressed mood the following day was decidedly less so.
Ecstasy is in its own class of drugs, both in chemical structure and in its potential applications. Couples counseling, treatment of PTSD, dance parties—what is it about this drug that makes it so appealing and are there risks associated with it?
What is ecstasy?
Ecstasy or MDMA (a grateful shortening of methylenedioxymethamphetamine) is considered an entactogen (meaning touch within), a class of psychoactive drug that produces feelings of emotional openness. Although not strictly a stimulant or hallucinogen, it has properties of both. (I know terminology can be confusing. Note, I will use MDMA and ecstasy interchangeably through the post).
MDMA typically comes in pill or powder form and can be swallowed, snorted, or mixed with water and drank.
What happens when you take MDMA?
Users will usually feel the effects within about 20-30 minutes and will typically last about 3-6 hours. When we take ecstasy, it increases levels of serotonin, the neurotransmitter responsible for feelings of wellbeing. Feelings of euphoria are often described, as well a sense of openness and decreases in fear or aggressiveness.
Since it has stimulant properties, it also provides an increase in energy and a sense of excitement. Ecstasy often increases sexual interest, but the high levels of serotonin often diminish sex drive. Although it may distort time perception, it does not typically cause hallucinations.
People are often disinhibited after taking MDMA and may become more social, more willing to dance, etc. Although most users find the effects pleasant, some people do report anxiety, panic attacks, or confusion after taking it.
Since ecstasy is illegal, there is no oversight, thus no guarantee of what the user is ingesting. Molly, which was rumored to be 100% pure MDMA in powder form has shown the same purity issues as traditional ecstasy. Some test samples have shown as few as 40% of samples to contain only ecstasy. MDMA is frequently cut with other substances, which may include “bath salts”, other stimulants, ketamine, etc. Thus, the risk of toxic reactions due to other additives remains a real concern.
However, even pure MDMA is not without risks, especially as the dose increases. Ecstasy raises body temperature and since it is often taken, in hot, crowded clubs this can have a synergistic effect. Raised body temperature can lead to problems such as dehydration and kidney failure. Higher doses (or those with bad contaminants) may also cause jitteriness, teeth clenching, paranoia, weakness, and confusion.
Users have indeed died from hyperthermia (heat stroke), and to combat this, users began to drink excessive amounts of water. This led to a new problem, hyponatremia. This is caused by consuming too much water in a short term, depleting the body of necessary sodium, which can lead to headache and seizures and in extreme cases death.
Hyponatremia occurs with athletes as well. A study from the 2002 Boston Marathon showed that 22% of women were hyponatremic by the end of the race. Although this can happen with anyone, women are more sensitive to the hyponatremia brought on by MDMA use.
MDMA, the day after
What goes up, must come down. It is true in physics and it is true for drug use. All those euphoric feelings were caused by excessive amounts of serotonin being dumped into the synapses. This serves to exhaust serotonin neurotransmitters, making the user feel depressed the following day and, in some cases, longer. This does not occur with everyone, but it is common. Taking more will not really help. At this point, the brain has downregulated its serotonin receptors. On average, it will take 10-14 days to regenerate the brain’s supply of serotonin.
MDMA and harm reduction
Nothing can make ecstasy 100% safe. Period. However, below are some things to help minimize harm and lead to a potentially safer roll.
· Avoid taking MDMA if you take MAOIs. This can further increase the supply of serotonin and lead to serotonin syndrome, which is potentially fatal.
· If you already struggle with depression, ecstasy can exacerbate the symptoms.
· Avoid combining drugs that might have a synergistic effect on heart rate, blood pressure or body temperature. Alcohol can increase the dehydrating effects of ecstasy.
· Test your pills for purity. Visit DanceSafe.org for safety information and purity testing kits.
· Drink water, but not too much. Drinking something with electrolytes or eating some salty snacks can help as well.
· Hydrate before taking ecstasy.
· Take breaks from being active while on ecstasy—rest and cool down periodically.
· If you see someone showing signs of hyperthermia, confusion, nausea or they seem to be unconscious, call 911.
Therapeutic applications of ecstasy
In the 1980’s some psychotherapists thought the emotional connection that ecstasy fosters would be useful in couples counseling. However, its subsequent classification of a schedule 1 drug moved ecstasy use underground. However, in recent years, the potential for clinical applications of MDMA is increasing along with psilocybin mushrooms.
Researchers think that within the context of a supervised setting, MDMA could be useful in treating PTSD. There have been some small phase 1 FDA-approved trials. While early results have shown no presence of dangerous effects at low, clinical doses, there are some larger, long-term questions that have researchers have not yet been able to answer. Namely, could the insights and positive feelings aroused during a drug-induced state carry over once no longer under the influence? Time will tell.
Support if you need it
If you struggle with substance use and you need support, Substance Use Therapy is available. Whether you want to examine your use, reduce harm, practice moderation, or work toward abstinence, Substance Use Therapy will support your goals.
Denning, P., & Little, J. (2017). Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use. The Guilford Press.
Kuhn, C., Swartzwelder, S., & Wilson, W. (2019). Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy. W.W. Norton & Company.
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples, and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.