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MDMA (Ecstasy)

3,4-methylenedioxy-N-methylamphetamine (MDMA), also known as Ecstasy or XTC, has amphetamine and hallucinogen-like properties, but is listed here in its own category due to its various unique properties. Its most characteristic effects are feelings of intimacy and empathy towards others and intensification of sensory experiences. Its use has been most commonly associated with rave culture.

How MDMA works

MDMA is most commonly ingested in pill form, though sometimes it is found in powdered form. Its effects start to be felt within 30-60 minutes and usually last for 4-6 hours. It can be detected in the urine up to 5 days after use.

Like amphetamines, MDMA seems to work by increasing the release of dopamine, norepinephrine and serotonin in the brain, though its effects on serotonin predominate and are thought to be responsible for many of the effects it produces. MDMA also stimulates the release or various brain hormones, including oxytocin, prolactin, ACTH, DHEA, and vasopressin. It is the increased action of oxytocin that is thought to cause the characteristic feelings of intimacy and empathy towards others.

MDMA Intoxication

MDMA produces feelings of euphoria, of openness, empathy and intimacy with others, inner peacefulness, decreased hostility and insecurity, heightened sensory perceptions, and increased energy. Loss of appetite and short-term memory lapses can also occur.

Physical symptoms include increased blood pressure, heart rate and body temperature, lockjaw, and involuntary teeth grinding. Serious medical complications include hyperthermia, hyponatremia (from increased vasopressin action), and, in rare cases, serotonin syndrome, all of which are more likely with higher doses and could be life-threatening. Over all, death from MDMA is rare.

When MDMA is taken in combination with marijuana, increases in heart rate and body temperature can become very pronounced and reach dangerous levels [ref].

Effects of long-term repeated MDMA use

Repeated use of MDMA has been linked with increased rates of depressive symptoms and a deterioration in cognitive abilities such as attention and verbal learning [ref], and these problems tend to endure long after MDMA use is stopped [ref]. It is thought that these effects are due to disruptions of the serotonin system in the brain.

MDMA Withdrawal

No withdrawal syndrome has been described following long-term MDMA use, but even after a single dose it is common for individuals to experience restlessness, malaise and dysphoria, which can last up to a few days.

Treating MDMA Abuse or Dependence

Treating MDMA use disorders follows the general treatment principles as outlined here. There are no medications that have been shown to be effective for this purpose


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