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MDMA/Ecstasy Withdrawal

MDMA (ecstasy, Molly) is what’s known as a substituted amphetamine and is a drug with both stimulant and hallucinogenic properties. When taken, it may induce a sense of euphoria, an altered sense of time, heightened sensory experiences, and increased energy.1,2 MDMA has developed a reputation as a “club drug” because it is commonly used by people to enhance their experiences at nightclubs, parties, or raves. While MDMA causes a temporary state of pleasure, it is often followed by a “crash” that can involve feelings of depression and fatigue. Users may also experience withdrawal symptoms if they are without the drug for a period of time.

MDMA Abuse

In 2016, approximately 1.39 million Americans ages 12 and over had used ecstasy within the past year, and over 14.5 million reported using it at least once in their lifetimes.3 Though prohibited in the United States, MDMA is illegally sold either in its pure form or as “ecstasy” or “Molly”:1,2

  • Ecstasy is most commonly encountered in tablet or capsule form. In addition to MDMA, the contents of these pills often contain other adulterant drugs like methamphetamine, ketamine, and even heroin.
  • Molly is a powdery form of MDMA that can be snorted or used to fill capsules. Molly has achieved a reputation of being pure MDMA, but testing has found that it often contains various other drugs, such as synthetic cathinones or bath salts, and sometimes no MDMA at all.1

Because users may not know exactly what they are ingesting, taking MDMA, ecstasy, or Molly can be risky. Between 2005 and 2011, the number of ecstasy-related emergency room visits increased 128% among Americans under 21 years old.4

Despite these dangers, MDMA can be a hard drug to quit. MDMA use can lead to neurochemical changes in the brain that may be associated with feelings of depression when the drug is not taken.1,2 Users trying to abstain from the drug may be compelled to use it again to alleviate these feelings, if only temporarily.

MDMA Dependence and Addiction

person passing mdma pillLike many other drugs, MDMA use may result in the development of tolerance. Tolerance develops as a person’s body becomes reliant on a drug, causing them to feel less of an effect when taking the same dose. This may lead them to use more of the drug in hopes of feeling the same high that they experienced when first taking the drug. Tolerance can develop quickly among MDMA users.7

Dependence is another problem that develops among many regular drug users. It involves the body essentially becoming used to a drug and eventually coming to rely on it.6 Dependence is tied to withdrawal. When your body is accustomed to having a drug, it reacts badly to the removal or reduction of that drug. This might show up in the form of psychological distress such as anxiety or depression or physical symptoms like insomnia. However, there is some debate over whether MDMA-only users will become physiologically dependent. What is known, however, is that over time, MDMA/ecstasy users may suffer some brain changes that result in depression and other psychological impairments and that some users do report these and other symptoms as withdrawal.1,2

Research studies on humans and animals have found that MDMA affects a number of neurotransmitter systems, including the serotonin and dopamine systems in the brain, which are both involved in addiction.1 People who consistently abuse MDMA may develop a problem with compulsive use and eventually show symptoms of a substance use disorder, commonly called addiction. These include:6

  • Taking more MDMA than intended.
  • Unsuccessfully attempting to cut back.
  • Spending a long time obtaining, using, or recovering from a drug.
  • Cravings for the drug.
  • Consistently neglecting responsibilities at home, work, or school because of drug use.
  • Continuously using a drug despite relationship problems caused or worsened by drug use.
  • Giving up or cutting back on social, work-related, and recreational activities that were once important.
  • Using MDMA in dangerous situations.
  • Using MDMA despite physical or psychological problems caused by drug use.

MDMA’s pleasurable euphoric high contributes to the compulsive use seen in addiction. However, this high can be short-lived and may be followed by a period of discomfort, fatigue, and depression. This is referred to as the “MDMA crash.”7

The High and the “Crash"

Ecstasy users may initially experience an intense and pleasurable high that can include:1,8

  • An increased sense of well-being and calm.
  • Increased confidence.
  • Enhanced feelings of empathy and connection with others.
  • Reduced anxiety.
  • Increased energy.
  • Greater desire for physical contact with others.
  • Increased sensitivity to touch.
  • Amplified reactions to lights, colors, and images.

MDMA/ecstasy users often refer to this initial rush as “rolling.”8 The drug’s pleasurable effects typically wear off within 6 hours and are then followed by a “crash,” which can feel similar to a severe hangover, make people feel sad and/or slowed down, and prompt some to use the term “E-tarded”.8 Recreational weekend users refer to this as the “terrible Tuesdays” or sometimes “Suicide Tuesday.”7,8 During this time, a person may experience:1,8

  • Muscle aches and pains.
  • Jaw pain.
  • Headaches.
  • Fatigue.
  • Insomnia.
  • Irritability.
  • Anxiety.
  • Anger.
  • Depression.
  • Paranoia.
  • Appetite loss.
  • Poor coordination.
  • Poor short-term memory.
  • Poor attention and concentration.

The MDMA crash can last for several days or weeks.8 In an effort to alleviate some of these symptoms, people may use marijuana or other drugs during this time. Despite the discomfort of the crash, people who have struggled with compulsive MDMA use may again return to the drug, repeating the pattern.

Withdrawal

The names ecstasy and Molly may make MDMA sound fun, but alongside the dangers it can cause during intoxication, such as hyperthermia and dehydration, people quitting can experience some less than desirable effects, as well. Habitual users will often report withdrawal symptoms that include those described above (fatigue, appetite loss, and problems with thinking, memory, and concentration).2,9

Probably the most notable and troublesome side effect of what MDMA users describe as the withdrawal is depression. This is likely related to the depletion of serotonin from regular use.

Serotonin’s Role

MDMA’s pleasurable high comes from its effects on 3 neurotransmitters in the brain: serotonin, dopamine, and norepinephrine.1,2  The drug increases the activity of these neurotransmitters in the brain by either releasing greater amounts of the chemicals or preventing their reuptake, or reabsorption, back into the neurons in the brain.

Serotonin is responsible for regulating mood, aggression, sex, sleep, and pain.1,2 MDMA causes certain brain cells to release large amounts of serotonin, contributing to the drug’s feel-good effects. Serotonin also triggers the release of oxytocin and vasopressin, which are believed to enhance feelings of emotional connection and empathy toward others. After the drug has worn off, however, the brain is relatively depleted of serotonin, which can cause withdrawal symptoms like lethargy, confusion, depression, anxiety, paranoia, cravings, and sleeping difficulties.1,2,7,11

This could be especially troubling for MDMA users who may use the drug to cope with depression, as the serotonin depletion caused by MDMA use could worsen the problem.7

Serotonin levels may take weeks to months to return to normal in chronic users.7

Involvement of Other Drugs

Abusing multiple drugs can cause a more uncomfortable and complicated withdrawal, since the body will be detoxing from several substances at the same time.

Many MDMA users may abuse multiple drugs, such as alcohol, heroin, and cocaine, at the same time that they use MDMA. These drugs can cause their own withdrawal symptoms that can coincide with and complicate MDMA withdrawal. Withdrawal from alcohol and prescription benzodiazepines and barbiturates is especially dangerous because of the risk for seizures and death.5

Users may also unknowingly buy counterfeit ecstasy or MDMA that is tainted with drugs like synthetic cathinones, or bath salts.12 These are man-made stimulants that can cause increased libido, hallucinations, anxiety, and paranoia.10 Bath salts are considered to be highly addictive and, when abruptly stopped, can result in withdrawal symptoms like depression, anxiety, shaking, insomnia, and paranoia.

Abusing multiple drugs can cause a more uncomfortable and complicated withdrawal, since the body will be detoxing from several substances at the same time.

Approximate Timeline

The effects of MDMA usually set in within 30 to 60 minutes of ingestion and peak around 90 minutes.2,7,8 During this time, users may experience pleasurable effects like euphoria, as well as the negative side effects such as anxiety, increased body temperature, and teeth grinding.1 These effects can last anywhere from 2 to 8 hours.

MDMA’s pleasurable high is often followed by a crash, or comedown, and, for some people, withdrawal. MDMA withdrawal symptoms can persist for several days or weeks.8

Long-Term Effects and Dangers

Withdrawal can be uncomfortable, but there are numerous reasons to quit using ecstasy, Molly, or MDMA. Over time, repeated use of these drugs can lead to long-term health problems, including:1,7

  • Sleep issues.
  • Heart disease.
  • Heart failure.
  • Liver damage.
  • Liver failure.

MDMA users with a history of physical health problems, such as cardiac and pulmonary disease and Wolff-Parkinson-White syndrome, are at higher risk of developing heart failure and arrhythmias.7 Combining MDMA with other drugs, such as caffeine, amphetamines, and alcohol, may also increase the risk of developing some of the long-term health problems linked to MDMA.1

Long-term MDMA abuse can also lead to psychological issues, such as:1,5

  • Paranoid thoughts.
  • Obsessive thoughts.
  • Depression.
  • Anxiety.
  • Attention and concentration problems.
  • Memory problems.
  • Psychosis.

It is never too late to quit, and stopping now can help reverse current health problems or prevent future ones.

Safe Withdrawal from Ecstasy

Because of the risk of developing significant mental health issues such as depression,2 people going through MDMA withdrawal can benefit from the support and safety of a detox program. This is especially true for people with preexisting mental health conditions, who may be at higher risk for depression during withdrawal. In some cases, untreated depression can lead to self-harm as well as suicidal thoughts and attempts. Detox facilities can help monitor and treat the symptoms of depression through the use of medications, therapy, and support.

Female patient talking to doctor, talking about detox conceptDetoxing from MDMA and other drugs can be done safely in a structured treatment environment. Detox programs specialize in treating drug withdrawal and are often the first step in getting help for an addiction problem. Types of detox programs include:5

  • Social detox, a type of non-medical program that provides support to people going through withdrawal. These programs offer therapy sessions, support groups, and encourage rest and healthy eating to recover from the effects of drugs and alcohol. They do not provide medical treatment for withdrawal but may refer a person to a hospital or doctor’s office if medical assistance is needed.
  • Medical detox, which provides medical treatment to help alleviate withdrawal symptoms. Doctors and other addiction professionals may prescribe medications to reduce discomfort and minimize the risk of complications during withdrawal. Some medical detox programs also offer therapy sessions and other forms of support.

Detox programs may be located in hospitals or treatment facilities. Hospitals typically offer brief treatment stays that may range from 5 to 10 days. Treatment facilities may offer detox only or follow it with additional treatment. Continuing treatment allows people to continue working on their addiction and recovery after withdrawal is over, which can help decrease the likelihood of a future relapse.

Some users mix MDMA with alcohol and other drugs, such as cocaine, heroin, and prescription medications like benzodiazepines. Withdrawing from multiple drugs at once can be especially dangerous, since different drugs can carry different risks during withdrawal.5 Detoxing from alcohol and benzodiazepines can cause serious symptoms like hallucinations, delirium, seizures, and even death. Withdrawing from these drugs in a medical detox environment is highly recommended because of the risk for dangerous complications.

Professional detox treatment can help you safely quit using MDMA and start building a life without drugs. If you or someone you know needs help quitting, consider reaching out today.

References:

  1. National Institute on Drug Abuse. (2017). MDMA (ecstasy) abuse.
  2. National Institute on Drug Abuse for Teens. (2017). MDMD (ecstasy or molly).
  3. Substance Abuse and Mental Health Services Administration. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed tables.
  4. Substance Abuse and Mental Health Services Administration. (2013). The DAWN Report: Ecstasy-related emergency department visits by young people increased between 2005 and 2011; Alcohol involvement remains a concern.
  5. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  7. Hahn, I. (2017). MDMA toxicity.
  8. Substance Abuse and Mental Health Services Administration. (2002). Ecstasy: What’s all the rave about?
  9. Nawata, Y., Hiranita, T., & Yamamoto, T. (2010). A cannabinoid CB 1 receptor antagonist ameliorates impairment of recognition memory on withdrawal from MDMA (Ecstasy)Neuropsychopharmacology35(2), 515-520.
  10. National Institute on Drug Abuse. (2018). DrugFacts: Synthetic cathinones (“bath salts”).
  11. American Academy of Neurology. (2000). Ecstasy use depletes brain’s serotonin levels.
  12. National Institute on Drug Abuse. (2018). Synthetic Cathinones (“Bath Salts”).
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