MDMA, Depression, and Anxiety: Does it Harm or Help?

Curated by Claudia Shannon / Research Scientist / ishonest

You’ve likely heard of MDMA, but you may know it better as ecstasy or molly.

A popular “club drug” in the 1980s and ’90s, more than 18 million people said they had tried MDMA at least once when asked in a 2017 National Institute on Drug Abuse (NIDA) report.

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MDMA has been in the news again lately because it may be a treatment option for severe post-traumatic stress disorder (PTSD), depression, and anxiety.

Even though the drug has been around a while, there’s still a lot we don’t know. There’s conflicting data about whether it causes depression and anxiety or helps individuals with those conditions. The answer isn’t that simple.

When MDMA is purchased illegally off the street, it’s often mixed with other drugs. That confuses the picture even more.

Let’s take a closer look at MDMA and its effects to understand how it works, whether it can be helpful, and whether it causes depression or anxiety.

What is MDMA?

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Methylenedioxymethamphetamine (MDMA) has both stimulant and hallucinogenic properties. It’s similar to the stimulant effects of amphetamine in many ways but also has some hallucinogenic traits like mescaline or peyote.

It can bring feelings of happiness and empathy. Users report feeling energetic and more emotional. But it has negative effects, too. More on that later.

MDMA is often used with other drugs, which can increase these harmful effects.

In the brain, MDMA works by affecting and increasing three brain chemicals:

  • Serotonin affects mood, behavior, thoughts, sleep, and other body functions.
  • Dopamine affects mood, movement, and energy.
  • Norepinephrine affects heart rate and blood pressure.
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MDMA starts to work within 45 minutes. Effects can last up to six hours, depending on the amount taken.

  • ecstasy
  • molly
  • XXTCAdamEve
  • beans
  • biscuit
  • go
  • peace
  • uppers

Is MDMA legal?

It’s illegal to possess or sell MDMA. The penalties can be severe, including prison sentences and fines.

In the United States, drugs are grouped into five schedule classes by the Drug Enforcement Administration (DEA) based on their abuse potential.

MDMA is a Schedule I drug. This means it has the highest potential for abuse and addiction, according to the DEA. Currently, there’s no approved medical use. Other examples of Schedule I drugs include heroin and Lysergic acid diethylamide (LSD).

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Researchers have to have special permission from the DEA to study these drugs with strict reporting and handling conditions. This can present challenges for scientists studying MDMA to learn more about its effects (good and bad).

Does MDMA cause depression?

The impact of MDMA use on the body and specifically on mood aren’t yet clear. Reactions to MDMA depend on:

  • dose taken
  • type of MDMA used
  • sex
  • if there’s a history of depression
  • other drugs taken in addition to MDMA
  • genetics
  • other individual characteristics

Some older studies found regular MDMA use can change serotonin levels in the brain, which can affect mood, feelings, and thoughts. Very little is known about long-term effects of using MDMA on memory or other brain functions.

According to NIDA, after-binge use (regular use for several days), MDMA can cause:

  • depression
  • anxiety
  • irritability
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Some earlier studies also link drops in serotonin levels after MDMA use to depression or suicidal thoughts. This might be temporary or last for a long time. It really depends on the person and their reaction.

MDMA is also often taken with marijuana, which can increase side effects and adverse reactions.

A recent study looked at the effects of taking both MDMA and marijuana together and found it increased psychosis. The reasons for this are unclear, but the MDMA dose might have something to do with the reaction.

Does MDMA cause anxiety?

Some studies show MDMA use can cause anxiety, even after only one dose. Generally, this is a mild effect. But for some people, this can be long-lasting.

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Like most drugs, effects depend on the individual and other factors, like drug dose, how often it’s used, and any prior history of anxiety, depression or panic attacks.

Scientists are still not sure how MDMA affects anxiety in those who use it. Most research data is based on recreational MDMA use. The purity, potency, and other environmental reasons can affect results.

Can MDMA be used to treat depression or anxiety?

MDMA isn’t a legal prescription medication. It can’t be prescribed for any condition, including depression and anxiety.

However, researchers are investigating MDMA as a potential treatment for PTSD, depression, and anxiety.

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In 2019, researchers investigated MDMA for therapeutic use in treating PTSD. The trials are ongoing, but initial results suggest MDMA may be an effective addition to psychotherapy for treating some individuals with PTSD.

Although more investigation is needed, the promising results of trials using MDMA to treat individuals with PTSD have led some researchers to suggest that MDMA might also be an effective support to psychotherapy for treating individuals with:

  • depression
  • anxiety disorders
  • obsessive-compulsive disorder (OCD)
  • suicidality
  • substance use disorders
  • eating disorders

Other studies have been looking at possible benefits of MDMA for anxiety. They include anxiety from social situations in autistic adults. Doses were between 75 milligrams (mg) to 125 mg. This was a very small study, though. More data is needed to understand the long-term benefits.

Research for the treatment of anxiety related to life-threatening illness with MDMA is also being done.

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We still don’t know enough about the drug’s effects on the brain. The newer studies show promise. We’ll know more about the best dose, results, and any long-term effects once these studies are completed.

According to NIDA, some reported side effects of MDMA include:

  • unclear thoughts
  • high blood pressure
  • jaw clenching
  • restless legs
  • loss of appetite
  • nausea
  • sweating
  • chills
  • hot flashes
  • headaches
  • muscle stiffness
  • problems with depth and spatial awareness (this can be dangerous when driving after using MDMA)
  • depression, anxiety, irritability, and hostility (after use)

What are the risks of taking MDMA?

Because MDMA is so often mixed with other drugs when sold on the street, it’s been difficult to know its full impact. Here are a few of the most serious risks:

  • Addiction. While researchers don’t know for sure whether MDMA is addictive, according to NIDA, MDMA affects the brain in similar ways as other known addictive drugs. So, it’s likely that MDMA is addictive.
  • It’s often mixed with other drugs. A main safety concern with MDMA is that it’s often mixed with other designer or novel psychoactive substances (NPS), such as amphetamines. There’s no way to know what’s in it.
  • Long-term changes in brain chemistry. Some researchers have found that MDMA may lower serotonin levels in the brain if taken for a long period of time. Other studies have shown that taking MDMA even once can lead to anxiety. In rare cases, the anxiety can be persistent.
  • Overdose. Too much MDMA can cause a sudden rise in heart rate and body temperature. This can become very serious quickly, especially in an overheated environment like a crowd or concert. Call 911 immediately if you suspect on overdose.

There are several other signs of overdose from MDMA. Call 911 immediately if you or someone you’re with has taken MDMA and is experiencing one or more of these symptoms:

  • body overheating (hyperthermia)
  • very high blood pressure
  • panic attacks
  • dehydration
  • seizures
  • arrhythmias (heart rhythm problem)
  • fainting or losing consciousness
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Unlike with opioid overdose, there’s no specific medication to treat MDMA or other stimulant overdoses. Doctors have to use supportive steps to control the symptoms. These include:

  • cooling body temperature
  • lowering heart rate
  • rehydrating

See your doctor

Don’t take MDMA or other designer drugs to self-treat any condition. These drugs aren’t regulated.

Instead, talk to your doctor about treatment choices for depression and anxiety and the options available. Also ask about any clinical trials that might be suitable.

Remember, for research studies, the purity, potency, and dose of MDMA are carefully controlled and watched.

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MDMA bought on the street or from the dark web is often mixed with other drugs, like:

  • amphetamines
  • methamphetamine
  • cocaine
  • ketamine
  • aspirin

These interact and produce different reactions. There’s often no way to tell how much has been cut into your MDMA.

Talk to a healthcare provider about your symptoms. You can also reach out to these organizations:

  • Anxiety and Depression Association of America’s Find a Therapist Directory
  • SAMHSA Treatment Provider Locator
  • National Alliance on Mental Health
  • National Suicide Prevention Lifeline, available 24/7 at 800-273-TALK
  • Veterans Crisis Line if you’re a veteran
  • If you have minimal or no insurance, check to see if there’s a federally qualified health center (FQHC) near you at the Health Center Program
  • For those of Native American descent, contact the Indian Health Service

The bottom line

MDMA has been around for a long time. It’s now being studied for its benefits in treating severe PTSD, depression, and certain types of anxiety.

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The Food and Drug Administration has granted the drug breakthrough therapy status to allow researchers to learn about its effects.

It’s not clear whether MDMA causes or helps with depression and anxiety. But research shows how it affects someone has to do with many factors, such as sex, genetics, dosage, medical history, and a person’s general health.

MDMA isn’t safe for self-dosing for anxiety or depression. The DEA considers it a Schedule I drug. There’s no consistency in the product and too much risk.

There are many legal prescription and nonprescription treatments available to treat both anxiety and depression.

Read more on: mental, depression


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