Can MDMA Cause or Treat Depression or Anxiety?

MDMA, or 3,4-methylenedioxymethamphetamine, is a popular illegal drug that is known to affect a person’s mood. Some of the other names for this recreational drug include Molly, X, and ecstasy. MDMA changes a person’s mood by altering the release of chemicals in the body that have a direct effect on your behavior and mood. MDMA has recently been in the news because of its potential to serve as a treatment option for depression, anxiety, and severe post-traumatic stress disorder. However, even though the drug has been around for decades, there is not much that we know about it. There are also conflicting data that indicates it may actually cause depression and anxiety. Here’s everything you need to know about MDMA, depression, and anxiety.

What is MDMA?

Methylenedioxymethamphetamine (MDMA), or 3,4-methylenedioxymethamphetamine, is a chemical that has both hallucinogenic and stimulant properties.(1,2,3,4) It is an illegal drug that affects a person’s mood and is commonly known as ecstasy, Molly, XTC, beans, Eve, Adam, and X. The drug changes a person’s mood by altering the release of various chemicals in the body that has a direct effect on your mood and behavior.(5,6) In many ways, MDMA is similar to the stimulant properties of amphetamine, but at the same time, MDMA has hallucinogenic traits like peyote or mescaline. MDMA can cause extreme feelings of happiness and empathy, and users report feeling very energetic and more emotional, but it has many negative effects as well.(7,8,9)

MDMA is usually used in combination with other drugs, which increases these negative effects manifolds.(10)

Upon reaching the brain, MDMA works by impacting and increase the production of three main brain chemicals, including:

  • Dopamine that impacts movement, energy, and mood.
  • Serotonin, which affects mood, behavior, sleep, thoughts, and other bodily functions.
  • Norepinephrine, which affects blood pressure and heart rate.

The drug starts working within 45 minutes of taking it, and the effects can last well up to six hours or more, depending on the amount taken.

It is illegal to sell or possess MDMA, and the penalties can be severe, including fines and prison sentences, depending on the country you live in. In the United States, for example, MDMA is classified as a Schedule 1 drug by the Drug Enforcement Administration (DEA), meaning that there is a very high potential for abuse and addiction to this drug.(11)

Currently, there is no approved medicinal use of MDMA, and researchers have to take special permission from the Drug Enforcement Administration if they want to study MDMA or other similar drugs. There are strict reporting and handling conditions in place for researching on these drugs as well, which pose various challenges for those studying MDMA to learn about its effects, both negative and positive.(12)

Can MDMA Cause Depression?

The effect of using MDMA on the body and especially on a person’s mood is not completely clear. Your reaction to this drug depends on various factors, including:

  • The dose taken
  • Type of MDMA used
  • If you have a history of depression(13)
  • Gender
  • Genetics
  • If some other drugs were also taken along with MDMA
  • Other individual factors

Many older studies have found that the regular use of MDMA can bring about some permanent changes in the serotonin levels in the brain, which can affect feelings, thoughts, and your mood.(14) However, even now, very little is known about what type of long-term effects using MDMA has on your memory and other brain functions.

According to the National Institute on Drug Abuse (NIDA), after regularly using MDMA for several days or after binge use, the drug can cause the following:(15)

  • Irritability
  • Depression
  • Anxiety

Several older studies had also linked a decrease in the serotonin levels after using MDMA, along with depression and suicidal thoughts.(16,17)

Many people often take MDMA with marijuana, which is known to significantly increase the side effects and adverse reactions. A recent study found that taking MDMA and marijuana together increased psychosis.(18) While the reasons for this remain unclear, but it is believed that the MDMA dosage has something to do with this type of adverse reaction.

MDMA and Anxiety

Many studies have found that using MDMA can cause anxiety, even if you have it only once.(19) Usually, this is just a mild effect and tends to go away after some time, but in some people, this effect can be more long-lasting, especially with regular use of the drug.

Just like most drugs, the anxiety effects of MDMA varies from person to person and also depends on other factors like how much MDMA you have taken, how often you used the drug, and if you have any history of anxiety, panic attacks, or depression in the past.

Researchers are still not sure about how exactly MDMA causes anxiety in people who use it.(20) Most of the data available to date are based on the recreational use of the drug. Environmental factors, the potency and purity of the drug, dosage, and frequency of use, and other such factors are believed to affect the result of these studies, due to which the exact cause still remains unknown.

Can MDMA Treat Anxiety or Depression?

MDMA is not a legally prescribed medication, and it cannot be prescribed for any medical condition, including anxiety and depression. Nevertheless, researchers have been looking into MDMA as a potential treatment for depression, anxiety, and post-traumatic stress disorder.

In a 2015 review of several studies, it was found that MDMA can be considered as a potential treatment for depression because of the rapid speed at which the drug works.

This is the biggest advantage MDMA has over the present-day medication options for treating depression, which typically takes several days to a few weeks to start working.
As recently as 2019, researchers were also investigating MDMA for testing its therapeutic use in the treatment of post-traumatic stress disorder.(22) The trials for this are still ongoing, and initial results indicate that MDMA may be an effective treatment in combination with psychotherapy for treating people with post-traumatic stress disorder.

Even though more research is needed, the promising results of such trials that are using MDMD to treat people with post-traumatic stress disorder have made researchers believe that MDMA might a good support to psychotherapy for treating people with the following conditions:(23)

Many other studies have also been researching the potential advantages of MDMA for anxiety.(24) This also includes autistic adults experiencing anxiety in social situations.(25) More research is still needed to establish whether or not MDMA can actually help in such conditions while also looking at the long-term effects of using the drug.

At the same time, there is ongoing research on the treatment of anxiety-related to various life-threatening diseases with MDMA. There is not much known about the exact effects of the drug on the brain. While such newer studies have shown promise, there is still a long way to go before we can determine the best dose, exact results, and the long-term effects of MDMA.

In the meantime, here are some of the reported side effects of MDMA as reported by the National Institute on Drug Abuse:

Problems with depth and spatial awareness – this is a dangerous side effect, especially if you are driving after using MDMA.

Are there are risks of taking MDMA?

Due to the fact that the MDMA available on the street is usually mixed with many other drugs, it is difficult to understand its full impact, but here are some of the most serious risks of taking MDMA:

Addiction: MDMA impacts the brain in the same ways as other known addictive drugs. Though researchers still do not know for sure whether MDMA is addictive, but it is highly likely that it is equally as addictive as other street drugs.

It is mixed with other drugs: One of the biggest safety concerns with MDMA is that it is usually mixed with other drugs, including designer drugs or novel psychoactive substances (NPS), including amphetamines.(25,26,27) There is no way of determining what is included in the mixture.

The long-term effect on brain chemistry: Some studies have found that MDMA may reduce the levels of serotonin in the brain if taken for a prolonged period of time.(28)

Other studies have also found that taking MDMA even once can cause anxiety.(29) In rare cases, this anxiety can become permanent.

Overdose: Taking too much of MDMA can lead to a sudden increase in your body temperature and heart rate, which can become a serious condition very quickly, especially if you are in an overheated environment like a concert or a crowded place. If you suspect an overdose of MDMA, immediately call 911 or your local area’s medical emergency number. Here are some signs and symptoms of an overdose:

  • Very high blood pressure
  • Body overheating (hyperthermia)
  • Dehydration
  • Arrhythmias, or irregular heart rate
  • Panic attacks
  • Losing consciousness or fainting

Conclusion

Do not take MDMA or any such drugs to self-treat depression or anxiety, or any other medical condition for that matter. These drugs are not regulated by any government authority, and their side effects are usually unknown.

It is always better to talk to your doctor about seeking the right treatment options for depression, anxiety, and post-traumatic stress disorder.

MDMA that is purchased on the street or from the dark web is usually mixed with other drugs, and they may interact and produce unknown and different reactions in people. There is generally no way of knowing what drugs are mixed in the MDMA bought on the street.

References:

  1. Green, A.R., Mechan, A.O., Elliott, J.M., O’Shea, E. and Colado, M.I., 2003. The pharmacology and clinical pharmacology of 3, 4-methylenedioxymethamphetamine (MDMA,“ecstasy”). Pharmacological reviews, 55(3), pp.463-508.
  2. De La Torre, R., Farré, M., Ortuno, J., Mas, M., Brenneisen, R., Roset, P.N., Segura, J. and Camí, J., 2000. Non‐linear pharmacokinetics of MDMA (‘ecstasy’) in humans. British journal of clinical pharmacology, 49(2), pp.104-109.
  3. Vollenweider, F.X., Gamma, A., Liechti, M. and Huber, T., 1998. Psychological and cardiovascular effects and short-term sequelae of MDMA (“ecstasy”) in MDMA-naıve healthy volunteers. Neuropsychopharmacology, 19(4), pp.241-251.
  4. Green, A.R., Cross, A.J. and Goodwin, G.M., 1995. Review of the pharmacology and clinical pharmacology of 3, 4-methylenedioxymethamphetamine (MDMA or “Ecstasy”). Psychopharmacology, 119(3), pp.247-260.
  5. McCann, U.D., Szabo, Z., Scheffel, U., Dannals, R.F. and Ricaurte, G.A., 1998. Positron emission tomographic evidence of toxic effect of MDMA (“Ecstasy”) on brain serotonin neurons in human beings. The Lancet, 352(9138), pp.1433-1437.
  6. Parrott, A.C. and Lasky, J., 1998. Ecstasy (MDMA) effects upon mood and cognition: before, during and after a Saturday night dance. Psychopharmacology, 139(3), pp.261-268.
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  9. Schwartz, R.H. and Miller, N.S., 1997. MDMA (ecstasy) and the rave: a review. Pediatrics, 100(4), pp.705-708.
  10. Palamar, J.J., Mauro, P.M., Han, B.H. and Martins, S.S., 2017. Shifting characteristics of ecstasy users ages 12–34 in the United States, 2007–2014. Drug and alcohol dependence, 181, pp.20-24.
  11. Dea.gov. 2021. Drug Scheduling. [online] Available at: <https://www.dea.gov/drug-scheduling> [Accessed 28 January 2021].
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  13. Lieb, R., Schuetz, C.G., Pfister, H., Von Sydow, K. and Wittchen, H.U., 2002. Mental disorders in ecstasy users: a prospective-longitudinal investigation. Drug and alcohol dependence, 68(2), pp.195-207.
  14. Morton, J., 2005. Ecstasy: pharmacology and neurotoxicity. Current opinion in pharmacology, 5(1), pp.79-86.
  15. National Institute on Drug Abuse. 2021. What are the effects of MDMA? | National Institute on Drug Abuse. [online] Available at: <https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-are-effects-mdma> [Accessed 28 January 2021].
  16. Verheyden, S.L., Henry, J.A. and Curran, H.V., 2003. Acute, sub‐acute and long‐term subjective consequences of ‘ecstasy’(MDMA) consumption in 430 regular users. Human Psychopharmacology: Clinical and Experimental, 18(7), pp.507-517.
  17. Kim, J., Fan, B., Liu, X., Kerner, N. and Wu, P., 2011. Ecstasy use and suicidal behavior among adolescents: Findings from a national survey. Suicide and Life‐Threatening Behavior, 41(4), pp.435-444.
  18. Duman, B., Sedes, N. and Baskak, B., 2017. Additive effects of former methylenedioxymethamphetamine and cannabis use on subclinical psychotic symptoms. Archives of Neuropsychiatry, 54(1), p.38.
  19. Kaplan, K., Kurtz, F. and Serafini, K., 2018. Substance-induced anxiety disorder after one dose of 3, 4-methylenedioxymethamphetamine: a case report. Journal of medical case reports, 12(1), pp.1-5.
  20. Patel, R. and Titheradge, D., 2015. MDMA for the treatment of mood disorder: all talk no substance?. Therapeutic advances in psychopharmacology, 5(3), pp.179-188. Sessa, B., Higbed, L. and Nutt, D., 2019. A review of 3, 4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. Frontiers in psychiatry, 10, p.138.
  21. Yazar‐Klosinski, B.B. and Mithoefer, M.C., 2017. Potential psychiatric uses for MDMA. Clinical pharmacology & therapeutics, 101(2), pp.194-196.
  22. Mithoefer, M.C., Grob, C.S. and Brewerton, T.D., 2016. Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. The Lancet Psychiatry, 3(5), pp.481-488.
  23. Danforth, A.L., Grob, C.S., Struble, C., Feduccia, A.A., Walker, N., Jerome, L., Yazar-Klosinski, B. and Emerson, A., 2018. Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study. Psychopharmacology, 235(11), pp.3137-3148.
  24. Saleemi, S., Pennybaker, S.J., Wooldridge, M. and Johnson, M.W., 2017. Who is ‘Molly’? MDMA adulterants by product name and the impact of harm-reduction services at raves. Journal of psychopharmacology, 31(8), pp.1056-1060.
  25. Palamar, J.J., Salomone, A., Vincenti, M. and Cleland, C.M., 2016. Detection of “bath salts” and other novel psychoactive substances in hair samples of ecstasy/MDMA/“Molly” users. Drug and alcohol dependence, 161, pp.200-205.
  26. Madras, B.K., 2016. The growing problem of new psychoactive substances (NPS). In Neuropharmacology of New Psychoactive Substances (NPS) (pp. 1-18). Springer, Cham.
  27. Morton, J., 2005. Ecstasy: pharmacology and neurotoxicity. Current opinion in pharmacology, 5(1), pp.79-86.
  28. Kaplan, K., Kurtz, F. and Serafini, K., 2018. Substance-induced anxiety disorder after one dose of 3, 4-methylenedioxymethamphetamine: a case report. Journal of medical case reports, 12(1), pp.1-5.

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