Effects and dependency - MDMA

MDMA speeds up messages between the brain and the body. It can make you feel alert, energetic or anxious.

MDMA can come as:

• powders
• crystals
• capsules
• pills with different logos and shapes - often called ecstasy

These can be swallowed, snorted or dabbed on the gums.

The strength of MDMA can vary. This increases the risk of taking too much at a time.

Effects of MDMA

The effects of MDMA can vary depending on:

• your size, weight and sex
• if you have any health conditions or mental health difficulties
• how you take the drug
• the strength of the drug
• how much you take
• if you take alcohol, medicines or other drugs at the same time
• where you take the drug and how you feel before you take it
• if you have taken the drug before and how often

The effects can start after 20 to 70 minutes and last for hours. But if you swallow MDMA the effects may take longer to start.

If you do not feel a sudden rush of effects, it does not mean that the drug is not working.

How you may feel or behave

You may feel:

• intense wellbeing or happiness (euphoria)
• more aware of colours and sounds
• alert, energetic or confident
• confused or anxious
• affectionate
• connected with other people (empathetic)
• agitated or restless

Effects on your brain and body

MDMA can cause:

• increased blood pressure and heart rate
• nausea (feeling sick)
• loss of appetite - this can affect your health and energy levels over time
• increased sweating and body temperature
• dehydration
• dry mouth and throat
• teeth grinding or jaw clenching
• dilated pupils
• problems peeing
• lower levels of sodium (hyponatremia)
• hallucinations - you may see, hear or feel things that are not there
• lower inhibitions - you may do things you would not usually do
• tremor
• seizures (fits)
• problems sleeping
• liver, kidney or heart problems - if you use it often

Water intoxication, hyponatremia and MDMA

Water intoxication is when there is too much water in your system. The extra water causes swelling in brain cells.

Water intoxication can happen because MDMA causes:

• increased sweating and body temperature - you may feel thirsty and want to drink
• problems peeing - you may not be able to pee until you come down
• lower levels of sodium (hyponatremia) - this pushes water into your cells

Female sex hormones affect how the body holds water. This means women, transgender and non-binary people with female sex hormones may be more at risk of hyponatremia.

Signs of water intoxication include:

• nausea and vomiting
• headache
• confusion and irritability
• dizziness
• swelling in your hands, feet or tummy
• drowsiness
• muscle pain and cramps

Serotonin syndrome and MDMA

Serotonin is a chemical that carries messages from your brain to your body. It helps with many body functions. For example, mood, sleep and digestion.

Serotonin syndrome is when your serotonin levels get too high. It is a medical emergency.

MDMA affects the serotonin levels in your body. There is a risk of serotonin syndrome if you use MDMA with other substances that affect serotonin levels. For example, mephedrone or antidepressants.

Signs of serotonin syndrome include:

• confusion
• agitation
• muscle twitches
• pain in your arms or legs
• sweating
• shivering or trembling
• a very high temperature (fever)
• seizures (fits)
• irregular heartbeat
• unconsciousness

Comedowns

A comedown is how you feel as the drug leaves your system.

Comedowns from MDMA can last a few days and cause:

• problems sleeping
• low mood
• headaches
• problems concentrating
• thoughts of suicide

It can help to find safe ways to cope with comedowns instead of taking other drugs. For example, make time for rest or sleep and talk to someone you trust about how you feel.

MDMA and mental health

MDMA can cause mental health difficulties or make existing difficulties worse.

Negative effects on your mental health can happen if you are going through a tough time, feel tired or feel low. But the risk is higher if you or someone in your family has mental health difficulties.

Regular and heavy use of MDMA affects serotonin levels and can cause:

• low mood or depression
• sleep problems

To reduce the risks, leave at least 4 weeks between use. But 3 to 4 months between use is best.

Medical research on MDMA

There are studies on the use of MDMA for specific conditions. For example, post-traumatic stress disorder (PTSD) that does not respond to other treatments.

The studies involve taking a specific dose in a supervised and medical setting. MDMA is usually only part of the treatment. For example, it is used in combination with talk therapy. This is often called MDMA-assisted therapy or psychedelic-assisted therapy. This is not available in Ireland.

It is not safe to take MDMA that you buy in the illegal or online drug market as a therapy. You can never be sure of the contents and strength of these drugs or how you will react.

If you are worried about your mental health, there are other treatments that are safe and effective.

About mental health supports and services

MDMA and dependency

Regular use of MDMA can cause:

• tolerance - when you need to take more of the drug to get the same effects
• dependency

Signs of dependency can include:

• cravings for a drug
• withdrawal symptoms
• continuing to use a drug even when it causes you harm

Withdrawal symptoms

If you stop taking MDMA after regular use, you may get withdrawal symptoms.

These include:

• low mood or depression
• aches and pains
• tiredness and problems sleeping
• problems concentrating

How long does MDMA stay in your system?

It can be hard to know how long MDMA stays in your system.

There are tests to detect MDMA. But different types of tests have different detection times.