3,4-methylenedioxymethamphetamine, commonly known as MDMA, is a synthetic psychoactive substance. It is widely recognized by street names such as ecstasy and molly. In the United States, MDMA is classified as a Schedule I controlled substance. This classification indicates that the drug has a high potential for misuse and currently lacks an approved medical purpose.
How MDMA Acts in the Body
MDMA primarily influences the brain’s neurotransmitter systems, specifically impacting serotonin, dopamine, and norepinephrine. It increases the release of these chemical messengers into the synaptic cleft, the space between neurons. Additionally, MDMA can hinder the reuptake of these neurotransmitters, prolonging their presence and activity in the synapse.
The drug has a stronger effect on serotonin and norepinephrine release compared to dopamine. Serotonin is involved in regulating mood, sleep, pain, and appetite, and its increased release likely contributes to the mood-elevating effects experienced by users. MDMA also enters neurons by using transporter proteins, disrupting neurotransmitter storage and further facilitating their release.
Immediate Physiological and Psychological Effects
The effects of MDMA typically begin within 30 to 45 minutes of ingestion and can last for three to six hours. Physiologically, users often experience an accelerated heart rate and breathing, along with a rise in blood pressure. Common physical effects include sweating, dehydration, and elevated body temperature (hyperthermia). Other manifestations are:
- Pupil dilation
- Involuntary jaw clenching
- Teeth grinding
- Muscle tension
- Nausea
Psychologically, MDMA is associated with feelings of euphoria, increased energy, and heightened alertness. Users frequently report an enhanced sense of well-being and emotional warmth, fostering increased empathy and closeness towards others. Sensory perception may be heightened, leading to increased sensitivity to sights, sounds, and touch. Users might also experience altered perceptions of time and reduced inhibitions.
Post-Use Experiences and Short-Term Consequences
Following the immediate effects of MDMA, users often experience a “comedown” or crash, which can last for one to three days. This aftermath is often attributed to the brain’s serotonin depletion following the drug’s effects. Replenishing serotonin levels can take days or weeks.
Common symptoms during this post-use period include:
- Fatigue and low energy
- Mood swings and irritability
- Increased anxiety or depression
- Difficulty sleeping
- Reduced appetite
- Impaired attention and memory
Potential Health Risks and Long-Term Considerations
MDMA use carries several acute health risks, with hyperthermia being a serious concern. A rise in body temperature can lead to severe dehydration, electrolyte imbalances, and potentially result in kidney failure or fatal brain swelling, especially in women. Cardiovascular complications, such as a rise in blood pressure and heart rate, are also possible. Serotonin syndrome, caused by an increase of serotonin in the brain, can also occur, presenting with symptoms like increased body temperature, rapid pulse, and confusion.
Chronic or high-dose MDMA use raises concerns about potential neurotoxicity, specifically damage to serotonin neurons in the brain. Research in animals suggests that moderate to high doses can damage nerve cells containing serotonin, and some MDMA-exposed primates showed reduced numbers of serotonergic neurons years later. This damage may contribute to persistent memory problems, difficulties with attention and concentration, and mood disorders like depression and anxiety. There is also a potential for psychological dependence with continued use.