MECHANISM OF ACTION
MDMA is a phenethylamine, a group of chemicals which also includes mescaline, the 2C-drugs, cathinones, and amphetamine. Its mechanism of action is quite unique: it not only stimulates the brain's serotonin system in a way that causes it to release large amounts of serotonin, but also mimics serotonin itself and binds directly to serotonin receptors. MDMA also releases dopamine and noradrenaline. The mechanism as a whole is very complex, and it is still not entirely clear how the drug produces its subjective effects. Neural imaging of brains under the influence of MDMA show increased activity in the prefrontal cortex, which plays a central role in functions like self-reflection and assessment of one's own actions; and reduced activity in the amygdala, which is central to base emotions such as fear, aggression, and sexual desire.
The subjective effects of MDMA normally last for 4 to 5 hours, followed by various after-effects for another 1 to 3 hours. Effects can become noticeable after anywhere between 15 and 60 minutes after intake, but it may take up to 90 minutes to feel anything if one has recently eaten a large meal. See here for a more thorough breakdown of how MDMA works. SUBJECTIVE EFFECTS
MDMA is known for its euphoric, empathy-promoting, and stimulant effects. Users tend to feel satisfied, wakeful, and energetic. Set and setting greatly affect the tone of the experience, and the drug will tend to feel different if taken in a calm, intimate setting with a few friends, than if taken at a crowded event with loud music and a barrage of sensory impressions. Even though MDMA is normally associated with satisfaction and bliss, it can also trigger difficult emotional experiences. Empathy and openness
MDMA tends to make users feel a sense of care and understanding towards people around them. However, users may also have a difficult time registering negative body language or facial expressions, which can lead to people around them seeming more gregarious or interested than they really are. MDMA thus tends to make people much less prone to conflict, but may at the same time cause some users to become very clingy or persistent unless told directly that their behavior makes others uncomfortable. Many users become very cuddly and feel a strong need for physical intimacy, albeit usually without any sexual interest. (However, MDMA may be sexually stimulating to some people, although it also causes sexual dysfunction and difficulty in achieving orgasm in both sexes.) New friendships are made very easily on MDMA, for better or for worse. On the one hand, this makes it possible to quickly build deep connections that end up lasting a lifetime; on the other hand, if there is no real chemistry with the other person in a sober state, then any intimacy with them on MDMA may feel awkward afterwards. Energy and wakefulness
People on MDMA tend to become very awake and alert due to its stimulant effects. Low to moderate doses can nevertheless instill a sense of calm and relaxation, and some users may even feel lightly sedated or "stoned". Higher doses, on the other hand, often lead to restlessness and a need to move around. Low to moderate doses usually come with a sense of mental clarity and sharpness, while higher doses are more confusing and disorienting. Users find they can easily socialize or party uninterrupted for several hours, and rarely feel any hunger while the drug is active. This can lead to the body using up more energy than it has readily available and instead starts burning glycogen, especially during intense dancing. This can, in turn, cause people to suddenly feel profoundly exhausted once the drug wears off – especially if they were not fully rested before taking the drug, forgot to eat something underway, or forgot to moderate their activity level during the experience (or any combination of these factors). Euphoria and pleasure
Most people feel a sense of bliss and euphoria, both physically and psychologically, on MDMA. This causes some people to feel upbeat, excited, and extroverted, whereas others might feel more reflective and introspective. Although MDMA normally comes with a sense of happiness, it can also bring about a very somber or deeply emotional atmosphere. It is not uncommon for people to want to talk about themselves and listen to others talk about themselves, or to tell people how much one cares about them and how beautiful they are, while banter and sarcasm often feel less natural. Difficult experiences
Although most people feel a reduced sense of fear and anxiety on MDMA, the opposite may be true for some individuals. It is important to keep in mind that MDMA is a powerful psychotherapeutic tool that can bring subconscious fears and concerns up to the surface. People who have a lot of trauma in their past, or who find themselves in a difficult life situation, may find that MDMA brings up memories and thoughts that they are not fully prepared to deal with. It is strongly recommended to keep this in mind when taking MDMA, and to make sure one has a trusted friend nearby to talk with if necessary, both during and after the experience. SIDE-EFFECTS
MDMA comes with a number of side-effects that many consider unpleasant. These become more pronounced at higher doses or more frequent use. Some people seem to generally experience more side-effects than others. Women appear to be more prone to uncomfortable side-effects than men, possibly related to menstruation and hormonal swings. Very common side-effects (regardless of dose)
Less common side-effects (more common with higher doses)
- Dry mouth, leading to bad breath. Mints or lozenges may help with this.
- Higher body temperature and sweating. Not a problem when sitting still at normal room temperature, but may become problematic with high physical activity and/or high ambient temperature. Cool down by getting fresh air and avoiding too warm clothing. Eating ice cream may help.
- Urinary retention, especially in women. Normally not an issue, but can become dangerous if one drinks too much water without also taking in electrolytes (salts), thereby diluting the body's electrolytes (hypoglycaemia). Eat some salty snacks if possible, or go for an isotonic sports drink (e.g. Powerade) when thirsty.
- Faster heart rate and higher blood pressure.
- "Twitchy" eye movements (nystagmus) and unfocused eyesight. Normally not an issue, and usually passes after a short while.
- Headache when coming down, which can be quite unpleasant for some. Sugary snacks or drinks may help.
- Mild hallucinations, especially at moderate to high doses. This results from MDMA being broken down into the drug MDA (3,4-methylenedioxyamphetamine), a more hallucinogenic and harmful relative of MDMA. The amount of MDA created during metabolism can be limited by eating certain foods that inhibit the enzyme CYP3A4 (including grapefruit juice and black pepper) before taking MDMA, and by avoiding re-dosing.
Rare, abnormal side-effects (possible signs of hypersensitivity or overdose)
- Clenched jaw muscles and involuntary jaw movements (bruxism). This can lead to involuntarily biting one's tongue or the inside of the cheeks, resulting in painful mouth sores. Magnesium supplements can help reduce bruxism, and antibacterial mouthwash reduces the risk of infection in open sores.
- Confusion and impaired short-term memory, especially in combination with other drugs like alcohol or cannabis.
- Transient anxiety, nausea, and/or headache.
- Sudden and intense nostalgia or disappointment when the effects wear off.
- Intense and somewhat realistic hallucinations, especially at high doses. This is a result of MDMA being metabolized into its more harmful metabolite MDA. This is one reason to avoid taking too high a dose of MDMA.
Hangover (1 to 5 days after)
- Overdose symptoms include nausea, headache, anxiety, confusion, and very high body temperature. If you suspect that someone is overdosing on MDMA, call an ambulance immediately. While you wait for the ambulance, try to lower the affected person's body temperature by removing excessive clothing, providing fresh air, and by holding an ice pack or a cold, damp cloth against the jugular arteries on either sides of their throat (taking care not to put pressure on their windpipe).
- There are cases of people taking MDMA for the first time and experiencing these symptoms, despite having taken a normal dose, which suggests that some subset of the population is hypersensitive to the drug. Since it is not possible to tell ahead of time whether someone is hypersensitive, it is always recommended to start with a maximum of 60 to 70 mg when taking MDMA for the first time, and to monitor the effects for at least half an hour before taking any more.
It is normal to feel worn out immediately an MDMA experience, especially for those who have taken a high dose and/or danced for several hours. It is therefore recommended to get a good night's sleep once the drug effects have worn off. However, some people may still feel restless for a while after coming down and hence struggle to fall asleep, especially after re-dosing several times or combining MDMA with other stimulants. Some people combat this by taking "downers" such as benzos and/or cannabis. This is generally not necessary, as the restlessness tends to go away after an hour or two; but if you decide to try, it is recommended to take as little of the downer as possible. It is also strongly recommended to ensure at least one full day off after taking MDMA, e.g. by taking it on a friday or saturday, so as to avoid having to go back to work/school/etc. in a reduced state.
Some people experience low energy and mood for around 3 to 5 days after taking MDMA, especially after taking a high dose. If you are worried about this possibly triggering a depressive episode, make sure to take at most a few small doses, avoid combinations with alcohol or stimulants, and avoid taking MDMA too often. There is some evidence to indicate that depressive symptoms after MDMA can be reduced by taking the supplement 5-HTP for a few days after the experience (see section below). Generally healthy habits, such as getting enough sleep, eating healthy foods, and regular exercise, all contribute to a faster recovery after MDMA.
Some people develop a tolerance to MDMA after having taken it many times, at which point they find they no longer achieve the same kind of experience as before. The effects are described as more similar to amphetamine, lacking the intense feelings of love and compassion that are normally expected from MDMA. People may then try to compensate for this "loss of magic" by taking higher doses in the hope of achieving the desired effect, which leads to even higher tolerance and a higher risk of harmful side-effects – until it becomes impossible to achieve the desired effect no matter the dose. It may then take several years to reset one's tolerance to the drug. Some users report a permanent loss of the full effects of MDMA after such a tolerance buildup, even after not taking it for several years, which may indicate permanent damage to the brain's serotonin system. If you notice your MDMA experiences getting noticeably less pleasant with each use, despite taking breaks between each use, consider taking a very long break (e.g. 6–12 months) or quitting MDMA altogether. SUPPLEMENTS Magnesium
One of the most common side-effects of MDMA is bruxism, a condition where the jaw muscles tense up and cause involuntary movements like clenching, chewing, and teeth grinding. In the worst case, this can lead to biting one's tongue or the inside of one's cheek, resulting in painful sores. Many users report that magnesium supplements help to combat bruxism, if taken beforehand or soon after the symptom arises. Any magnesium supplement appears to work, but it is recommended to choose one that contains a highly bioavailable form of the mineral, e.g. magnesium gluconate, magnesium glycinate or magnesium citrate. Chewing gum can also help by offering a more controlled outlet for the bruxism, as well as lending some protection against teeth grinding. Some users who get especially intense bruxism on MDMA choose to wear a dental guard during the experience. Antioxidants
Some research seems to indicate that strong or high-dosed antioxidants can help prevent MDMA-related neurotoxicity. Animal studies have shown that high doses of vitamin C (ascorbic acid), vitamin E (tocopherol), ALA (ɑ-lipoic acid), and ALCAR (acetyl-L-carnitine) appear to have a neuroprotective effect against high doses of MDMA. However, it is unclear whether MDMA at recreational doses is neurotoxic in humans, and results from animal studies do not always translate directly to similar results in humans. Moreover, antioxidants will not help in case of a severe overdose, and supplementing strong antioxidants on a regular basis can be harmful in itself. That said, it is probably not harmful to take an antioxidant supplement when using MDMA, if only to be on the safe side. 5-HTP/L-tryptophan
Many users report that the supplement 5-HTP (which is converted to serotonin in the body) can reduce and prevent the depressive symptoms that often appear a few days after taking MDMA. If you decide to take 5-HTP, it is recommended to combine it with green tea extract, which contains high levels of ECGC (epigallocathchin gallate). This is because ECGC prevents the body from converting the extra 5-HTP into serotonin outside of the brain, so that one avoids unwanted high levels of serotonin in the rest of the blood stream. (Note, however, that this combination may cause digestion problems.) In any case, never take 5-HTP before or during MDMA, as this can increase the risk of serotonin syndrome; wait at least several hours after the effects have worn off, or even until the next day. Take as recommended by the manufacturer for up to a few days, or until the low mood goes away.