by Isha Khurana
MDMA, otherwise known as methylenedioxymethamphetamine or ecstasy, is an empathogenic stimulant with weak hallucinogenic properties. As a stimulant, it activates the central nervous system, making one feel a burst of energy, and at high doses can alter one’s perception of reality, giving it hallucinogenic qualities.
As an empathogen, it increases a person’s empathy and benevolence towards others. It alters the serotonin levels in the brain and triggers the release of dopamine. Serotonin controls appetite, weight, sleep, and mood. They may also result in increased sociability.
Empathogens such as MDMA are usually found in pill, crystal, powder or capsule forms. Pills are usually different colours and have pictures or logos on them. They are usually swallowed but can be snorted, injected and occasionally smoked.
Today, MDMA is illegally produced in laboratories, which means that users are not aware of the strength of the dosage. More so whether the pill actually contains MDMA or not. It is highly possible for pills sold as ecstasy tablets to contain little to no MDMA.
MDMA is frequently adulterated, contaminated or outright replaced with other psychoactive substances such as synthetic cathinones (bath salts) or methamphetamine and ketamine, which may have unexpected side effects often unknown to the user.
Effects of MDMA
The effects of MDMA usually kick in about 20 minutes to an hour after it’s taken and lasts for three to four hours. The height of this experience is known as “peaking.”
While its effects may differ from person to person, some common signs of an MDMA high are:
- euphoria
- increased energy and confidence
- increased empathy and friendliness
- hyperthermia (overheating of the body)
- jaw clenching and teeth grinding (bruxism)
- heightened senses (sight, hearing and touch)
- excessive sweating and skin tingles
- muscle aches and pains
- fast heartbeat
- feeling the need to drink excessive amounts of water (can cause death)
If you take a large amount or have a strong batch of MDMA, you may also experience the following:
- depression and anxiety
- visual and auditory hallucinations
- irritability, paranoia and aggression
- floating sensations
- memory impairment
- vomiting
- convulsions (rapid muscle contractions causing uncontrollable shaking and rigid movements)
MDMA is a recreational drug, notably popular among attendees of EDM venues and events, including raves, nightclubs and dance festivals since the 1980s given its ability to induce prosocial behaviour. The spread of MDMA use to other populations, along with the rising concerns about its safety profile highlighted during the US Food and Drug Administration approval process, serves as a testament to the potential dangers it can pose to physical and psychological well-being.
- MDMA, dehydration and overheating
MDMA is often consumed at festivals, parties and nightclubs where people are likely to be dancing in crowded or hot spaces, which in combination with the effects of MDMA can raise the body temperature to dangerous levels. Severe dehydration from MDMA use causes electrolyte imbalances in the body. These fluid imbalances can acutely affect the kidney, with some cases requiring ongoing medical care.
- Drinking too much water with MDMA is dangerous.
It’s ironic how MDMA can make you want to drink more water, but too much water can be dangerous. It can result in dilutional hyponatraemia – a condition where the brain swells from drinking too much water due to low sodium levels. It may result in death or cause one to fall into a coma.
- Damage to nasal tissue from snorting of MDMA
Snorting molly means that it is absorbed by the blood vessels in the nasal passage, reaching the brain more rapidly. This could mean that the peak of the drug is more intense than with oral administration, but it also wears off quickly. This may encourage users to take more of it in a short period of time. This practice can increase the risk of overdose and addiction.
Additionally, nasal passages have frail mucous membranes, and snorting can damage the nasal tissue. It could also cause an inflammation of the nasal lining, blocking the nasal airways and respiratory tract. In severe cases it may cause people to lose their sense of smell.
- Serotonin Syndrome
Serotonin is a chemical naturally produced by the body for the nerve cells and brain to function. Typically, nerve cells in the brain and spinal cord produce serotonin that helps regulate attention, behaviour and body temperature. The intestines also produce serotonin, playing a role in regulating the digestive process, blood flow and breathing.
Serotonin in optimal amounts is necessary for bodily function; however, its excess accumulation can result in symptoms of serotonin syndrome.
While MDMA use is not always the sole factor responsible for causing serotonin syndrome, it is far more common for this syndrome to arise when ecstasy is combined with other psychotropic substances such as stimulants, opioids and anti-depressants.
Risk factors
- You recently started taking or increased the dose of a medication known to increase serotonin levels.
- You take more than one drug known to increase serotonin levels.
- You take herbal supplements known to increase serotonin levels.
- You use an illicit drug known to increase serotonin levels.
Signs and Symptoms
The symptoms usually appear within several hours of taking a new drug or after increasing the dosage of the drug one is already taking.
- agitation and restlessness
- insomnia
- involuntary muscle movements
- sweating
- shivering
- diarrhoea
- goosebumps
Some signs can be life-threatening:
- high-fever
- tremors
- seizures
Treatment
Symptoms in the case of mild serotonin syndrome may disappear within a few days of stopping the medications causing the symptoms or, sometimes, by taking serotonin blockers. On the other hand, moderate or severe cases may require cooling, fluid replacement and potential sedation and hospitalisation.
Long-term psychological impacts
- Increased glutamate levels
Prolonged MDMA use is believed to increase GLX (glutamate) levels in the striatum (the primary input centre for motor and reward pathways). Glutamate and GABA are the excitatory and inhibitory neurotransmitters in the central nervous system. Disruptions in the balance of these two neurotransmitters have been implicated in various psychiatric and neurological conditions.
Such alterations in the GLX levels may be responsible for the cognitive deficits observed among MDMA users. Ecstasy use can impair impulse control and declarative memory (conscious, intentional recollection of information and past events).
2. Impact on serotoninergic system
MDMA-induced central nervous system abnormalities are partly a result of serotonin depletion after a sudden surge following use and may damage serotonergic nerve endings from prolonged use. Heavy use is believed to reduce serotonergic neurones, which may cause depression, anxiety, mood disorders, and memory impairment commonly seen among chronic users of MDMA.
3. Anxiety and depression
Polydrug use common among ecstasy users is more likely to exacerbate its psychological impacts. Anxiety can manifest itself during intoxication and in the days following use, and may become persistent with chronic use. Sleep disturbances and other lifestyle impacts linked to regular drug use further intensify anxiety. Research indicates the presence of generalized anxiety and panic attacks among frequent users.
‘Mid-week blues’ is the term used to describe the lows in mood one may experience following MDMA use, which may continue to persist even after the immediate comedown in frequent users. The typical comedown effects of MDMA include lethargy, feeling paranoid, and difficulty sleeping.
Some users have also reported low mood and concentration problems between episodes of using the drug. This shows that users are likely to experience poor mental health when not under the influence of the drug until the next time they use it. Such dependence makes it harder for one to function normally in everyday life affecting work and relationships.
4. Cognitive decline
Several studies have shown that repeated ecstasy use can weaken episodic memory, such as immediate and delayed verbal recall. Prospective long-term deficits in memory have also been reported among users and appear to be associated with storage and retrieval difficulties. It interferes with hippocampal function, mainly through alterations in dopaminergic and NMDA receptors responsible for regulating learning and memory formation.
Reducing harm and treatment
- Avoid high doses and re-dosing rapidly during a single use
- Do not mix MDMA with other substances such as cocaine, alcohol or prescription medication.
- Checking drugs for the presence of adulterants wherever legally available
- Take regular breaks from dancing, stay in cooler environments, and sip water regularly while avoiding excessive fluid intake (approximately 250 ml per hour if active) to reduce risks of hyperthermia and hyponatraemia.
- Avoid using MDMA if you have a history of heart problems, high blood pressure, liver problems, or mental health conditions.
MDMA is a highly neurotoxic drug with life-threatening consequences upon dependence. Take a step towards sobriety today with Umeed Deaddiction and Rehabilitation Centre, offering inpatient rehab and support from licensed medical professionals that are dedicated to help you reclaim your life again.
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