Ecstasy (MDMA) Withdrawal:  Symptoms, Effects, and Treatment

Ecstasy, or 3,4-methylenedioxy-methamphetamine (MDMA), is a manmade drug that has both stimulant and hallucinogenic properties. It increases energy, warmth, a sense of closeness, and pleasure while enhancing and distorting the senses.

There are conflicting reports as to the drug’s addictive nature. The National Institute on Drug Abuse (NIDA) reports that ecstasy use can lead to tolerance, physical dependence, withdrawal symptoms, and continued use regardless of the knowledge that doing so will have negative physiological or physical consequences. The journal Drug and Alcohol Dependence reports that ecstasy abuse can lead to dependence, just to a lesser extent than many other drugs. Before dependence often comes tolerance, which occurs when a person’s body gets used to certain levels of a drug. When this happens, an individual may need to take more and more of the drug to keep feeling any of its desired effects. Increasing the dosage can raise the rate of dependence and heighten the odds for addiction, or compulsive drug use.

When someone uses ecstasy, the National Institute on Drug Abuse (NIDA) publishes that the activity of three of the brain’s chemical messengers are impacted and artificially increased: serotonin, dopamine, and norepinephrine. Serotonin is responsible for regulating moods, appetite levels, sleep functions, and sexual arousal. Dopamine increases pleasure and energy levels, while norepinephrine elevates blood pressure and heart rate.

The effects of ecstasy may only last a few hours, leading individuals to “stack” the doses or use the drug in a binge pattern, taking more than one dose back to back. When ecstasy then wears off, individuals may experience a difficult “crash” and feel fatigued, depressed, anxious, impulsive, and irritable. In some cases, users may become aggressive, and have difficulty sleeping, a depressed appetite, and trouble concentrating and remembering things. Repeated use of ecstasy can interfere with normal brain chemistry and potentially lead to dependence and uncomfortable withdrawal symptoms when use is stopped.


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Withdrawal Symptoms and Potential Side Effects

As the levels of dopamine, serotonin, and norepinephrine drop as ecstasy processes out of the bloodstream, individuals may experience withdrawal symptoms. Ecstasy withdrawal is typically thought to be more psychological than physical in nature.

Symptoms may include:

  • Fatigue
  • Depression
  • Anxiety
  • Irritability
  • Attention and memory issues
  • Insomnia
  • Decreased interest in sex
  • Hostility
  • Mood swings
  • Loss of appetite
  • Paranoia
  • Lack of motor control
  • Mental confusion
  • Panic attacks
  • Depersonalization
  • Psychosis
  • Irritability
  • Hallucinations and delusions

The Drug Abuse Warning Network (DAWN) publishes that almost a quarter-million people in the United States received emergency medical care in an emergency department (ED) for a negative interaction with ecstasy (MDMA) in 2011. Chronic ecstasy use disrupts the normal production and transmission of serotonin in the brain, which can lead to life-threatening serotonin syndrome. If ecstasy is combined with an SSRI (selective serotonin reuptake inhibitor), a common form of antidepressant medication, the risk for severe serotonin syndrome is greatly increased, the International Journal of Adolescent Medicine and Health warns. Serotonin production can be extensively damaged by ecstasy abuse, and the reduction in this important brain chemical can take a significant amount of time to reverse after ecstasy use is stopped.

The journal Clinical Correlations reports that long-term ecstasy use can lead to significant cognitive issues, including difficulties with executive processing, problem-solving, logical reasoning, and emotional intelligence as well as overall mental dysfunction. An individual who uses ecstasy regularly may have trouble regulating their emotions or feeling any kind of pleasure whatsoever without ecstasy. Suicidal thoughts, behaviors, and actions may be the unfortunate result of ecstasy withdrawal.

Ecstasy Withdrawal Timeline and Influencing Factors

Generally speaking, withdrawal symptoms may start within 12 hours or so after the last dose of ecstasy and peak after a few days. It can take time for the brain to stabilize itself and for levels of norepinephrine, dopamine, and serotonin to return to normal, meaning that some of the withdrawal symptoms may persist for a few weeks or even months after stopping use. The longer a person used ecstasy, and the higher the dosage, the more intense and longer in duration the withdrawal symptoms will likely be.

Ecstasy is often used in conjunction with other drugs, which can extend and further complicate withdrawal. Co-occurring medical and mental health disorders can also influence the withdrawal timeline and the severity of the possible side effects.

Biological and genetic factors factor into the intensity and duration of withdrawal. Things like metabolism, age, gender, and a family or personal history of addiction can be mitigating factors, for instance. Environmental aspects can also play a role in ecstasy withdrawal, as high levels of stress, exposure to trauma, and lack of a supportive home environment can increase some of the negative psychological symptoms and potentially exacerbate cravings.

Medical Detox for Ecstasy Withdrawal

Medical detox offers the safest and most effective means of withdrawal. It provides a stable and safe environment where ecstasy can process out of the body while helping the individual reach a physical and psychological level of stability before continuing on in treatment.

Ecstasy withdrawal is not typically considered to be physically life-threatening as withdrawal from other drugs and alcohol may be; however, this is not to say that the side effects may not be intense and significant. Anxiety, insomnia, and depression can be particularly difficult, and a medical detox program can help to manage these symptoms of ecstasy withdrawal.

In a medical detox program, individuals are admitted to a specialized facility that provides medical and mental healthcare and supervision 24 hours a day, seven days a week. The environment is calm and secure, and individuals are encouraged and supported around the clock. Relapse and cravings can be minimized through supportive care and therapeutic methods.

Currently, there are no specific medications approved to treat ecstasy dependence or withdrawal; however, different pharmacological tools may be helpful in managing specific symptoms. For instance, sleep aids may help to combat insomnia, and this can be essential as a healthy amount of sleep enhances healing. In a similar fashion, antidepressant medications may help to replenish serotonin and/or dopamine levels in order to manage depression and anxiety.

Individuals who have abused ecstasy on a long-term basis often suffer from lost appetite, malnutrition, and even possible weight loss or anorexia. Nutritional deficits can be rectified via regular, healthy, and balanced meals that are provided in a professional detox program. Dehydration can be a result of ecstasy abuse, and this can be addressed with increased fluids during detox. When a person is well-rested and nutritionally balanced, they are more able to think clearly and make better decisions; thus, they are better equipped to avoid relapse.

Medical detox programs generally last 5-7 days. While they are an essential component of recovery, further treatment is needed. Ideally, clients progress directly from medical detox into a comprehensive addiction treatment program.

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