Ecstasy Withdrawal: Symptoms, Timeline & Detox Treatment

What is Ecstasy?

Ecstasy, or 3,4-methylenedioxy-methamphetamine (MDMA), is a manmade, psychoactive drug that has both stimulant and hallucinogenic properties.^1,2 Its intoxicating properties can have an energizing effect, distort perceptions and time, and increase pleasure from sensory experiences.¹ Ecstasy may be referred to as MDMA, Molly, X, and more.

Ecstasy Withdrawal Symptoms

The effects of ecstasy typically last 3-6 hours, but individuals may take a second dose as the effects of the initial dose fade or use the drug in a binge pattern, taking more than one dose back-to-back. After about a week of such use, individuals may experience issues such as irritability, impulsivity, sleep disturbances, anxiety, memory and attention problems, and a disinterest in sex.³ When ecstasy use stops, some individuals, who repeatedly take the drug, report withdrawal symptoms, which may include:³

• Fatigue.
• Depression.
• Difficulty concentrating.
• Loss of appetite.
• Sleep issues.
• Anxiety.
• Irritability.

What Causes MDMA Withdrawal & Addiction?

Ecstasy impacts and artificially increases the activity of three of the brain’s chemical messengers—serotonin, dopamine, and norepinephrine.³ Serotonin is a neurotransmitter involved with mood regulation, appetite, sleep, and sexual arousal. Dopamine impacts energy and activity and is instrumental in rewarding or reinforcing pleasurable behaviors. Norepinephrine is important for a range of physiological functions, and an increase in its activity can lead to a rise in blood pressure and heart rate.³

There are conflicting reports as to the addictive nature of MDMA. Ecstasy affects many of the same neurotransmitters in the brain that other known addictive substances target.¹ Some individuals report several features common to addiction in connection with their ecstasy use, including the development of tolerance (needing to take more of the drug to achieve the desired effect), physical dependence and an associated withdrawal syndrome, as well as patterns of continued use regardless of the knowledge that doing so will have negative physiological or physical consequences.¹ On the other hand, some studies suggest that ecstasy addiction may be relatively less likely than with other drugs more commonly associated with compulsive patterns of use because ecstasy’s rewarding effects sharply decline and unpleasant effects increase with frequent use of the drug.⁴

Additionally, though people may develop compulsive patterns of ecstasy use, such cases of ecstasy addiction and related symptoms are often less profound than those seen with other substances, including alcohol, opioids, cocaine, and methamphetamine. Similarly, though people may experience withdrawal when they stop taking ecstasy, it may include less significant physical symptoms than those associated with many other substance withdrawal syndromes.⁵

Ecstasy Withdrawal Timeline and Factors Affecting Withdrawal

Though the phenomenon of MDMA withdrawal hasn’t been as robustly studied or well documented as many other addictive substances, withdrawal symptom severity and progression has been reported as similar to a relatively mild stimulant withdrawal.^6,7 Generally speaking, stimulant withdrawal symptoms can start within 24 hours after last use and resolve over the course of the next 3-5 days.⁸ Factors that influence the length and intensity of withdrawal symptoms may include average amount or dose, frequency, and duration of ecstasy use.

Additionally, polysubstance use (using other substances such as marijuana and alcohol in conjunction with ecstasy) may extend and further complicate withdrawal and increase the individual’s risk for other harmful health effects.³ Co-occurring medical and mental health disorders can also influence the withdrawal timeline as well as the character and severity of withdrawal effects.⁹

Ecstasy Comedown Vs. Withdrawal

Some studies have indicated that what is often described as an ecstasy “comedown” may differ somewhat from more concrete phenomenon of ecstasy dependence and withdrawal. The comedown or “crash” refers to the acute recovery phase following ecstasy use.¹⁰ Similar to a hangover some individuals may feel after a night of drinking, ecstasy can produce a comedown that some may feel 1-3 days after use with symptoms that may include:¹⁰

• A general dissatisfaction with life.
• Depression.
• Lethargy.
• Irritability.
• Anxiety.
• Agitation.
• Abnormal increase in appetite.
• Excessive sleepiness.

The comedown symptoms and timeline mimic ecstasy withdrawal symptoms, making it difficult to differentiate between the two.¹⁰ The difference is that withdrawal occurs after abruptly stopping the drug after long-term use; comedown can take place after a single episodic use of ecstasy.¹⁰

Dangers and Long-Term Effects of Ecstasy Use

Among people aged 12 and older, 2.6 million people reported using MDMA in 2020, in the United States.¹¹ In 2021, approximately 0.6% of 8th-grade students, 0.7% of 10th-grade students, and 1.1% of 12th-grade students reported using MDMA within the previous 12 months.¹²

There are several adverse health effects associated with long-term ecstasy use. High doses of MDMA can interfere with the body’s ability to regulate temperature, causing it to spike, which, in rare instances, can lead to kidney failure, heart failure, and death.³

Additionally, a condition known as serotonin syndrome has been described in association with ecstasy use. Though the condition is relatively uncommon, its effects can be exacerbated by certain environmental conditions (such as hot ambient temperatures and physical activity), potentially resulting in severe, lasting, and/or life-threatening health effects.¹³ Similarly, if ecstasy is combined with an SSRI (selective serotonin reuptake inhibitor), a common form of antidepressant medication like Prozac, the risk for severe serotonin syndrome is greatly increased.¹⁴ Serotonin syndrome symptoms may include:^13,15

• Elevated body temperature.
• Sweating.
• Dry mucous membranes.
• Flushed skin.
• High blood pressure.
• Rapid pulse.
• Arrhythmias (abnormal heart rhythm).
• Rapid breathing.
• Respiratory distress.
• Headache.
• Gastrointestinal issues (e.g., nausea, vomiting, diarrhea).
• Confusion.
• Disorientation.
• Neuromuscular hyperactivity.
• Psychomotor agitation.
• Seizures.
• Rhabdomyolysis (muscle cell damage).
• Metabolic acidosis.
• Kidney injury or renal failure.

Furthermore, some cognitive issues might result from long-term ecstasy use though there is conflicting evidence on the topic. Some studies suggest that working memory, fluency, and abstract reasoning deficits exist among ecstasy users.¹⁶ Other research, on the other hand, shows executive functioning largely intact despite prolonged ecstasy use.¹⁶

When to Seek Professional Help for Ecstasy Addiction

Individuals who use ecstasy may not think they have a problem. They may view the substance safe to use in moderation. Yet, there are warning signs to look for in someone who uses ecstasy. Problematic ecstasy use may include:¹⁷

• Pulling away from friends and family and avoiding social functions due to ecstasy use.
• An inability to cut down or stop despite attempts to do so.
• Persistent use of ecstasy despite the negative emotional, financial, legal, medical, and mental implications it causes.
• Spending a lot of time and energy focused on buying and using the drug.
• Using more ecstasy than originally intended (such as taking back-to-back doses to maintain pleasurable effects).

Ecstasy Withdrawal Detox and Treatment

Although there are currently no medications approved by the U.S. Food and Drug Administration (FDA) for treating ecstasy addiction, medical detox can provide a stable and safe environment where any lingering acute intoxication and ecstasy withdrawal can be more comfortably managed.¹⁸ Detox is generally the first step on the path to recovery and is usually not enough on its own to help you sustain long-term recovery. Thus, after detox, treatment, which can take place in a variety of settings, continues.

Inpatient rehab centers provide you a high level of care and might be beneficial if you have a history of polysubstance use or have co-occurring mental health conditions. You’ll live onsite and receive different types of therapies and round-the-clock support and monitoring.¹⁹

Outpatient rehab allows you to live at home or in a sober living environment and attend treatment one to several times per week. It might be a good option if you have a supportive home environment or require less intensive treatment.¹⁹

Ecstasy addiction is primarily treated using cognitive-behavioral methods.¹ These techniques are designed to help people modify thoughts and behaviors that contribute to substance use and teach them healthier ways of coping with stress and other life issues.¹ People can receive cognitive-behavioral therapies in individual counseling sessions or during group therapy. Participating in mutual-help groups can be a beneficial adjunct to cognitive-behavioral treatment, as you receive support from others who are also involved in the recovery process.