3,4-Methylenedioxymethamphetamine (MDMA) is a potent empathogen–entactogen, which means that it belongs to a class of drugs that produce experiences of empathy, emotional openness, oneness, and interrelatedness. MDMA is commonly seen in tablet form known as ecstasy. In crystal form, MDMA is colloquially referred to as molly or mandy. This drug is primarily used for recreational purposes to achieve feelings of pleasure, empathy, and increased energy. When taken by mouth, the individual can start to experience the effects in 30-45 minutes and they last for 3-6 hours. Aside from recreational purposes, MDMA can also be used for medical purposes. In 2017, the United States Food and Drug Administration (FDA) approved MDMA-assisted psychotherapy for the treatment of mental health conditions such as post-traumatic stress disorder (PTSD).
In the serotonergic neurons (unique resource of the neurotransmitter/brain chemical serotonin), extracellular MDMA significantly increases the amount of serotonin in the synaptic clefts which are junctions through which signals from the neurons/nerve cells can be sent to each other. It does this by binding to serotonin transporters (SERT). Intracellular MDMA also boosts serotonin release by inhibiting vesicular monoamine transporter 2 (VMAT2) and monoamine oxidase A (MAO-A). Since the neurotransmitter serotonin regulates mood and is known as the body’s natural “feel good” chemical, increasing serotonin levels may help treat mood disorders such as anxiety, depression, and PTSD.
PTSD is a disorder that develops in individuals who have experienced a terrifying or dangerous event. Symptoms may include flashbacks, severe anxiety, nightmares, and uncontrollable thoughts about the stressful event. MDMA causes the release of oxytocin (also known as the “love hormone”) in the brain, which creates feelings of trust, bonding closeness, desire, and social recognition. When combined with psychotherapy or talk therapy, MDMA can help reduce symptoms of PTSD and improve the quality of life of affected individuals.
Studies show that MDMA administration in addition to psychotherapy may produce beneficial effects in the treatment of PTSD:
MDMA binds to serotonin transporters (SERT) and boosts serotonin release by inhibiting vesicular monoamine transporter 2 (VMAT2) and monoamine oxidase A (MAO-A). With increased serotonin levels, the overall mood can be improved since this neurotransmitter regulates mood and is known as the body’s natural “feel good” chemical.
Studies found that MDMA can help improve mood through its antidepressant and anti-anxiety effects:
Narrative reports and data from early investigations found that MDMA may indirectly activate 5-HT2A receptors, which are known to control the neurochemical and behavioral effects of addictive substances including alcohol.  In addition, MDMA has anti-anxiety and antidepressant effects – both of which can help treat alcohol addiction since the disorder is associated with traumatic experiences and depression.
Evidence suggests that MDMA administration can help address the symptoms of alcohol addiction:
MDMA side effects are very uncommon. There have been some side effects associated with the use of this drug wherein the patient had one of the issues listed below at some point while being on MDMA. However, these side effects weren’t confirmed to be associated with the treatment and could have been a coincidence and not related to the use of MDMA. Despite this, it was listed as a side effect associated with MDMA even though these associated side effects are very uncommon.
Side effects associated with MDMA may include the following:
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