The Link Between Ecstasy Use and Depression

What is MDMA?

MDMA, also called ecstasy, is a synthetic drug, meaning it’s made in a lab. Experts often refer to it as a psychedelic drug because it can alter perception.

In addition to this effect, ecstasy tends to elicit feelings of warmth and love. After taking ecstasy, a person is likely to feel quite happy because it increases levels of brain chemicals like dopamine and serotonin, which play a role in mood⁠^[3].

MDMA was originally known as a “club drug” because people tended to use it in nightclubs. Recently, there has been an interest in using ecstasy to treat conditions like PTSD, so its use has expanded beyond the party scene. Nonetheless, ecstasy still remains a controlled substance, and it doesn’t currently have approved medical uses⁠^[3].

MDMA can produce euphoria and altered perception, but its effects can also include anxiety, confusion, depression, and sleep problems. These risks should not be reduced to a simple claim that one neurotransmitter explains every person’s mood response⁠^[4].

The Link Between MDMA Use and Depression

Depressive symptoms can occur in connection with MDMA use. Their presence warrants attention, but symptoms alone do not prove permanent damage to the serotonin system or establish the cause of a depressive disorder⁠^[4].

First, with chronic ecstasy use, the serotonin release following ecstasy use decreases. So, if a person uses MDMA to boost mood, these effects will weaken over time. Additionally, repeated MDMA use reduces levels of serotonin in general, which can also contribute to depression⁠^[5].

Depression and sleep problems are among the reported adverse effects of MDMA. The severity and duration can vary, and a single percentage should not be used to predict an individual’s experience after taking the drug⁠^[4][6].

Mood symptoms after MDMA use should not be assumed to reflect irreversible brain damage. Their course and possible causes need assessment, especially when symptoms persist or worsen.

Short-term and Long-term Mental Health Risks of MDMA Use

People may experience temporary bouts of joy and pleasure while using ecstasy, but these effects usually aren’t long-lasting. In fact, over time, MDMA use can lead to mental health problems. Some of these problems are seen immediately after MDMA use, whereas others develop with prolonged misuse of the drug.

Short-term Mental Health Effects of MDMA

MDMA has stimulant and hallucinogenic effects. Anxiety, confusion, low mood, and sleep problems can occur, so feeling distressed after use should be taken seriously⁠^[4].

Reported psychological effects of MDMA include anxiety, depression, paranoia, and sleep problems. Persistent or severe symptoms need clinical assessment rather than being dismissed as an inevitable “come down.”⁠^[4]

The come down effects noted above are not the only negative consequences associated with MDMA use. In one study, a majority of MDMA users stated that they experienced low mood and concentration problems between episodes of using the drug⁠^[7]. This suggests that when ecstasy users are not under the influence of the drug, they are likely to experience poor mental health until the next time they can use it.

Long-term Mental Health Effects of MDMA

Some of the negative mental health effects of ecstasy are linked to coming off the drug after a period of short-term use. On the other hand, there are some long-term consequences that may persist, particularly with chronic MDMA use. Depression is one such consequence that has received attention⁠^[2].

So, can MDMA cause depression? There is some evidence that it can, especially with long-term use. In a study of MDMA users, 37% stated that depression was a side effect of long-term use⁠^[7]. Another study found that current and past MDMA users scored higher on a depression scale than people who had never used drugs.

However, MDMA users experienced similar levels of depression when compared to users of other illicit drugs. Study authors concluded that MDMA depression likely results from physical side effects of the drug, such as sleep problems and weight loss⁠^[2].

Regardless of the specific cause of MDMA-related depression, some evidence suggests that long-term MDMA users seem to experience higher levels of depression than those who never use the drug. This is not surprising, given the fact that MDMA can damage serotonin neurons and, therefore, negatively impact mood⁠^[2].

Depression is not the only long-term mental health effect associated with MDMA. Among long-term MDMA users, 38% report that they struggle to concentrate⁠^[7]. This can make it difficult to function in settings like school and work, where attention to tasks is necessary.

MDMA use also leads to deficits in an area of the brain called the hippocampus, which plays a role in memory. As such, long-term ecstasy users may have problems with learning and memory⁠^[6].

Finally, people who use ecstasy over the long term may develop an addiction to the drug, although this is very rare. When an addiction develops, a person will continue to use ecstasy despite dangers and other negative consequences.

Some research suggests that people who become dependent on ecstasy are at risk of developing anxiety disorders. They are also at high risk of cognitive problems with long-term MDMA use⁠^[8].

How to Prevent MDMA-Related Depression

The most effective way to prevent MDMA-induced depression is to avoid using this drug. There are no legally-accepted medical uses for MDMA. If used to self-medicate depression, ecstasy may make depression symptoms worse over the long term⁠^[2][7][8]. So, ecstasy should not be used at home to treat depression or other mental health problems.

Studies assessing the use of MDMA for treating mental health disorders are highly controlled and involve supervision from medical professionals⁠^[1]. The best course of action is to always reach out to a professional, such as a physician, psychologist, or clinical social worker, rather than attempting to self-medicate mental health symptoms.

That being said, current and former MDMA users may be experiencing depression symptoms and seeking relief. If you’re using or have used MDMA, the strategies below can be beneficial for coping with post-MDMA depression:

• Seek addiction treatment: If you’re experiencing depression as a result of MDMA use, but you’re unable to stop using the drug, you may be struggling with addiction. In this case, it can be beneficial to seek addiction treatment. Individual and group therapy can help you develop coping skills and learn to manage stressors without turning to MDMA use.
• Participate in professional depression treatment: You may experience chronic depression with long-term MDMA use, but treatment is available. Reach out to a mental health professional who can provide counseling to help you cope with symptoms of depression. A doctor can also prescribe anti-depressant medications, which can be helpful, even for cases of MDMA depression⁠^[9].
• Practice healthy lifestyle habits: Rest, regular meals, and support from trusted people can complement care, but they do not replace assessment of persistent or severe mood symptoms after MDMA use. Seek urgent help for severe physical symptoms or immediate safety concerns⁠^[4][10].

If you’re experiencing depression after MDMA, you’re not alone. Professional treatment is available, and there’s no shame in reaching out for help. Contact a local mental health agency to obtain information about treatment or community resources, or talk to a trusted friend or family member if you need support in seeking assistance.

Subject matter expert

Simone Hoermann Ph.D.

Personality disorders, anxiety, and depression

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