The use of ecstasy or MDMA is relatively rare, but the drug has recently become more popular, as it has undergone testing for PTSD treatment [1]. However, there are some concerns about post-MDMA depression [2], which will be discussed below.

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].
One concern related to ecstasy centers on its role in the serotonin system. Most of the effects of MDMA, such as feelings of warmth and happiness, are a result of serotonin, as this neurotransmitter plays a role in mood. When a person uses MDMA, there is more serotonin available, which can be pleasurable over the short term. However, over the long term, repeated ecstasy use can damage the serotonin system [4].
The Link Between MDMA Use and Depression
As indicated above, chronic MDMA use may damage the serotonin system, increasing the risk of depression [4]. There are several specific mechanisms by which ecstasy can harm the serotonin system and lead to depression after MDMA misuse.
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 after ecstasy use can also occur because of the withdrawal or “come down” effects associated with this drug. After stopping ecstasy use, people are likely to experience sadness, sleep problems, and fatigue, all of which align with depression symptoms [6]. In fact, after using ecstasy, around 80% of people experience some degree of rebound depression due to the serotonin depletion that occurs [7]. In simpler terms, the serotonin release during ecstasy use may result in euphoria, but the “crash” afterward is likely to lead to sadness and low energy.
Unfortunately, the damage to the brain’s serotonin system can be permanent, especially in heavy ecstasy users. When these individuals stop using ecstasy, they are likely to be left with the loss of serotonin in the brain, which can cause lasting problems related to mood, memory, and sleep [7].
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
The short-term mental health impacts associated with MDMA are generally linked to the “come down effect” of this drug. After a period of ecstasy intoxication, the body rids itself of the drug, leading to the effects associated with “coming down” from the high. Since ecstasy has some stimulant properties, its withdrawal side effects can be similar to those seen with stimulants [6].
Typical come down effects after MDMA use include feeling lethargic and moody, having a difficult time sleeping, and feeling paranoid. Irritability and depression are also common [6]. These symptoms can make it difficult to function and carry out daily responsibilities, and they can lead to deteriorating mental health.
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 [8]. 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 [8]. 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 [8]. 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 [7].
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 [9].
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][8][9]. 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 [10].
- Practice healthy lifestyle habits: The “come down” period after ecstasy use can cause depression symptoms and lethargy [6]. It’s important to be kind to yourself during this time and prioritize self-care. Establish a regular sleep schedule with a calming bedtime routine to ensure you get plenty of rest. You may not be feeling particularly motivated if you’re experiencing depression, but taking time to get some exercise and prepare nutritious foods can boost your mood. It’s also healthy and beneficial to talk to supportive people about how you’re feeling [11].
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.
- Feduccia, A. A., Jerome, L., Yazar-Klosinski, B., Emerson, A., Mitheofer, M. C., & Doblin, R. (2019). Breakthrough for trauma treatment: Safety and efficacy of MDMA-assisted psychotherapy compared to paroxetine and sertraline. Frontiers in Psychiatry, 12(10), 650. Available at: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2019.00650/full
- Roiser, J. P., & Sahakian, B. J. (2004). Relationship between ecstasy use and depression: A study controlling for poly-drug use. Psychopharmacology, 173(3-4), 411–417. Available at: https://link.springer.com/article/10.1007/s00213-003-1705-6
- National Institute on Drug Abuse. (2024). MDMA (ecstasy/molly). Available at: https://nida.nih.gov/research-topics/mdma-ecstasy-molly#work
- Montgomery, C., & Roberts, C. A. (2022). Neurological and cognitive alterations induced by MDMA in humans. Experimental Neurology, 347, 113888. Available at: https://www.sciencedirect.com/science/article/abs/pii/S001448862100296X
- Schenk, S., & Highgate, Q. (2021). Methylenedioxymethamphetamine (MDMA): Serotonergic and dopaminergic mechanisms related to its use and misuse. Journal of Neurochemistry, 157, 1714–1724. Available at: https://onlinelibrary.wiley.com/doi/10.1111/jnc.15348
- McKetin, R., Copeland, J., Norberg, M. M., Bruno, R., Hides, L., & Khawar, L. (2014). The effect of the ecstasy ‘come-down’ on the diagnosis of ecstasy dependence. Drug and Alcohol Dependence, 139, 26-32. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0376871614007522?via%3Dihub
- Parrott, A. C. (2001). Human psychopharmacology of Ecstasy (MDMA): A review of 15 years of empirical research. Human Psychopharmacology: Clinical & Experimental, 16(8), 557-577. Available at: https://onlinelibrary.wiley.com/doi/10.1002/hup.351
- Verheyden, S. L., Henry, J. A., & Curran, H. V. (2003). Acute, sub-acute and long-term subjective consequences of ‘ecstasy’ (MDMA) consumption in 430 regular users. Human Psychopharmacology: Clinical & Experimental, 18(7), 507-517. Available at: https://onlinelibrary.wiley.com/doi/10.1002/hup.529
- Thomasius, R., Petersen, K. U., Zapletalova, P., Wartberg, L., Zeichner, D., & Schmoldt, A. (2005). Mental disorders in current and former heavy ecstasy (MDMA) users. Addiction, 100, 1310-1319. Available at: https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01180.x
- Thompson, M., Li, K., Clemens, K., et al. (2004). Chronic fluoxetine treatment partly attenuates the long-term anxiety and depressive symptoms induced by MDMA (‘ecstasy’) in rats. Neuropsychopharmacology, 29, 694–704. Available at: https://www.nature.com/articles/1300347
- National Institute of Mental Health. (2024). Depression. Available at: https://www.nimh.nih.gov/health/topics/depression
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MentalHealth.com is a health technology company guiding people towards self-understanding and connection. The platform provides reliable resources, accessible services, and nurturing communities. Its purpose is to educate, support, and empower people in their pursuit of well-being.
Dr. Jenni Jacobsen, PhD is a medical reviewer, licensed social worker, and behavioral health consultant, holding a PhD in clinical psychology.
Jennie Stanford is a dual-board certified physician in both family medicine and obesity medicine, holding an MD, FAAFP, and DipABOM. She has experience in both clinical practice and peer-quality reviews.
Our Medical Affairs Team is a dedicated group of medical professionals with diverse and extensive clinical experience who actively contribute to the development of our content, products, and services. They meticulously evaluate and review all medical content before publication to ensure it is medically accurate and aligned with current discussions and research developments in mental health. For more information, visit our Editorial Policy.
MentalHealth.com is a health technology company guiding people towards self-understanding and connection. The platform provides reliable resources, accessible services, and nurturing communities. Its purpose is to educate, support, and empower people in their pursuit of well-being.