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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • ecstasy - name given by its users to 3,4-methylene-dioxymethamphetamine (MDMA)
    • second most commonly used controlled drug (after cannabis) in Europe
    • MDMA is a ring-substituted amphetamine derivative
    • related to the hallucinogenic compound mescaline
      • does not produce the profound sensory disruptions or hallucinations associated with classical hallucinogens such as lysergic acid diethylamine (LSD)e
      • increases emotional sensitivity and empathy
        • also MDMA use associated with a loss of inhibitions; reduced anxiety; increased sense of closeness with other people
  • pharmacology
    • action in the central nervous system is complex
      • major effects on serotonin (5-hydroxytryptamine [5-HT]) pathways - however also affects two other major transmitter systems in the brain: dopamine (DA) and noradrenaline
      • use of MDMA causes an acute and rapid increase in extracellular 5-HT
        • causes a marked depletion of 5-HT from brain tissue in the first few hours following drug administration
      • in rat models 5-HT levels recover within 24 h after a single dose of MDMA; however higher doses of MDMA can result in sustained depletion of 5-HT that can last for up to 12 months
        • MDMA also blocks the activity of tryptophan hydroxylase (rate-limiting enzyme in the biosynthesis of 5-HT)
          • this effect occurs within 15 min following administration - can last for up to two weeks
  • acute toxic effects
    • malignant hyperthermia - this syndrome of persistent hyperthermia which leads to the rhabdomyolysis with subsequent renal and other organ failure
      • mechanism for this is unknown - there may be a possible role for uncoupling protein-3, a mitochondrial protein known to play a role in thermogenesis
  • neuropsychological effects of depletion of brain levels of 5-HT
    • following MDMA use
      • subjective effects reported are euphoria, changes in perception (sound and light), a reduction in defensiveness (negative affect), emotional openness, empathy and a reduction of inhibitions
        • effects are likely to be mediated via the 5-HT-system
        • the use of ectasy does not leave the user with a "neutral" mood
          • following ecstasy use there is an ‘offset’ period - during this period there is a worsening of mood - this low mood persists for several days (known as the ‘midweek blues’)
          • it has been suggested that there may be an increase in aggression/anger/anxiety occurs after taking ecstasy - tends to peak four days after taking the drug
          • effects of ecstasy on mood appear to be reversible
          • there is study evidence that indicate that depression, impulsivity, and sensation seeking do not predict first time ecstasy use in a population of young adults with the intention to start using ecstasy (2)
  • there is evidence from studies of long term MDMA use of long-term (weeks to months) impairments in memory and learning; in particular, working memory, planning ability, executive control and cognitive impulsivity

The effects of ecstasy on the cardiovascular system are described in the linked item.


  • a study investigating the safety of single or low dose of ecstasy has been undertaken (3):
    • the study showed no differences in metabolites concentrations before and after ecstasy use and found no indications for major neuronal damage after a single or low dose of ecstasy use in first time ecstasy users. Howeve the authors stated that, because there might be various factors that play a role in individual vulnerability for acute and long-term effects of ecstasy, it is not possible to state that the use of a single or low dose of ecstasy is totally safe


  1. Curr Opin Pharmacol. 2005 Feb;5(1):79-86
  2. J Psychopharmacol. 2006 Mar;20(2):226-35.
  3. Europ Neuropsychopharm 2006; 16(1): S79-S80.

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