Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/25/2021
Number of References: 7 Sources
Ecstasy, also referred to as MDMA and Molly, is one of the most popular party drugs used in America today. Also referred to as a “love drug” ecstasy is addictive and is capable of producing long term changes in the brain through chronic use. These effects can alter a wide range of neurological systems and processes resulting in a deep depression, anxiety disorders, and permanent mood problems. In this article, we will examine the process of ecstasy withdrawal including the symptoms, withdrawal timeline, contributing factors, and what may be done to reduce or manage these symptoms during the ecstasy detox process.
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The symptoms of acute withdrawal are identical to the symptoms of the immediate come down of ecstasy, although possibly a little less intense. This comedown commonly occurs after every instance of ecstasy use as the drug is fully metabolized. The comedown from ecstasy will typically worsen with repeated use, and the increasing severity and duration of this come down may act as an indicator of dependence. An ecstasy comedown may resolve 24 hours after the last use, and any symptoms which persist after this period may be classified as acute withdrawal.
Some of the symptoms of ecstasy withdrawal may include:
These symptoms are due to the lowered efficacy of the neurotransmitters serotonin, dopamine, and norepinephrine which results from downregulation. When someone stops using ecstasy, the levels of these neurotransmitters will drop substantially. Now that the brain is less sensitive to them via downregulation, the neurotransmitters themselves will have less of an effect. This combined action of lowered neurotransmitter levels plus the fact that they are less effective will produce profound psychological symptoms in the time immediately after ceasing ecstasy use.
While the symptoms of ecstasy withdrawal are fairly well known, there is very little reliable information available as to the exact timeline for ecstasy withdrawal. The differences in recovery timelines, as well as the symptoms experienced during withdrawal, can be quite large, and illustrate the current lack of knowledge regarding the long term effects of ecstasy in humans. This is largely due to the fact that ecstasy addiction is fairly rare when compared to addiction to other drugs.
The post-acute phase of withdrawal is less intense but much longer-lasting than the acute phase. The post-acute withdrawal syndrome from ecstasy may last for many months or years, and this can vary greatly between individuals. There have not been many controlled studies done regarding ecstasy and post-acute withdrawal, so accurate and reliable information is scarce. Of the information which is available, some of the most commonly reported symptoms of post-acute withdrawal include:
These symptoms vary greatly between individuals in terms of severity and duration. Problems with memory, problems concentrating, and cognitive deficits are by far the most commonly reported symptoms, in some cases persisting for many years. There is currently no clear picture as to the recovery rate or timeline of these symptoms.
There are many factors that contribute to the symptoms of ecstasy withdrawal which is evidenced by the great variance between individuals regarding symptom intensity and duration. Some of the factors which influence the symptoms of ecstasy withdrawal include:
The single largest contributing factor to ecstasy withdrawal intensity appears to be the amount of ecstasy someone has used. The length of time that ecstasy was used most likely plays a large role as well, however, not much research has been done focusing on chronic ecstasy use in humans.
While ecstasy is technically an amphetamine, it is considered both a stimulant and a hallucinogen as it shares structural similarity to mescaline. Like other amphetamines, ecstasy does not produce physical withdrawal symptoms. The symptoms of ecstasy withdrawal may be similar to amphetamine withdrawal, but they are typically much less intense. However, the psychological symptoms of withdrawal can be very intense and long-lasting; sometimes lasting for years, and include depression, anxiety, paranoia, cravings for ecstasy, and extreme mental fatigue. These can typically last from several weeks to several months and there are a variety of factors that contribute to the intensity and the duration between individuals.
Ecstasy’s main mechanism of action is to increase the levels of the neurotransmitters serotonin, dopamine, and norepinephrine through reuptake inhibition while also acting as a direct activator of serotonin receptors. Serotonin is a mood elevator and regulator, while dopamine acts as a mediator of memory, motivations, feeling of pleasure, and certain motor functions. Norepinephrine is a neurotransmitter that is in part responsible for emotions, learning and focus, and proper sleep regulation. Ecstasy is also hypothesized to promote the release of oxytocin in humans, but this requires further study and confirmation. Oxytocin is known to be a very important neurotransmitter that is responsible for social awareness and connection, feelings of trust and safety such as between a mother and an infant, and feelings of intimate or romantic connection.
Continued use of ecstasy will raise levels of the neurotransmitters serotonin, dopamine, and norepinephrine which is how the high from ecstasy is produced. Through continued use, and subsequently chronic elevation of these neurotransmitters, the brain will adapt through a process called downregulation. This is an attempt of the brain to protect itself from excitotoxicity which is when nerve cells become overstimulated and suffer damage or even cell death. This process reduces sensitivity to these neurotransmitters. This will protect the brain from damage, but it also produces tolerance at first, and eventually physical dependence. The brain gets used to the elevated levels due to chronic ecstasy use, makes subsequent adjustments, and once this happens the brain will be out of balance once ecstasy is removed.
Withdrawal from ecstasy can be a very slow and painful process. It may last for weeks, months, or possibly even years. The brain must reverse the changes it made due to chronic ecstasy use through a process called upregulation. This is the act of increasing neurotransmitter sensitivity back to a normal level; the levels prior to ecstasy use. This is a slow process, and the duration of this process can vary greatly between people. There are different phases of withdrawal from ecstasy. The immediate and most intense phase is known as acute withdrawal and this phase is experienced while upregulation is taking place. The longer-lasting but less intense phase is referred to as post-acute withdrawal, and this phase can commonly last for months.
Entering an ecstasy detox center can be an enormous benefit as far as recovery from ecstasy addiction and withdrawal treatment is concerned. The medications, therapies, and medical monitoring provided by these facilities can reduce the risks and the symptoms of withdrawal, and help provide resources for someone beginning the journey of recovery. These centers are an invaluable benefit to anyone attempting to complete ecstasy withdrawal and will help provide a solid foundation for life after ecstasy addiction.
Ecstasy Detox CentersThere are several other drugs that can produce uncomfortable or even dangerous withdrawal symptoms. We have more in-depth withdrawal guides for drugs such as:
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