MDMA (Ecstasy/Molly)

MDMA (an abbreviation of 3,4-methylenedioxymethamphetamine), also called “Molly” or “Ecstasy,” is a lab-made (synthetic) drug that has effects similar to stimulants like methamphetamine. It is typically sold illicitly as colorful tablets with imprinted logos, capsules, powder, or liquid. Some researchers and organizations consider MDMA to be a psychedelic drug because it can also mildly alter visual and time perception. MDMA’s effects may include feeling more energetic and alert and having an increased sense of well-being, warmth, and openness toward others.

MDMA first became popular in nightclubs, but people now take it in a wide range of settings. Researchers are also studying MDMA as a treatment for depression and post-traumatic stress disorder (PTSD) in supervised clinical research trials.

A person may experience the effects of MDMA within 45 minutes or so after taking a single dose. Effects include feeling happy, energetic, alert, and closer to others.^1,2  In addition, people report increased sensitivity to sights, sounds, touch, and smells. These effects peak within 15 to 30 minutes and last an average of three hours.³ However, there may be side effects of using MDMA, some of them potentially dangerous.  See “Is MDMA Safe?”

MDMA influences the activity of at least three neurotransmitters—chemical messengers in the brain—that can strongly influence people’s mood and behavior: serotonin, dopamine, and norepinephrine. For example, serotonin is a neurotransmitter that plays an important role in the regulation of mood, sleep, pain, and appetite. Like amphetamines, which are chemically similar, MDMA enhances the release of these neurotransmitters and/or blocks their reuptake into nerve cells that send and receive signals in the brain. This increases levels of these neurotransmitters in the brain, which likely causes changes in mood, energy and visual hallucinations, or perceiving things other than reality.⁴

MDMA can cause negative health effects, some potentially serious. Its effects depend on the amount used, the purity of MDMA taken, and where and how a person is taking it. Using MDMA with other substances such as alcohol or some prescription drugs, including selective serotonin reuptake inhibitors (SSRIs), may increase the risk of negative health effects.⁵  Health risks associated with using MDMA include:

Potentially Dangerous Effects in the Body

Negative health effects of taking MDMA may include higher blood pressure, involuntary jaw clenching, nausea, vomiting, and restless legs. While deaths associated with MDMA use are rare, taking it can also lead to more severe side effects. People can experience a dangerously steep rise in body temperature, called hyperpyrexia, particularly if they are very physically active or are in a warm environment such as a club.⁶  Long-term MDMA use can also lead to heart problems or liver damage.²

Changes in Mood and Brain Function

MDMA use has been associated with anxiety and panic attacks.⁴ Studies have shown that people who regularly use MDMA may experience poor sleep, a lack of appetite, confusion, depression, anxiety, paranoia, and memory or attention problems.²

Contamination With Other Drugs

Chemical analyses of drugs sold as MDMA have shown that they may be adulterated, meaning they contain other types of drugs, perhaps without the purchaser knowing it. These hidden ingredients have included ketamine, amphetamine, synthetic cathinones (“bath salts”), 3,4-methylinedioxy-amphetamine (MDA), and methamphetamine.⁷

Taking an adulterated drug can lead to unexpected and unwelcome side effects and may increase its potential health risks. Over the past decade, illegally made opioids like fentanyl have been increasingly found in the drug supply, and have contributed to a dramatic rise in drug overdose deaths in the United States. Learn more about ways to test drugs for hidden ingredients.

Harms During Pregnancy

Only a few studies have examined the effects of prenatal MDMA exposure, but evidence suggests that children born to people who took MDMA during pregnancy had an increased risk of birth defects, including heart problems and developmental delays in motor skills like standing and walking.^8,9 

Research suggests MDMA is potentially addictive, although more research is needed. Some people who use MDMA do report symptoms of an MDMA-related substance use disorder.¹⁰ These symptoms include continued use despite negative side effects, tolerance—which is needing to take increasingly larger amounts of a drug for the same effects—withdrawal side effects, and craving.

Studies have also shown that animals will self-administer MDMA—an important indicator of a drug’s addictive potential. However, those studies show that animals did not take MDMA as much as some other addictive drugs, such as cocaine.² 

However, to be diagnosed with a substance use disorder, a person must meet specific diagnostic criteria for continued substance use despite negative consequences. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)—a reference text professionals use to diagnose substance use disorders and other psychiatric disorders—includes diagnoses of phencyclidine (PCP) use disorder and “other hallucinogen use disorder” but does not include substance use disorder diagnoses related to other specific psychedelic and dissociative drugs.

The U.S. Food and Drug Administration (FDA) has not approved MDMA as a treatment for any medical condition. However, the FDA has designated MDMA a breakthrough therapy to expedite research for it as a treatment for post-traumatic stress disorder. MDMA is always administered under medical supervision during research studies, usually in combination with treatments such as talk therapy. For more information, see “Psychedelic and Dissociative Drugs as Medicines.”