What Is Ecstasy Withdrawal?
Ecstasy, or MDMA, is a synthetic “club drug” with both stimulant and hallucinogenic properties. It belongs to a class of drugs known as substituted amphetamines, but is capable of producing effects similar to LSD and mescaline. Ecstasy can affect mental and physical health, and it can cause unpleasant withdrawal symptoms. 3,5,7,8
Ecstasy Withdrawal Symptoms
The primary symptoms associated with Ecstasy withdrawal include: 1,3,5,7,8,9
- Loss of appetite.
- Difficulties with concentration.
- Unpleasant dreams.
- Cravings to use Ecstasy.
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Risks of Withdrawal
The withdrawal process from MDMA is not considered to be life-threatening. But people who are experiencing severe emotional distress are at risk for harm, and people withdrawing from Ecstasy may benefit from professional assistance.
Further, users may be unaware that Ecstasy is rarely pure MDMA, and often contains other drugs, such as ketamine, methamphetamine, cocaine, or bath salts. These drugs can be dangerous when mixed with MDMA.5 Individuals who routinely use MDMA with other drugs will generally experience more severe and lengthier withdrawal effects.
There is no formal identified timeline associated with Ecstasy or MDMA. But several studies have documented withdrawal symptoms from self-reports of Ecstasy users. The following speculative timeline is based on reports in literature:1, 2, 3, 7, 8, 9
- The initial symptoms of withdrawal will typically begin within 1 to 3 days after the last dose of Ecstasy. People may experience depression, anxiety, fatigue, loss of appetite, insomnia, irritability, drowsiness, difficulties with concentration, and headache.
- The withdrawal symptoms will typically last approximately 7 to 10 days, with the intensity of the symptoms decreasing over time. People will still experience anxiety, depression, confusion, insomnia, irritability, and fatigue.
- After 7 to 10 days, the severity of the symptoms will have diminished significantly. But the symptoms may last up to a month after the last use.
The severity of withdrawal symptoms may be influenced by a number of factors, including:
- The length of time the person used Ecstasy.
- The amount of Ecstasy he or she used.
- The use of other drugs with Ecstasy.
- Differences in individual metabolism and psychological resiliency.
Post-Acute Withdrawal Syndrome
Some people may continue to experience emotional difficulties and cravings following the withdrawal process. These symptoms are known as post-acute withdrawal syndrome (PAWS).
Although PAWS is considered more common among alcohol, benzodiazepine, and opioid users, it has been known to occur in people who abuse other drugs. 10
Symptoms of PAWS include: 11
- Sleep problems.
- Problems with memory and attention.
Causes of Withdrawal
After use, the brain is depleted of serotonin.
Ecstasy increases the activity of 3 neurotransmitters: serotonin, dopamine, and norepinephrine. After use, the brain is depleted of serotonin, and the user may experience withdrawal symptoms such as confusion, depression, sleep problems, and anxiety. The symptoms can begin days or weeks after taking the drug.
Some heavy users may experience longer-lasting confusion, depression, sleep problems, and problems with memory and attention, though these effects may be due to the use of other drugs with Ecstasy. 12
There is conflicting evidence on whether Ecstasy causes physical dependence and addiction. The pattern of Ecstasy use tends to differ from that of other addictive substances, such as alcohol, cocaine, and opioids, because daily, compulsive use is uncommon.
- Some research studies have revealed that animals will self-administer Ecstasy, which is typically a sign of high abuse potential. However, they don’t self-administer Ecstasy to the same extent as they do highly addictive drugs, such as cocaine.5
- The Drug Enforcement Administration (DEA) classifies Ecstasy as a Schedule I controlled substance, indicating that the drug has a severe potential for abuse, can cause psychological or physical dependence, and has no medicinal purposes.6
- One study on adolescents and young adults suggests that dependence, tolerance, and a withdrawal syndrome may be present in MDMA users.8
- Some sources suggest that the after-effects of the drug do not constitute a withdrawal syndrome and can lead to a false diagnosis of physical dependence.1, 9
Treatment for Withdrawal
If you need help choosing a program for Ecstasy addiction or withdrawal, call 1-888-319-2606
People who are recovering from Ecstasy addiction and withdrawal can benefit from a formal withdrawal management program where they receive medical supervision.
Following the withdrawal process, a person should consider a substance abuse treatment program that includes:
- Therapy for substance use disorders.
- Participation in social support groups.
- Dual diagnosis treatment for any co-occurring disorders and access to medical services for any medical conditions.
- Any other personalized interventions.
Individuals who simply go through the withdrawal process and do not seek formal treatment for Ecstasy abuse or addiction are at a significant risk for relapse.
Types of withdrawal and addiction recovery programs include:
- Inpatient rehabilitation programs: A person who participates in an inpatient Ecstasy recovery program may be shielded from relapse triggers present in their home environment and will be monitored around the clock so that any complications from withdrawal can be addressed immediately. Inpatient programs typically offer detoxification services to ensure that you withdraw from MDMA as safely and comfortably as possible. Once a person completes detox, he or she receives an individualized treatment plan that often includes individual and group therapy, addiction education, 12-step meetings, and other recovery activities.
- Outpatient rehabilitation programs: Outpatient rehab programs may also offer detox. Heavy users should consider medical supervision to address any potential physical or psychological complications. Outpatient programs may also include group therapy and one-on-one therapy.
- 12-step programs: Groups such as Narcotics Anonymous can help a recovering Ecstasy user see that many other people struggle with addiction. The person can receive peer support and participate in a structured program of recovery.
- Dual diagnosis programs: These are inpatient or outpatient rehab programs that can treat substance abuse and mental health disorders simultaneously. Many Ecstasy users may struggle with mental health disorders or abuse other drugs, and these problems can lead to relapse if they are not addressed.
Medications for Withdrawal
There are no approved medications to treat the symptoms of withdrawal from MDMA. However, people may receive antidepressant medications, anti-anxiety medications, and other supportive medications to manage specific physical and mental health symptoms.
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. Peroutka, S. J. (Ed.). (1989). Ecstasy: The clinical, pharmacological and neurotoxicological effects of the drug MDMA (Vol. 9). New York: Springer Science & Business Media.
. Oehen, P., Traber, R., Widmer, V., & Schnyder, U. (2013). A randomized, controlled pilot study of MDMA (±3, 4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). Journal of Psychopharmacology, 27(1), 40-52.
. Doweiko, H. (2011). Concepts of chemical dependency. Stanford, CT: Nelson Education.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing.
. National Institute on Drug Abuse. (2016). Drug facts: (MDMA: Ecstasy.
. United States Drug Enforcement Administration. (N. D.) Drug scheduling.
. Ries, R. K., Fiellin, D. A., Miller, S. C., & Saitz, R. (2014). The ASAM principles of addiction medicine. New York: Lippincott Williams & Wilkins.
. Cottler, L. B., Womack, S. B., Compton, W. M., & Ben-Abdallah, A. (2001). Ecstasy abuse and dependence among adolescents and young adults: applicability and reliability of DSM-IV criteria. Human Psychopharmacology: Clinical and Experimental, 16(8), 599-606.
. 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.
. UCLA Dual Diagnosis Program. Post-Acute Withdrawal Syndrome (PAWS).
. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal. Substance Abuse Treatment Advisory 9(1), 1-6.
. National Institute on Drug Abuse. (2012). DrugFacts: MDMA (“Ecstasy”).
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