Ecstasy Withdrawal: Causes, Symptoms, and Treatment

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Ecstasy (MDMA), a Schedule I controlled substance, is a psychostimulant drug that produces both hallucinogenic and stimulant effects. Many people who use ecstasy or MDMA report experiencing withdrawal symptoms when they stop taking it. Ecstasy withdrawal can be unpleasant and may lead people to continue using MDMA to stave off these symptoms. Fortunately, a professional detox program can help manage ecstasy withdrawal.^1,2

What Causes Ecstasy Withdrawal?

When you use a drug like ecstasy over an extended period of time, your brain and body begin to adapt to the presence of MDMA in what is called “neuroadaptations.” These neuroadaptations involve changes to various neurotransmitter systems in your brain’s effort to create equilibrium. Because ecstasy increases the activity of the neurotransmitters, dopamine, serotonin, and norepinephrine, your brain may respond by reducing the number of receptor sites for these neurotransmitters because it is used to the stimulatory action of MDMA. This manifestation is known as physiological dependence, which means you need to keep using the drug to function optimally.²

If you suddenly stop using ecstasy after becoming dependent on it, you’ll experience ecstasy withdrawal symptoms. These symptoms are the brain and body’s response to a lack of ecstasy in the system. And without MDMA, dopamine, norepinephrine, and serotonin levels are drastically reduced, which is what causes these unwanted symptoms.²

Ecstasy is a relatively unique drug in that even if you aren’t dependent on it, you may experience symptoms that resemble MDMA withdrawal but they are actually referred to as a “come-down.” You don’t have to be dependent on ecstasy to experience the aftereffects of ecstasy intoxication. Anyone who uses ecstasy, particularly in large doses, will likely feel a comedown, characterized by extreme fatigue and sadness.^3,4,5

Ecstasy Withdrawal Symptoms

Ecstasy withdrawal symptoms may include:^2,6

Fatigue, or loss of energy
Reduced appetite
Depressed mood
Difficulty concentrating

The symptoms of ecstasy withdrawal differ from the after-effects experienced in the hours and days following ecstasy use. Some of the effects of an ecstasy come-down include:²

Decreased sexual desire or satisfaction
Problems sleeping
Depression
Anxiety
Memory problems
Inattention
Difficulty concentrating
Lowered appetite
Impulsivity
Aggressive behavior or thoughts
Irritability

Long-term health consequences stemming from ecstasy use may include:⁷

Irregular heart activity
Heart disease
Impulsive behavior
Impaired brain or cognitive functioning

If you are concerned that you or someone you know is struggling with ecstasy use or withdrawal, call our 24/7 helpline at 800-681-1058 (Who Answers?) to speak to a treatment support specialist about rehab or detox options.

Withdrawal Timeline

Ecstasy’s effects tend to wear off within about six hours, after which individuals may begin to feel the come-down effects, such as fatigue and depression. But it’s common for people to take second or even third doses of ecstasy in order to keep the high going, which would delay the withdrawal timeline.²

There is no established timeline for ecstasy withdrawal and the length of withdrawal depends on many factors, such as:

Individual biology and physiology
Age
Metabolism
Gender
History of substance use
Presence of co-occurring mental health disorders
How much ecstasy is typically used
How long the person’s been using ecstasy
Environmental factors, such as stress

Is Ecstasy Withdrawal Dangerous?

While ecstasy withdrawal does not tend to be as severe or complicated as that of other substances, such as heroin, prescription opioids, benzodiazepines, and alcohol, it can be dangerous if the person’s depression is profound and leads to suicidal ideation or behaviors. If someone already has clinical depression, then ecstasy withdrawal could exacerbate it, leading to potentially harmful consequences.

In such cases, you or someone you know should seek medical or mental health care immediately. A hospital can help you detox from ecstasy safely while also providing you with counseling. Once you are medically stabilized and have successfully detoxed from MDMA, the treatment team can transition you to a dual diagnosis program where you’ll receive treatment for you ecstasy addiction and co-occurring depression.

Detox: Managing Ecstasy Withdrawal Symptoms

The detox process describes a set of medical services that allow you to safely remove a substance like ecstasy from your system.⁸ Now commonly referred to as withdrawal management, these services can occur across several settings. Where you choose to seek withdrawal management services may depend on the severity of your MDMA withdrawal symptoms.

Some people may experience potentially life-threatening medical, behavioral, or psychological concerns during the withdrawal process.⁸ A hospital setting with medical services can offer a safe environment for a person to get the comprehensive support they need.

For less severe ecstasy withdrawal symptoms, inpatient or residential settings can facilitate the withdrawal management process.⁸ These facilities may offer support for other aspects of recovery. Either setting can help you get connected with a substance use treatment program once you overcome withdrawal symptoms.

Withdrawal management services can also take place in outpatient settings, which involves living at home and attending detox sessions at a clinic. This option is best if someone is experiencing mild withdrawal symptoms or has a strong internal motivation to quit.

Risk of Overdose After Ecstasy Withdrawal

An ecstasy overdose can occur when a person takes so much of this drug that their body struggles to safely process it.⁹ This experience, also known as toxicity, can cause potentially life-threatening damage to your body.

Many dealers cut ecstasy with other substances, such as fentanyl, which can result in accidental overdose due to its extremely high potency. Intentionally mixing ecstasy with other substances can also increase your risk of overdose.⁹

The period following withdrawal can also increase your risk of overdose. Individuals who relapse or return to using MDMA after a period of abstinence may have a lower tolerance to the substance. And if they return to the same dose they were previously using, their body may be unable to handle this amount and it could result in severe and dangerous effects.

Overdosing on pure ecstasy (as opposed to ecstasy that’s cut with other drugs like fentanyl or methamphetamine or cocaine) is a rare occurrence.⁷ However, it can happen. The symptoms of ecstasy overdose may include:⁷

Panic attacks
Seizures
Losing consciousness
Elevated blood pressure
Fainting
Death

Treat every overdose like an emergency. Seek medical attention right away if you think you or someone else using this substance has begun to overdose.

Transition to a Rehab Program

Completing ecstasy withdrawal management and detox serves is an important first step on the continuum of addiction care but it likely won’t create lasting changes. For that, you’ll need to enter an ecstasy addiction treatment program, either on an inpatient or outpatient basis. At a rehab program, you’ll learn many types of relapse prevention skills that can help you obtain and maintain sobriety in the long run. These skills may include:

Healthy coping strategies
Drug refusal skills
Sober social skills
Anger management skills
Emotional regulation strategies

Ecstasy addiction treatment programs use various interventions to help you develop the skills you need in early and long-term recovery. Some approaches to treatment that can help you overcome MDMA addiction include:⁸

Regular and comprehensive assessments
Individual therapy
Family therapy
Group therapy
Case management
Holistic interventions
Medical treatment
Mutual support groups
Relapse prevention planning

Different programs offer different approaches to therapy and recovery support.⁸ Therapy can help you examine your thoughts, feelings, and actions, especially as they relate to ecstasy use. A qualified substance use provider can also help you manage the personal challenges associated with addiction. Some approaches to ecstasy addiction therapy include:

Cognitive behavioral therapy
Motivational interviewing
Brief therapy
Mindfulness
Skills training
Contingency management

Case management services can help you manage the logistics of starting a treatment program. If you have chosen to engage in withdrawal management services, talk with treatment staff about transitioning to long-term care. Together, you can address several potential barriers to accessing treatment including:⁸

Work
Finances
Childcare
Pets
Medical concerns
Transportation
Location
Motivation
Medication management

Increase your access to support by connecting with a substance use treatment provider. They can walk you through the process of examining your needs, building a recovery-focused lifestyle, and shaping connections that promote your health and wellness.

For more information on treatment for ecstasy use and withdrawal, call 800-681-1058 (Who Answers?) today to speak with a treatment specialist about your recovery options.

Resources

Montvilo, R. K., Ph.D. (2019). MDMA. Salem Press Encyclopedia of Health.
National Institute on Drug Abuse. (2020, June 15). MDMA (ecstasy/molly) DrugFacts.
American Psychiatric Association. (2013). Substance-related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
McKetin, R., Copeland, J., Norberg, M. M., Bruno, R., Khawar, L., & Hides, L. (2013). Should withdrawal be included in a diagnosis of ecstasy dependence?: Paper 182. Drug and Alcohol Review, 32 Supp. 1, 51.
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.
National Institute on Drug Abuse. (2020, August 20). Commonly used drug charts.
National Institute on Drug Abuse (September 2017). MDMA (ecstasy) abuse research report.
Miller, W. R., Forcehimes, A. A., & Zweben, A. (2019). Treating addiction: A guide for professionals. The Guilford Press.
Hoey, N.M. (2019). Overdose. Salem Press Encyclopedia of Health. Salem Press.