Detox Local

Ecstasy Withdrawal & Detox

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/14/2020

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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What is Ecstasy Withdrawal?

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. It is highly recommended for someone to enter an ecstasy detox center if they are expecting to undergo withdrawal, as these centers can provide care and treatment to minimize the risks.

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.

Ecstasy Withdrawal Symptoms

Withdrawal from ecstasy can be a mentally painful process. The downregulation which occurs to serotonin and dopamine, in particular, can cause extreme depression and lowered mood in the short term. These symptoms are the most intense in the days and weeks immediately after ceasing ecstasy use.

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 most common symptoms experienced during acute withdrawal include:

  • Deep Depression
  • Intense Anxiety
  • Extreme Fatigue and Lethargy
  • Confusion and Clouded Thinking
  • Inability to Focus or Concentrate
  • Anhedonia (an inability to experience pleasure)
  • Strong Feeling of Disconnection from Others
  • Hypersomnia (sleeping much more than usual)
  • Bruxism (repeatedly grinding teeth)
  • Lack of Appetite

These symptoms are due to the lowered efficacy of the neurotransmitters serotonin, dopamine, and norepinephrine which results from downregulation. When ceasing ecstasy use 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.

Post-Acute Withdrawal Symptoms

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:

  • Memory Problems (with both short and long term memory)
  • Cognitive Deficits (such as shortcoming regarding logic and reasoning)
  • Issues with Concentration or Attention
  • Depression
  • Anxiety Disorders
  • Reduced Impulse Control
  • Increased Aggression or Hostility
  • Insomnia

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.

Withdrawal Timeline

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.

Based on the little that is known, the variability between the recovery timeline of individuals can be extreme, with some people recovering completely within weeks while others may continue to experience symptoms for many years. Further studies are needed to paint a more detailed picture of the timeline for recovery from withdrawal.

Factors that Influence Intensity

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:

  • Amounts of ecstasy used
  • The length of time that ecstasy was used
  • Genetics (there is evidence of some genetic component for addiction)
  • Co-Occurring Mental Health Issues (anxiety, depression, mood swings, etc.)

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.

The Importance Of Detox

Entering an ecstasy detox center can be a game-changer 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 Centers

What Happens To The Body During Withdrawal?

Ecstasy is similar to other amphetamines and hallucinogens in that it does not produce direct physical withdrawal symptoms. That being said, there are physical issues that do occur, albeit indirectly, during withdrawal from ecstasy. While being psychological in origin, bruxism is very common during ecstasy withdrawal. This is a constant grinding of teeth which can result in dental problems and jaw issues. This behavior is common during the high produced by ecstasy but is known to persist throughout withdrawal. In one case, bruxism persisted for over 1 year after the last time this person had used ecstasy. Other than this, there are no notable physical symptoms that result from ecstasy withdrawal.

What Happens To The Mind During Withdrawal?

The psychological effects of ecstasy withdrawal can be intense, and in some cases very long-lasting. Some of the most commonly reported symptoms include mood disorders, slowed or disorganized thinking, and more rarely psychosis. Symptoms vary between people, including the particular symptoms someone experiences, as well as the severity of these symptoms.

Some of the psychological symptoms which are most frequently experienced during withdrawal include:

-Cognitive Deficits

These symptoms can manifest in a variety of ways but are most often issues with memory and troubles with logical thinking or reasoning. Both short term and long term memory function seem to suffer both during ecstasy withdrawal, and sometimes for long periods afterward. The issues with logical thinking or reasoning are commonly described as difficulties with general problem-solving.

This may be a secondary effect of memory issues, but may also be due to imbalances or damage in the prefrontal cortex of the brain, which is responsible for so-called “big picture” thinking modes. There is currently too little research on these particular symptoms to conclusively point to the cause, but it is certainly a common problem with past ecstasy users. These symptoms can be subjectively described as clouded or disorganized thinking, coupled with an overall degradation of memory.

-Depression

Depression is common during withdrawal from any drug but can be especially prominent during withdrawal from ecstasy. One of ecstasy’s main mechanisms of action is changing the way serotonin systems operate in the brain. Serotonin helps to elevate and stabilize moods, and disruption of this system in the manner produced by ecstasy is known to create mood swings and/or depressive states until the brain can restore balance. It is common for recovering ecstasy users to exhibit a general negative affect and depression in the months after ceasing ecstasy use.

Ecstasy is not only an amphetamine and a hallucinogen but is also classified as an entactogen. The term entactogen is used to describe drugs that produce feelings of intense connection, empathy, and a sense of communion with others. Becoming habituated to this experience, an ecstasy user may feel extremely disconnected, distant, and lonely in the aftermath of ecstasy addiction. Coupled with serotonin instabilities, this can amplify the depressive symptoms that someone experiences.

-Increased Aggression

An increase in aggressive behavior is a common symptom of ecstasy withdrawal. This doesn’t necessarily mean violence, but a general state of combativeness or irritability. While the exact mechanisms for this are unclear at present, it would make sense that decreased impulse control coupled with confusion, anxiety, and a reduced ability to empathize could conspire to produce a more overtly hostile state of mind. Being an entactogen, ecstasy increases the feeling of meaningful connection to others. Possibly through neurotoxicity and downregulation of oxytocin receptors, the ability to empathize, relate, and connect with others may become compromised. This may result in an increased outward display of negative emotions and decreased sensitivity to the feelings of others.

-Anxiety

While typically not considered severe, increased anxiety is common during withdrawal. These symptoms are commonly described as mild to moderate but they may persist for long periods. Most often expressed as a general state of restlessness or unease, this increase in anxiety can complicate some of the other symptoms such as depression or increased aggression.

Ecstasy Withdrawal Treatments

The experience of ecstasy withdrawal, while certainly unpleasant, can benefit from treatment by medical and psychiatric professionals. The first step would be to contact an ecstasy or drug detox center, as medical supervision is highly recommended during ecstasy withdrawal. At present there are no medications that are FDA approved to treat withdrawal from ecstasy, however, there are many medications that can be used to treat specific symptoms as needed. There are also a variety of therapies that have been found useful in aiding treatment and recovery from ecstasy withdrawal.

-Medications

While there is no standard medication regime that is used to treat ecstasy withdrawal, some common medications may be used to treat individual symptoms. Some medications which may be commonly used include:

  • Antidepressants: Particularly selective serotonin reuptake inhibitors (SSRIs), these medications are typically well-tolerated. They work by preventing the brain from recycling serotonin and subsequently increase the levels of serotonin in the brain. This can help offset some of the depressive symptoms due to ecstasy induced serotonin disruption.
  • Anti-Anxiety Medications: These medications are safe and effective at treating moderate to severe anxiety disorders such as those produced by ecstasy withdrawal. Initially, benzodiazepines may be used in the short term, followed by a change to other medications that pose less potential for abuse.
  • Antipsychotics: These may be used in cases of psychosis or extreme aggression, but are not commonly used to treat ecstasy withdrawal.
  • Dopamine Agents: Medications used to treat disorders such as Parkinson’s disease, these are fairly safe with minimal potential for abuse. They may help reduce the dopamine imbalances produced during ecstasy withdrawal.

Due to the wide range of possible symptoms along with their intensity and duration, an individual will need to work with medical professionals to find medications that are best suited to their specific needs. These are just a few of the medications which may help, but there are many more options available.

-Therapies

Due to the way ecstasy interacts with a user’s ability to empathize and connect with others, therapeutic techniques may be extremely effective at treating the withdrawal symptoms. The profound isolation, depression, and anxiety which is characteristic of ecstasy withdrawal may be reduced and lightened through a comprehensive approach including a variety of therapeutic techniques.

Some therapies commonly used to treat ecstasy withdrawal include:

  • Group and Individual Therapy or Counseling
  • Integrative Talk Therapies
  • Behavioral Therapies
  • Art and Mindfulness Therapies
  • Fitness or Adventure Therapy
  • Development of Coping Skills

A specialty drug detox center is a highly recommended first step in completing ecstasy withdrawal. These facilities offer programs that will not only help someone to successfully complete withdrawal from ecstasy but help them to build a foundation in recovery. This could take the form of referrals to continue treatment, introduction to local support groups, or connecting someone to a sober living facility.

This is just an example of some potentially effective treatment approaches. Ecstasy is somewhat unique in that it is most commonly combined with other drugs and is rarely done on its own. This results in a high percentage of those experiencing ecstasy withdrawal having polydrug addiction issues. Oftentimes when someone is struggling with polydrug addiction, their best chance for successful recovery comes in the form of professional treatment at a specialty detox and treatment center. Help is available and recovery is possible, but someone must first take the step to reach out and ask for help.

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