People use ecstasy to experience intense elation, energy, wakefulness, sexual arousal, and postponement of sleepiness and fatigue. However, in addition to these desired effects, the drug can have serious adverse effects, which can sometimes prove fatal. Long-term or more regular use heightens the risk of these adverse effects. Some of the harmful effects of ecstasy include: 
- Confusion and impaired judgment
- Anxiety and depression
- Bizarre or reckless behavior
- Panic attacks
- Mood swings, irritability
- Fatigue and trouble focusing
- Trouble sleeping
- Increase in body temperature
- Muscle tension and cramping
- Involuntary clenching of teeth
- Blurred vision
- Dry mouth
- Rapid eye movements
- Restless leg movements
People with heart disease or circulation problems are at a particularly high risk of health complications from ecstasy because it can increase blood pressure, heart rate, and workload on the heart.
It is worth noting that people who abuse MDMA can experience hyperthermia (very high body temperature) and dehydration, leading to kidney and heart failure. The risk is especially high when the drug is used in a hot place with exertion, such as dancing for hours at a crowded party.
Each year there are around 50 deaths involving ecstasy, and around 10 cases where it is the only drug to blame for the event. The cause of death is almost always either hyperthermia (too high temperature) or hyponatremia (low sodium levels). The latter can be caused by drinking too much water. 
Long-Term MDMA/Ecstasy Use
Long-term MDMA use can result in undesirable adverse effects like irritability, aggression, impulsiveness, sleep problems, anxiety, depression, memory problems, decreased appetite, and decreased interest in sex.
MDMA promotes feelings of emotional closeness. When it is used, especially in combination with the erectile dysfunction drug Viagra (sildenafil), ecstasy can lead to unsafe sexual encounters. This puts ecstasy users at risk of contracting infections like HIV/AIDS and hepatitis.
Occasionally, something called serotonin syndrome can occur, which can prove fatal. In the days following ecstasy use, 4 out of 5 users report rebound lethargy and depression during the “crash”. This is due to a depletion (falling levels) of serotonin in the brain. Regular users may escalate the dose to avoid these effects.
Repeated doses of ecstasy are neurotoxic and can cause permanent damage in the brain. Regular ecstasy users may therefore experience problems with learning and memory, difficulty with higher cognition, changes in sleep and appetite, and loss of interest in sex. The destruction of brain cells can be permanent and may last well after heavy recreational use of ecstasy has stopped. 
Is MDMA Addictive?
There are varying theories about the addictive potential of MDMA (ecstasy). Experiments in animals indicate that subjects will self-administer the drug.This is an important indicator in the laboratory of a drug’s potential for abuse. It is also worth noting that MDMA targets the same brain chemistry as other drugs deemed highly addictive. But it is widely regarded that ecstasy is less addictive than some other Schedule I drugs like cocaine.
Studies show that the continued use of ecstasy, despite physical and psychological problems, occurs in more than 85% of users. 
Other studies have shown that more than 40% of ecstasy users meet the criteria for dependence, and more than 30% meet the criteria for abuse. 
Ecstasy is considered addictive because nearly 70% of users experience unpleasant withdrawal symptoms when they stop using the drug after regular use. Withdrawal symptoms typically start about 12 hours after the last dose and are intense for the first few days. Some of the withdrawal symptoms of ecstasy include:
- Appetite loss
- Problems with concentrating
On the other hand, studies have also shown that many ecstasy users do not report high levels of craving for the drug. 
Ecstasy users may not experience intense cravings when the drug contains additives, and users do not always know precisely what “ecstasy” contains when they take it. Therefore, any craving they experience could be the result of mixed drugs. In other words, some additives like amphetamines are more addictive than ecstasy, and cravings for the adulterant may be stronger than cravings for MDMA.
Last updated: March 8, 2023
Hailey Shafir, M.Ed., LCMHCS, LCAS, CCS
Hailey Shafir is a licensed addiction specialist and mental health counselor. She graduated from North Carolina State University with a master of education in clinical mental health counseling in 2012, and has developed deep expertise in the areas of mental health, behavioral addictions and substance abuse. She is passionate about using this knowledge to raise awareness, provide clear and accurate information, and to improve the quality of treatment for these disorders.
Hailey is an LCMHCS (license number: S9539) under the North Carolina Board of Mental Health Counselors, and an LCAS (ID: LCAS-21333) and CSS (ID: CCS-20721) under the North Carolina Addictions Specialist Professional Practice Board.
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