MDMA

What it feels like

From the come-up to the Tuesday after.

A typical night

• 20 minutes to an hour, The come-up: Usually around 30–45 minutes, sometimes longer.
• The next few hours, The peak: Happy, energetic, close to everyone, with sights, sounds, touch and smell heightened — lasting about 2–4 hours.
• Hours after, Wired: A fast heartbeat and trouble sleeping can outlast the high.
• The next days, The comedown: Lower mood midweek — measurably lower than after a weekend of drinking — sometimes for several days.

What it can feel like

• Warmth: Mood and emotional sensitivity lifted, without hallucinations.
• Closeness: Feeling sociable and close to others — even strangers.
• Senses: Heightened sensory awareness, and a changed sense of space and time.
• Lights: Wide pupils that react slowly to light, so in a dark club every light glares.
• Jaw: Clenching — the most common physical complaint — along with no appetite and an unsteady walk.
• Heat: Body temperature rises — above 38 °C in about 1 in 5 people even sitting still in a lab.

What's happening in the brain

A serotonin flood, a closeness hormone, and fear switched down. The model lights each one as you read.

The flood

Serotonin comes from the raphe nuclei in the brainstem, whose neurons send it up into the rest of the brain, shaping mood. Normally a transporter pulls it back in after use; MDMA reverses that transporter, so serotonin pours out instead.

Closeness

MDMA raises oxytocin, one of the hormones the hypothalamus makes and the pituitary releases — and the more it rose, the more sociable people felt. That's the sense that a stranger is an old friend.

Fear down

It reduces blood flow in the amygdala and hippocampus, and the bigger the drop, the stronger the effects feel. Worries that normally hold you back go quiet.

Faces, friendlier

It turns down the amygdala's response to angry faces and turns up the reward system's response to happy ones. Everyone seems friendlier because, for a while, threat registers less and warmth registers more.

The comedown is the other side of the flood. People who took ecstasy at the weekend reported lower mood in the days after than people who'd only drunk alcohol.

Questions people ask

The things people wonder about on MDMA — answered.

Risks and staying safe

The few things behind most of the harm.

The real risks

• Overheating: A steep rise in body temperature, more likely dancing in the heat; at worst, muscle breakdown and organ failure.
• Too much water: Drinking a lot on MDMA can dilute the blood's sodium and swell the brain.
• What's in it: Pills and powders sold as MDMA can contain other drugs — ketamine, amphetamine, cathinones, methamphetamine.
• Mixing: With alcohol, or with SSRI antidepressants, the risks go up.

Keeping it safer

• Start small — a quarter or half a pill — and wait at least an hour before any more.
• Take breaks from dancing to cool down, and keep an eye on your friends.
• Sip no more than about a pint of water or soft drink an hour.
• Where drug-checking services exist, use them.

If someone overheats

1. Call for help: Very hot skin, a racing pulse, confusion or collapse is a medical emergency. Tell the crew what was taken.
2. Cool them: Somewhere cooler, with cool wet cloths.
3. Stay with them: And don't make a seriously ill person drink.

Check what you know

Five questions about what MDMA does.

• On MDMA, you find yourself hugging someone you met twenty minutes ago and telling them they're your best friend. What's behind it? Oxytocin, raised by MDMA — and the more it rises, the more sociable people feel. MDMA raised oxytocin, and the rise correlated with how sociable people felt.
• Everyone in the room looks warm and friendly — even people you'd normally find intimidating. Why? MDMA turns down the amygdala's response to angry faces and turns up the reward response to happy ones. That's what an imaging study found.
• In a dark club on MDMA, every light has a glare around it. Why? MDMA widens the pupils and slows their reaction to light, so more light gets in. MDMA dilated the pupils and slowed and weakened their response to light.
• Tuesday after a festival, you feel flat and teary for no obvious reason. What's going on? The comedown — lower mood in the days after MDMA is common. People who'd taken ecstasy reported lower mood midweek than people who'd only drunk alcohol, and it can last several days.
• A friend says the heat is the main thing to watch on MDMA. Another says it's water. Who's right? Both — overheating and drinking too much water are both serious dangers. MDMA can cause dangerous overheating, and drinking too much can dilute the blood's sodium. The advice is regular breaks and no more than about a pint an hour.