While positive results show that more research into the therapeutic use of MDMA is needed, people tempted to use it for therapeutic reasons should use an abundance of caution.

People researching the link between MDMA and depression have found evidence that it can both cause and alleviate depression. Studies show that MDMA-assisted therapy can promote increased trust between therapist and client, improving therapeutic outcomes. Other research indicates that the drug’s effects on serotonin and the sympathetic nervous system can have negative long-term impacts on mood and induce depressive episodes.

While positive results show that more research into the therapeutic use of MDMA is needed, people tempted to use it for therapeutic reasons should use an abundance of caution. Current research shows that the risks of using MDMA far outweigh the benefits. Even when MDMA is not cut with other drugs that increase the chance of toxic effects, it can trigger psychological and medical emergencies, especially when it is not used under controlled conditions and the guidance of a therapist.

Article at a Glance:

  • Among the drugs receiving renewed attention for potential clinical uses in mental health treatment, MDMA may be the most controversial.
  • Trials of MDMA-assisted therapy show that using the drug can cause therapeutic breakthroughs to occur sooner, which may be especially important for people with treatment-resistant depression.
  • However, a wide range of research also shows that MDMA causes depression in a significant number of people who use it.
  • More research is needed to determine the long-term risks of MDMA depression treatment.
  • In the meantime, other lower-risk interventions are available that are effective for many people.

Does MDMA Cause Depression?

The acute medical risks of using MDMA are well documented. Among other effects, it acts as a stimulant and can induce rapid breathing and heart rate. Many people who have used it at events where they were dancing have suffered acute hyperthermia and dehydration. When people have this kind of MDMA overdose and do not receive emergency medical intervention in time, they can die from brain swelling, seizures or kidney failure.

Better-known psychological risks of MDMA use include acute anxiety and panic attacks. Stimulants like MDMA activate the sympathetic nervous system, which initiates the fight-or-flight response and triggers the release of adrenaline. The natural psychological response to these neurochemical changes is anxiety, which naturally dwindles after threat passes. When the sympathetic nervous system is activated by drugs, there is no environmental cue to relax, which can result in prolonged anxiety.

Among common MDMA side effects, depression may be the least understandable to people who have not experienced it. It is not unusual for people to experience periods of depression when they use stimulant drugs on a regular basis. The brain chemicals responsible for the rush and elevated feelings MDMA induces are eventually depleted and a recovery period is needed for the brain to replenish them. During this period, people often feel depressed.

Research Results: MDMA and Depression

There are unique aspects of MDMA that link it even more strongly to subsequent periods of depression. Research by Valerie Curran and Ross Travill showed that people who used MDMA experienced a predictable pattern of elevated mood immediately after using it and significantly low mood by the fifth day after use. Not only was their mood worse than it was before using, but it was also low enough to meet criteria for clinical depression.

Research by Dr. Lynn Taurah at London Metropolitan University that was first published in 2003 showed that people who had used MDMA only a few times suffered from lasting and especially high depression levels, even compared to people who had taken other drugs the same number of times. Animal research suggests the reason for this effect is that MDMA not only affects serotonin levels but kills brain cells that produce it.

This MDMA depression appears to be uniquely potent and long-lasting. Newer research by Taurah and associates that was published in 2014 showed that people who had used MDMA heavily in the past had elevated rates of depression, poor sleep quality and impaired memory even after abstaining from MDMA use for years. A 2012 studyby Briere and associates at the University of Montreal showed that teenagers who used MDMA were significantly more likely than other teenagers to suffer elevated depressive symptoms the next year.

Can MDMA cause depression? These studies leave no doubt that it can. However, caution should be taken before accepting the bleak conclusion that MDMA causes permanent brain damage and incurable depression. Not only do most people who enter recovery for a substance use disorder experience improved brain function and mental health, but other research from the same period also shows that MDMA can actually help some people who have depressive disorders.

Can MDMA Help Depression?

In addition to MDMA-assisted treatment for post-traumatic stress disorder (PTSD), MDMA for depression treatment has been the subject of promising new clinical trials. These studies show that clinical supervision in a safe environment can potentially counteract some of the negative effects of recreational MDMA use. By making sure people are supported with ongoing therapy, MDMA’s depressive aftereffects may be mitigated.

The MDMA used to treat depression in these sessions is clinically pure. It is administered prior to an eight-hour session of talk therapy that takes place three times a month. These sessions are supported with additional weekly counseling sessions in which no drugs are used. The purpose of using MDMA in these sessions is to help people overcome the fear that holds them back from delving into difficult emotional material. It also helps people establish rapport with a therapist more quickly. These aspects may be especially useful to people who have histories of trauma and greater difficulty opening up to a professional.

This MDMA therapy for depression is currently only available in clinical trials. One element that requires further study is whether the short-term therapeutic benefits of using MDMA in this way are outweighed by long-term effects that make people more prone to depression. Only further research and time will reveal whether the link between MDMA and subsequent depression can be mitigated by the context in which it is used.

Co-Occurring MDMA and Depression Treatment

The right treatment for depression must always be determined on a case-by-case basis. For some people, the breakthrough potential of MDMA treatment might outweigh the risks. Treatment-resistant depression has pushed some people to try controversial therapies like electroconvulsive, or “shock therapy,” which also has significant risks but has provided relief from depressive symptoms for some people for the first time in years.

However, for people with histories of addiction to MDMA or other substances, mixing MDMA and depression treatment may involve significantly more risk than reward. The MDMA depression treatment currently being evaluated in clinical trials could trigger cravings and increase the risk of a recurrence of substance use for people with co-occurring disorders.

Depression can be caused by many factors, including biological differences and personal experiences. In the first stages of depression treatment, people often focus on the way that depressive thinking maintains the characteristic low mood of the disorder. For many people, refraining from substance use is essential in stabilizing their moods and maintaining cognitive clarity.

For most, an integrated treatment program is all that is needed to begin the process of recovery from co-occurring depressive and substance use disorders. In integrated treatment, clinicians work as a team to coordinate different interventions and develop a treatment plan to help people address underlying mental health issues at the same time they are addressing a substance use disorder. Integrated treatment programs often involve a combination of substance abuse treatment groups, individual mental health therapy, psychiatric medication management and complementary therapies that are relatively low-risk therapeutic options.

If you have been struggling with symptoms of depression and want to learn more about how depression is diagnosed and treated, you can read more here or take this quiz. If you are in a psychiatric emergency and are at risk of harm, reach out for emergency help through local emergency services or a crisis hotline. If you are not at immediate risk but know you need help with depression and substance abuse, you can reach out to The Recovery Village today. A representative can talk to you about integrated treatment options that can meet your needs.

Megan Hull
Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
Stephanie Hairston
Medically Reviewed By – Stephanie Hairston, MSW
Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more
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The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.