Ecstasy symptoms | during use and after

Some ecstasy symptoms come straight from the drug: what you feel in your body and mind while you are high, and in the days that follow. Others point to a pattern of use that has become hard to stop. These say more about ecstasy addiction than any single night out.

In the UK, ecstasy usually means pills. Ecstasy pills typically contain MDMA alongside binding agents and other inactive ingredients that help the tablets hold their shape. MDMA crystals and powder, on the other hand, are generally sold as MDMA without these added ingredients. However, neither form is guaranteed to be pure, and you cannot know exactly what it contains without drug testing.

The effects of ecstasy usually start 30 to 60 minutes after you swallow a pill. The high often lasts 2 to 4 hours, and effects such as a racing heart or poor sleep can carry on for several hours after that. Ecstasy releases large amounts of serotonin, along with dopamine and noradrenaline, which explains both the high and much of what follows.

Physical ecstasy effects

• dilated pupils and blurred vision
• jaw clenching and teeth grinding
• a faster heart rate and higher blood pressure
• sweating, rising body temperature and dehydration
• nausea and loss of appetite
• muscle tension and restlessness

Psychological ecstasy effects

• euphoria and feeling warm and close to the people around you
• light, sound and touch feeling more intense
• more energy and less need for sleep
• anxiety, confusion or paranoia, particularly at higher doses

The high can also tip over into fear or a panic attack, especially in a crowded or unfamiliar setting.

Once ecstasy wears off, your brain has used up much of its serotonin and needs time to replenish it. That shortfall explains the comedown, which can last several days:

• tiredness and disturbed sleep
• low mood, irritability or tearfulness
• difficulty concentrating
• a sore jaw and reduced appetite

Chasing that first ecstasy high

The first time you take ecstasy is often the strongest high you will have, and that feeling is hard to let go of. Taking more does not bring it back, however. The warm, close feeling is never as intense as your first time, while the speedy, restless side and the comedown afterwards get stronger.

Overheating is the most serious risk of ecstasy, and it can develop within a single night. Ecstasy raises your body temperature, and hours of dancing in a hot, crowded space push it up further. If your temperature keeps rising, this can lead to seizures, muscle breakdown, kidney or liver failure and, in some cases, death.

Water intoxication

Ecstasy makes your body hold on to water, so drinking a lot in a short time can dilute the sodium in your blood. This is known as water intoxication, or hyponatraemia, and it can cause your brain to swell. Sipping around a pint of water an hour is generally enough to stay hydrated without overloading your body.

Serotonin syndrome

Combining ecstasy with certain antidepressants or other drugs that act on serotonin increases the risk of serotonin syndrome. Its symptoms include agitation, muscle stiffness and a high fever.

Unknown strength and content

Pills vary widely in strength, and many now contain far more MDMA than they used to. What is sold as ecstasy can also contain other stimulants or substances such as PMA, which takes longer to work. That delay can lead someone to take a second pill before the first has fully taken effect.

Even a single use can affect your mood and your brain. With frequent use, your serotonin levels do not have time to recover between nights out. The effects then build up, and each comedown lasts longer and hits harder. Over time, this can show up as:

• memory and concentration problems
• persistent low mood or depression
• ongoing anxiety
• poor sleep and lasting fatigue
• worn teeth and jaw pain from grinding
• weight loss
• strain on the heart, liver and kidneys
• a drug-induced psychosis

Effects on work and relationships

Work, study and relationships tend to suffer too, as more of your week goes on recovering from the weekend. Some of these effects ease once you stop using ecstasy, while others can last for months.

Signs of ecstasy addiction usually show up in your behaviour long before you put a name to them. Ecstasy is not physically addictive like alcohol or heroin, and it rarely becomes something you take every day, due to the very intense hangover which worsens the more often you take ecstasy. The dependence is psychological and tends to be bound up with going out: you start to rely on ecstasy to feel relaxed, confident and close to others at parties and in clubs. Common signs include:

• using more often than planned, moving from the occasional event to most weekends
• taking more pills in the hope of feeling the same effect again
• a night out or a festival no longer feeling like fun without it
• trying to cut down and starting again within weeks
• carrying on despite longer comedowns, missed work or arguments at home
• combining ecstasy with cocaine, ketamine or alcohol to stretch the high or soften the comedown

If several of these signs apply, the questions on Am I addicted? can help put them in perspective.

Ecstasy addiction symptoms are what dependence feels like from the inside, and they often appear in the days between nights out rather than while you are high. They include:

• strong cravings in the run-up to a weekend or event
• low mood, anxiety or irritability on days without it
• tiredness and poor sleep that never fully lift during the week
• finding less pleasure in things you used to enjoy
• planning your weekends around the next chance to use

Ecstasy and underlying mental health problems

You may use ecstasy to cope with anxiety, low mood, difficult experiences or feeling easily overwhelmed by noise and crowds. The dependence and the underlying problem then tend to feed off each other. This combination of an addiction and a mental health condition is known as dual diagnosis.

Ecstasy addiction signs in your partner, child or friend are often more obvious to you than to them. Common examples are:

• a social life that increasingly revolves around parties, festivals or the same group of friends
• mood dips or irritability early in the week
• missed work or study after weekends
• secrecy about their plans or how they spent the weekend 

We also talk to family and friends whose loved one is addicted. You can call us on +27 21 541 0643 for information and personal advice.

An addiction to ecstasy mainly shows in two ways: nights out no longer feel like fun without it, and you keep using even though it is causing you problems. If that sounds familiar, you can talk it through with Connection Mental Healthcare in confidence on +27 21 541 0643. An addiction assessment gives a clear picture of your use and of any anxiety, low mood or other conditions that come with it.

Treatment at our rehabilitation centre

Treatment focuses on what ecstasy has been doing for you: the patterns, triggers and feelings behind your use. This is inpatient treatment: you stay with us, away from the venues, people and weekend routines you associate with using. Our rehabilitation centre in South Africa gives you that distance. The cost and fees of your stay depend on the type of accommodation you choose. If you have questions about your ecstasy symptoms or what treatment might involve, you can call us on +27 21 541 0643.