Can MDMA Treat Depression and Anxiety?

You may have heard of MDMA (3,4-methylenedioxy-methamphetamine). It’s a psychedelic drug that goes by many other names, including “molly” and “ecstasy.” MDMA can increase energy and feelings of happiness, empathy, openness, and social connection. It can also cause serious side effects, like a dangerous increase in body temperature. 

Even though MDMA is illegal today, it was once used as a psychotherapy tool back in the 1970s. While it showed benefits in psychotherapy, MDMA got a bad reputation when it became a popular recreational drug. By 1985, it became illegal in most countries. 

After that, MDMA-assisted therapy (MDMA-AT) could only be used legally as part of a clinical trial.

Since then, researchers have taken a renewed interest in psychedelic-assisted therapy. Strong research supports MDMA-AT for people with post-traumatic stress disorder (PTSD). But what about using it as treatment for other mental illnesses? Here’s what the science says about MDMA-AT for depression and anxiety.

How does MDMA work for depression and anxiety?

Most of the research on MDMA-AT has focused on people with PTSD. There hasn’t been as much research on using MDMA to treat depression and anxiety. But scientists believe it might help in different ways. 

MDMA boosts the activity of certain chemical messengers in your brain and body, including:

• Serotonin, which balances mood and may lead to an increased sense of connectedness 

• Norepinephrine, a chemical that increases energy and alertness

• Dopamine, which plays a role in pleasure, motivation, and focus

• Oxytocin, a hormone important for social learning, sexuality, trust, and empathy

MDMA also affects activity in areas of your brain that control mood, emotions, and memory. It may also help your amygdala and hippocampus (the brain’s memory center) communicate better. 

Because of these effects, MDMA might make it easier to talk about stress and trauma or to reprocess painful memories. It could also help with:

• A positive mood and lower stress levels

• Being less defensive when talking about difficult experiences

• Trusting and opening up to others

• Seeing problems in a new way

• A better ability to remember and confront memories

• Understanding emotional and social relationships better

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But recreational MDMA use can sometimes cause anxiety, depression, or panic attacks — especially in the days or weeks after using it. This is sometimes called the “mid-week blues.” It’s not clear if MDMA itself causes these problems, or if other things — like contamination, dosage, or multiple substance use — are to blame. 

So far, most research on MDMA-AT for anxiety and depression has focused on two groups of people: people with end-of-life anxiety and people with autism who have social anxiety. More research is needed to understand if the benefits can apply to wider populations.

Can MDMA help social anxiety?

Maybe — but the research is limited. One trial using 2 sessions of MDMA-AT found that it led to less social anxiety in people with autism at 6 months. But this study was very small — it only included 12 people. And there hasn’t been any published research to support these results since.

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Theories of why MDMA might be helpful for social anxiety include:

• MDMA might help people change how they feel about negative memories, especially memories about themselves or relationships with others.

• MDMA may be able to promote positive emotions, including toward yourself.

• MDMA may reduce fear in social situations and help people feel more connected to others.

Can MDMA help end-of-life anxiety?

Nearly half of people with a life-limiting illness feel anxiety or depression. Palliative care experts are looking into newer ways to help, including psychedelics like MDMA. 

One study suggests MDMA-AT may help ease anxiety related to life-threatening illness or help people who are dying find a sense of meaning and purpose. But more research is needed to say for sure how well this works.

What does MDMA-assisted therapy (MDMA-AT) for depression look like?

MDMA-AT is talk therapy combined with MDMA. When researchers do MDMA-AT with study participants, they follow special guidelines. These guidelines, created by the Multidisciplinary Association for Psychedelic Studies (MAPS), are based on methods created by therapists who studied MDMA before it became illegal. 

Let’s take a look at what that process looks like.

Preparatory session(s)

These sessions lay the groundwork for the MDMA-AT process. They might include:

• Medical screening to be sure MDMA use is safe

• A meeting between the therapist and participant to establish a relationship, create a safe physical and mental environment, and set goals 

• Education about the possible physical and psychological effects of MDMA

Participants may have more than one preparatory session. They move to the next step when both the participant and therapist feel ready. 

MDMA-assisted session

The MDMA-assisted session begins with the study participant taking a capsule of MDMA. The full session lasts several hours. Sometimes participants stay overnight at the clinic or with informed friends or family.

During the session, participants sit or lie down in a comfortable room. They wear eye shades and headphones with a preset music playlist. Music is often used in psychedelic therapy and is shown to help improve the experience and outcome of the session. 

The session may alternate between periods of introspection (thinking to oneself) and periods of interaction with the therapists. A therapist or other facilitator stays with the participant at all times.

Everyone’s personal experience will be different, and sometimes the session may be challenging. During the session, people may:

• See and hear things differently (like brighter, louder, or clearer for example)

• Rethink aspects of their lives from a new perspective

• Feel like they’re reliving or reexperiencing past moments

• Feel less fear

• Talk more openly about thoughts or memories that cause anxiety or depression.

Therapists don’t lead or guide the session. Instead, they:

• Listen and encourage trust 

• Ensure participant safety

• Take notes or recordings to help participants recall their experiences

Integration

After the session, the participant and therapist(s) work together to make sense of the experience. The outcome may not be clear right away. That’s because the psychedelic experience can be confusing and hard to describe.

There are many definitions of integration. In general, this is the process of taking lessons or insights from the session and using them in everyday life. This process usually involves methods of talk therapy. Different models of integration focus on:

• Spiritual growth

• Relationships

• Self-reflection

• The body or nature 

A range of practices may be part of the process, like exercise, meditation, healthier habits, or art therapy. 

The number of sessions for each step may vary. For example, in the MAPS research program, there are two MDMA sessions (separated by a month), three preparatory sessions, and three or four integration sessions before and after each MDMA session. 

What are the risks of MDMA?

MDMA comes with risks, and some of them can be life-threatening. Soon after taking MDMA, you may develop:

• Large, dilated pupils

• Uncontrollable clenching of your jaw

• Nausea and decreased appetite

• Tingling sensation in your arms or legs

• Faster heart rate

• Elevated blood pressure

• Difficulty concentrating or remembering things

• Difficulty balancing

More serious side effects of MDMA use include:

• Overheating: A fast rise in body temperature can occur, especially in a warm environment like a dance club. When it happens, it’s often fatal.

• Harm to your organs: Heart problems (like an abnormal rhythm or heart attack) and liver damage may occur after taking MDMA.

• Death: Although rare, overdoses leading to death are possible. This is more likely when taken recreationally because of contamination or dangerous interactions with other recreational or prescription medicines.

Is MDMA addictive?

It’s unclear if MDMA is addictive. Some people report continued use of MDMA despite negative side effects. Others need more of it over time to feel the same positive result. But a small study suggested MDMA-AT may help treat alcohol use disorder. In addition to lower alcohol consumption, people reported no interest in using illegal MDMA after their sessions.

Does MDMA damage the brain?

It’s unclear if MDMA causes long-term brain damage. In animal studies, MDMA has toxic effects on nerve cells in the brain. A review paper concluded that people who repeatedly use MDMA experienced changes in brain function and cognition. It’s possible that these changes may be reversed over time when a person no longer uses MDMA. But the long-term effects haven’t been adequately studied. 

Theoretically, risks might be lower in MDMA-AT. That’s because the doses are small, and the number of sessions are limited. But it’s impossible to say for sure.

Is MDMA-AT safer than MDMA?

Yes, MDMA-AT is likely safer than recreational use because:

• People go through a medical screening to make sure participation is safe. 

• The dose and purity of MDMA are carefully monitored. 

• Healthcare professionals are present to make sure participants are safe. 

What drugs interact with MDMA?

It’s risky to combine MDMA with other drugs or medications. Avoid taking MDMA in combination with:

• Antidepressants: Commonly prescribed antidepressants include selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). Combining MDMA with SSRIs or MAOIs can lead to “serotonin syndrome” — a dangerous and often deadly condition. Bupropion is a norepinephrine/dopamine-reuptake inhibitor (NDRI) that, when combined with MDMA, increases blood levels of both substances, making overdose more likely.

• Amphetamines and stimulants: Cocaine or stimulant medications like methylphenidate (often used to treat ADHD) can cause a dangerous increase in heart rate when combined with MDMA.

• Alcohol: Mixing alcohol with MDMA may be dangerous because it increases the risk of dehydration and low sodium levels.

• Opioids, anesthetics like ketamine, and muscle relaxers: These increase the risk of death when mixed with MDMA.

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Written by:

Arielle Tandowski, MPH

Arielle Tandowski, MPH, is a freelance writer for GoodRx. She holds a master's degree in public health from the University of Haifa, where she focused on mental health, substance use, and harm reduction.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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DISCLAIMER: MDMA-AT is only legal in some states when used as part of a government-approved clinical trial under limited circumstances, but not in others. MDMA is still illegal under federal law.