MDMA Risk Evaluation in Buy a Ticket, Take a Ride

Question: If Ecstasy/MDMA is more harmful than I have anticipated, do I stand by my decision to use it? Short answer: yes.

For some people, MDMA is a reward worthy of risk. If one's life is in danger, the risk of MDMA is most understandable. MDMA is currently being studied as a treatment for post-traumatic stress disorder. For people with severe PTSD, this is a life-saving treatment. For people with something like anxiety, it might be less than life-saving, but still significant.

Is it a risk to not take MDMA? Wow, I hate to be a bad influence, but personally that seems like a legitimate question. I do not want to ignore what my experience on MDMA means to me.

Ecstasy is no more dangerous than riding a horse. If riding a horse does not scare you, it should. Horses are dangerous animals. Christopher Reeve was paralyzed after being thrown from a horse, this seems like a worst case scenario of horse back riding. If I had to guess, I'd say MDMA used most responsibly is less dangerous than horseback riding...but maybe the typical Ecstasy experience approaches the danger of horseback riding.

I have written about the dangers of Ecstasy before. I worry about it because Ecstasy is the most dangerous drug I have used. This substance should absolutely be taken seriously.

Realistically, it seems like my worst case scenario for me involves the neurotoxciticty of MDMA. This is not well understood, but I believe that MDMA can make me more vulnerable to developing chronic depression, especially with repeated exposure.

Since I attempt to use it responsibly as possible, I do not imagine that Christopher Reeves is my worst case scenario. Maybe I am wrong.

As I interpret it, the Christopher Reeves worst scenario for someone taking Ecstasy is at a party. Death or injury due to the drug and the party's combined effects on risk taking behavior: exhaustion, dehydration, hypothermia, water poisoning, over-exertion. The next worst risk is either prosecution or getting the wrong chemical from the black market.

MDMA is somewhat unique. As far as I know, not many substances are comparable to MDMA as neurotransmitter powerhouses, although they do exist. I don't know as much about them. I believe MDPV is such a drug, it works on a different neurotransmitter than MDMA. (MDPV is relatively new and the big one sold as "bath salts".)

For the risk/benefit analysis I would frame risk this way: Some neurotoxicity from Ecstasy use is unavoidable. The limits of neurotoxicity are unknown, so the damage potential is high. If you are unlucky, if you make the wrong mistakes, ESPECIALLY if you take it often or more than once, you could sustain a life-altering injury to your serotonin system.

I have been reading a great deal, including something that I actually bought (wow!) Ecstasy: The Complete Guide. It's a long book. If you are interested in neuroscience, I will attempt to explain why MDMA is neurotoxic based on my reading. I AM NOT AN EXPERT, obviously. Mostly, I learn from Wikipedia and Google.

I'm going to start with explaining what MDMA has in common with Prozac, which is not a whole lot, but they both work on serotonin. (MDMA is like Prozac...on CRACK!) Their effects on the serotonin system are very different, but I guess you could say they are both anti-depressants. MDMA works on other neurotransmitters too, like dopamine and oxytocin, but its unique properties and its potential for neurotoxicity lie in its effect on serotonin.

Imagine that your serotonin system is a kitchen sink. Serotonin is represented by the water. The sink is a receptacle where the serotonin has the greatest effect on your mood.

You are not on any drugs. The faucet is slowly dripping water droplets into the sink. The water droplets go down the drain.

You take Prozac. Prozac plugs the drain. Water accumulates in the sink, water level rises slowly, but your water flow is not enough to over fill the sink. The faucet is still dripping just as it was before you took Prozac.

Prozac is an SSRI, serotonin reuptake inhibitor. Water going down the drain is serotonin reuptake. When the sink is plugged and the water can't drain, this is serotonin reuptake being inhibited.

Accumulating serotonin by inhibiting serotonin reuptake is supposed to increase total capacity for happiness. The theory, based on the effectiveness of SSRIs like Prozac, is that depressed people do not have enough serotonin.

Go back to the kitchen sink. Water is dripping down the drain. (Don't combine SSRIs and MDMA.) Now you take MDMA, the drain is plugged, the faucet is now totally opened, water is flowing at a higher rate. Your sink is overflowing. This can potentially damage serotonin receptors.

We know that there is a rebound effect following MDMA's serotonin high. During this period there is less working serotonin in the brain. Gradually, serotonin levels return to normal. Recovery seems to take about a month, sometimes more, but do not know how completely the brain is able to recover.

The subjective crash seems shorter than total recovery time. It lasts anywhere from a few days to a few weeks. Some people have more trouble with this than others. I had trouble my first time, but felt fine afterward. Regardless of one's willingness to tolerate the subjective effects of the MDMA crash, I would advise waiting 2-4 months between MDMA trips to allow the serotonin system plenty of time to recover.

Damage to serotonin neurotransmitters seem to occur when, while there is less serotonin available, serotonin receptors pick up material other than serotonin. The most destructive materials available to these neurotransmitters are free radicals released by MDMA. Another scenario involves the possibility of these receptors picking up some other neurochemical like dopamine. When this occurs, the receptor could change and prefer dopamine forever, which isn't good.

Certain measures, like taking specific vitamins, often referred to as anti-oxidants, seem to reduce the amount of free radicals. Vitamin C is most frequently mentioned, sometimes it is taken in large doses. Some supplements are packaged as pills that are more bio-available than others. It would be wise to research which supplements are made most effectively.

There is some real evidence that using SSRIs after the MDMA dose improves serotonin levels and prevents some neurotoxicity. This seems logical.

5HT is an ingredient for your brain to make more serotonin, it is often referred to as a serotonin supplement, and it is available over the counter. It supposed to increase serotonin levels, which could help improve the days or weeks following the serotonin surge. Some people even report "pre-loading" by taking 5HT for one or multiple days before taking MDMA improves the intensity of MDMA high.

I have never experimented with 5HT, but some people take it daily and find it more effective than shit like Prozac. If it does work, I can see how it could help. (I intend to try it but I haven't gotten around to it. It seems like if this were true, someone would have sold me 5HT by now.)

There also seems to be some real evidence that THC (marijuana) helps prevent neurotoxicity...but I don't understand how that is supposed to work, that seems really odd to me.

I have a completely unqualified theory that LSD, as it works on the serotonin system, would also improve neurotoxicity. I don't think LSD increases serotonin levels, but it seems like it takes a similar path through the brain that serotonin does, therefore would help serotonin receptors avoid picking up bad materials. This combination is called "candy flipping" and I have done this more frequently than taking MDMA alone.

Risks other then neurotoxicity...

You might have read in the news that a minority of people experience a particularly nasty emotional side effect from taking an SSRI. These patients are at an increased risk of suicide. This is called suicidal idealation. If my opinion is worth anything, based partly upon my experience with Zoloft (also an SSRI) and partly based this research, I think serotonin is a necessary is not only a happiness component, but also a necessary component emotions other than happiness. Not all of those emotions are desirable. Increasing serotonin could lead to an increase in less desirable emotions, although this does not seem to be the case for most people.

A minority of people who take MDMA also experience negative mood swings. I have only seen this reported from those who choose to expose themselves to MDMA repeatedly. I believe that cocaine follows a similar pattern of less euphoria over prolonged use. I guess this is when coke addicts tend to become paranoid.

(Subjectively, I could compare cocaine euphoria as drastically inferior but similar in nature to MDMA. I am not sure, because cocaine studies are generally not studying responsible use, but I think it might be more dangerous than MDMA. This seems reasonable, if only because it is more addictive, and damage to the sinus cavities. Rectum is the way to go for coke, in my opinion. Anyway, it doesn't seem like either drug is very dangerous to me when used responsibly.)

I have experienced negativity on MDMA. I completely lost track of time and I went on a very long rant for hours where I was dwelling on my negative emotions from occasions where Ben had hurt me in the past. It was mildly combative, but not aggressive, it was not directed toward myself, and although MDMA was the catalyst the fault probably lies on other drugs-- Vyvanse and mushrooms were the significant variables.

(It was probably the Vyvanse. I have successfully combined LSD with MDMA, although mushrooms are not the same as LSD, Vyvanse was the most novel variable. In my case, prescription stimulants have been known to create a negative disposition, although Vyvanse is gentle compared to alternatives like Adderall. I avoid combining MDMA with stimulants but on this occasion I forgot I had already taken the Vyvanse when I decided to take MDMA. Despite the accidental combination of stimulants, I was probably not close to accidentally making my heart explode.)

Edit: Interestingly, MDMA seems to have an effect on my facial expressions and tone of voice. When I am excited on MDMA, it seems like excitement is confusable for aggression even when there is no aggression or combativeness. I had this problem in real life, too, but it was a bigger deal under the influence of MDMA. After I experienced this on MDMA, I was motivated to bring up the symptom to my doctor. That's when I was put on Strattera, which seemed to help...who knows why that works? Not me.

Last updated January 30, 2014