There are some things that you just accept. Having chocolate for dinner will make you feel sick. Drinking four pints will – increasingly, you’re noticing, as you get older – mean the next day is a write-off. And taking MDMA means that you are most likely in for a comedown.
Will you spend “blue Monday” crying due to tiny humiliations like someone pushing in front of you on the bus? Will it be good old depression, paranoia, or heightened anxiety? So many flavours of comedown to choose from!
Comedowns have long been thought of as an unavoidable result of MDMA use, but some recent research has brought this near-universally accepted truth into question. A Journal of Psychopharmacology study, titled “Debunking the myth of ‘Blue Mondays’”, sought to find out whether the comedowns associated with illicit use of the drug use also occurred when MDMA was taken in clinical settings.
The results were surprising, to say the least. The study followed 14 people enrolled on a course of MDMA-assisted psychotherapy to treat alcohol use disorder. It found no evidence of a drop in mood following clinical use of MDMA. That’s right – they didn’t feel bad at all.
In fact, the participants maintained a positive mood for a whole week afterwards (AKA that elusive post-MD afterglow) with no significant negative fluctuations. We spoke to Dr Ben Sessa, the co-author of the study, and a research fellow at Imperial College, London, affiliated with the Imperial Centre for Neuropsychopharmacology.
VICE: Part of the rationale behind the study was to inform your understanding of the drug’s post-use effects in a clinical context. What did you find?
Dr Ben Sessa: Using the data we submitted, we found that clinical [use of] MDMA, compared to data submitted from studies assessing ecstasy users, resulted in no acute mood or affect drops immediately after the drug as it wears off – [meaning] no comedowns – and no protracted mood or affect drops – [i.e.] Blue Mondays – in the week after each drug-assisted session.
We measured mood for a week after each session using the Profile of Mood States (POMS) questionnaire [a standard psychological test]. It shows that across 25 clinical MDMA sessions mood was not reduced. Indeed, it was elevated – an afterglow effect – for seven days post-clinical MDMA in all patients.
What implications does this have for recreational users? Are comedowns real or are we just lying to ourselves?
To be clear - comedowns and Blue Mondays are real amongst recreational ecstasy users! I got some criticism of the paper on Twitter from people who misunderstood the paper; people thinking I was saying that comedowns don't exist - and multiple people posting that I was wrong to say they don’t happen because they have had them! But they were all missing the point. They do exist when MDMA is taken recreationally. The point I was making is that they don’t exist when it is given clinically.
You’ve used MDMA in a clinical context to treat mental health conditions for a number of years. So what does clinical use of MDMA look like compared to recreational use?
The differences between clinical MDMA and recreational ecstasy are massive. An ecstasy tablet or a bag of crystal MDMA may contain anywhere between 0mg and 350mg of MDMA, plus any number of adulterants. In contrast, when we give MDMA clinically we use clinical grade MDMA, which is 99.98 percent pure.
When people take ecstasy recreationally, they tend to exercise excessively –namely, dancing! This has been shown to increase risk of toxicity and hyperthermia [abnormally high body temperature]. MDMA can [also] raise body temperature slightly. In a clinical setting, we monitor temperature throughout the session and can adjust the room temperature accordingly to prevent hyperthermia – plus patients do not dance in clinical sessions! They remain lying still on a couch. In a hot nightclub people often dance throughout the night without chilling out. Raised temperature increases the risk of toxicity.
When taking ecstasy recreationally, people often drink too much because they feel hot, or they may drink too little because they sweat excessively. Water imbalance risks the phenomenon hyponatreamia [when sodium levels in your blood drop below normal], which can be toxic. So, with recreational ecstasy, problems can occur from either drinking too much or too little water. In a clinical setting, we can carefully monitor the rate of fluid intake to ensure they do not over or under drink water.
[Sleep loss] is perhaps the greatest difference and biggest contributor to ecstasy hangovers. People usually take recreational ecstasy at night. They stay up all night, missing out on sleep. This hugely contributes to feeling unwell and hungover the next day. The low mood effects persist for several days after missing a night’s sleep, which also causes this “Blue Monday” effect a few days later. In contrast, we administer clinical MDMA at 9.30AM, and the effects have worn off by the evening, at which point the patients feel back to baseline and naturally tired. They then get a good night's sleep and do not have any immediate hangover effects in the following week.
So what can recreational users take from your findings? Is there anything they can do to lessen comedowns?
Simple: only take 99.98 percent pure MDMA; not some adulterated substance where dose and adulterants are unknown. [Editor’s note: Though the purity of MDMA has risen in recent years in the UK, recent testing has suggested a sharp decline in purity since the pandemic.] Drug testing – for example [through drug testing organisation] The Loop etc – are one way of testing purity and dose, though these are not often available.
Don't take ecstasy at night [either] and miss out on a night’s sleep – take it only during the day. I appreciate this is rather unrealistic. Most raves take place at night! Pay close attention to fluid balance when taking ecstasy. Don’t drink too little water, risking hyperthermia, and don’t drink too much water [and risk] hyponatreamia. Drink moderately. Don't exercise [or] dance excessively. Take breaks. Chill out. Cool down periodically.