When MDMA is taken orally, the effects start about 30-45 minutes later; snorting, smoking or injecting produces much quicker onset. The primary effects usually reach a plateau at around one hour to 90 minutes after taking the dose, stay there for about two hours, then start tapering gradually. The primary effects are pretty much over by four to six hours. Secondary effects may be felt for days.

Short-term effects

Common reported effects include:

• feelings of wellbeing and confidence
• feelings of closeness and empathy for others
• increased energy and focus
• jaw clenching/teeth grinding
• jittery vision
• an inability to concentrate
• nausea
• anxiety
• increased temperature, heart rate and blood pressure.

After this initial ‘rush’ the consumer usually experiences a plateau in effects lasting around six hours before the beginning of the ‘come-down’. The ‘come-down’ from ecstasy use can last up to several days. Reported effects include:  

• low energy/ fatigue
• irritability
• visual disturbances
• mentally drained
• insomnia
• mild depression
• anxiety
• paranoia
• difficulty concentrating
• loss of appetite.

Side-effects are usually associated with higher doses and are reported to include convulsions, vomiting, floating sensations, irrational or bizarre behaviour, hallucinations and prolonged ‘come down’.

Long-term effects

Long-term users report after effects that can last from days to weeks. These include memory loss, unpleasant depressive episodes, difficulty making decisions, long-term jaw grinding (an effect that arises from the amphetamines often included in ‘ecstasy’), balance problems and dizziness.

Early research had suggested that ecstasy use causes damage to some parts of the brain, however research in 2011 found that such effects were likely due to behaviour (such as attending many all-night dance parties, and not hydrating enough), rather than consumption of MDMA per se.  Long-term ecstasy use is relatively uncommon, likely due to the increase in undesirable effects and diminishing of the pleasurable effects over time. However, regular ecstasy consumers have reported tendencies to find they are not eating or sleeping enough and that they become run down and susceptible to cold, flu, and infections.

Risks

Ecstasy increases the desire to be physically active. This carries with it the risk of overheating, exhaustion, seizures and collapse, especially when in the hot and crowded environments like dance parties and nightclubs. People with a history of heart disease, hypertension, epilepsy, liver problems or diabetes are at greater risk of harm from ecstasy use. 

Water consumption should be monitored when using ecstasy. Not enough water and too much physical activity can cause dehydration and overheating or hyperthermia. Too much water can lead to a condition called dilutional hyponatremia where the brain swells, inducing coma and sometimes death. See the reducing the harm section for guidelines on water consumption.

Higher doses do not appear to enhance the desirable effects of ecstasy, but do increase the risk of negative side-effects.