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In general, MDMA users report feeling the onset of subjective effects within 30–60 minutes of MDMA consumption and reaching the peak effect at 75–120 minutes, which then plateaus for about 3.5 hours. The desired short-term psychoactive effects of MDMA have been reported to include:
- Euphoria – a sense of general well-being and happiness
- Increased self-confidence, sociability and feelings of communication being easy or simple
- Entactogenic effects – increased empathy or feelings of closeness with others and oneself
- Relaxation and reduced anxiety
- Increased emotionality
- A sense of inner peace
- Mild hallucination
- Enhanced sensation, perception, or sexuality
- Altered sense of time
The experience elicited by MDMA depends on the dose, setting, and user. The variability of the induced altered state by MDMA is lower compared to other psychedelics.
MDMA is often considered the drug of choice within the rave culture and is also used at clubs, festivals and house parties. In the rave environment, the sensory effects from the music and lighting are often highly synergistic with the drug. The psychedelic amphetamine quality of MDMA offers multiple reasons for its appeal to users in the rave setting. Some users enjoy the feeling of mass communion from the inhibition-reducing effects of the drug, while others use it as party fuel because of the drug’s stimulatory effects. MDMA is used less frequently than other stimulants, typically less than once per week.
As of 2017, MDMA has no accepted medical indications. Before it was widely banned, it saw limited use in therapy. A small number of therapists continue to use MDMA in therapy despite its illegal status.
Small doses of MDMA are used as an entheogen to enhance prayer or meditation by some religious practitioners. MDMA has been used as an adjunct to New Age spiritual practices.
Acute adverse effects are usually the result of high or multiple doses, although single dose toxicity can occur in susceptible individuals. The most serious short-term physical health risks of MDMA are hyperthermia and dehydration. Cases of life-threatening or fatal hyponatremia (excessively low sodium concentration in the blood) have developed in MDMA users attempting to prevent dehydration by consuming excessive amounts of water without replenishing electrolytes.
The immediate adverse effects of MDMA use can include:
- Bruxism (grinding and clenching of the teeth)
- Increased wakefulness or insomnia
- Increased perspiration and sweating
- Increased heart rate and blood pressure
- Increased psychomotor activity
- Loss of appetite
- Nausea and vomiting
- Erectile dysfunction
- Visual and auditory hallucinations (rarely)