“The comedown can bring crushing self-doubt on a good day and on a bad day it can make you question your whole existence,” says Sarah*, a 24-year-old teacher. “On more than one occasion I stayed up for two or three days to keep the comedown away but that made it ten thousand times worse when it did eventually come.” The low mood and creeping paranoia that left Sarah combing through her every interaction after a night out on ecstasy is usually attributed to reduced serotonin. The comedown, like ‘beer fear’ or a wine headache, is normally accepted as an inevitable consequence of taking drugs on a night out. But those familiar with these feelings of midweek misery, which one friend describes to me as “being in your happiness overdraft”, might be surprised to learn that therapists could be administering MDMA to their patients by 2021. In the United States, the Food and Drug Administration (FDA) has approved the drug for final trials as a treatment for Post-Traumatic Stress Disorder (PTSD). However, Dr Ben Sessa, a British psychiatrist who is leading MDMA research in the UK, is keen to divorce this new treatment from what people know about the party drug.
“Clinical MDMA has as much to do with ecstasy as going to a surgeon to have your appendix out in a clean hospital theatre has to do with lying on a kitchen table and cutting it out yourself with a pair of rusty scissors,” he tells me. Dr Sessa explains that the chemical differences between the clinical substance MDMA and party drug ecstasy (which contains MDMA) are only a small part of the misconceptions about the experimental treatment. “Clinical MDMA is prescribed by a doctor in a medical setting with a nurse and a psychotherapist present throughout,” he says. “They're doing it as a part of psychotherapy with specific goals and then, crucially, they're followed up for weeks and months afterwards.” Patients aren’t given doses of MDMA to take home and they have a limited number of MDMA-assisted therapy sessions, alongside regular talking therapy. As part of his training to administer MDMA therapy, Dr Sessa underwent the treatment himself. “One lies down in a bed with headphones on and an eye mask on, motionless, in silence for many hours,” he recalls. “It's very much about using the medicine to go inside and to be with one's thoughts.” Dr Sessa likens MDMA to a pharmacological “life jacket” that fosters empathy and allows people to visit memories of abuse and trauma that they have been avoiding, in some cases, for their entire lives. “I speak to many people with PTSD and the amount of suffering is huge,” says London-based psychiatrist Dr Alberto Pertusa. “The level of impairment and distress is immense and the suicide rates are very high.” Dr Pertusa points out that before MDMA was criminalised in the U.S. in 1985, it was already being used in a therapeutic context. Researchers estimate that around 500,000 doses of MDMA were administered before the ban, treating everything from trauma to marital issues. Dr Pertusa’s reservation about the treatment is that patients may attempt to self-medicate. Used irresponsibly, ecstasy can be harmful and even fatal – last year, 57 ecstasy-related deaths were recorded by the Office for National Statistics.
“The dark web is the bane of psychiatrists’ existence,” he says. “Our patients have access to anything, without knowing a dealer, just with a few clicks.” The 2016 Global Drug Survey reported an increase from 4.5 to 6.7% of respondents reporting having used the Dark Web to purchase drugs the previous year, with one in 10 drug users having used it in their lifetime. A report by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) this year also claimed that ecstasy is getting stronger. Sarah found herself using the drug more heavily when she was feeling low during her parents’ divorce while at university. “MDMA is an easy coping mechanism instead of actually dealing with emotional issues or everyday stress,” she says. “During one of my heaviest use periods when things were really bad at home, I ended up in the urgent doctors needing to be put on a massive dose of citalopram.” Professor Philip Murphy, who has been researching the drug for more than 20 years, warns that long-term recreational ecstasy use may have lasting consequences for users’ mental health. “Reports of mood disruption, feelings of paranoia, sometimes mental confusion and memory deficits all increase with length of use over time,” he says. Assessing either the short- or long-term mental health impacts of using ecstasy on a night out is complicated by the circumstances under which it is taken. “People go to the pub on Saturday night, drink five pints, go to a club, take an ecstasy tablet at midnight, drink more, smoke lots of cigarettes, take another ecstasy tablet at 2am, go back to someone's house, smoke loads of cannabis, sit up till midday, do some cocaine,” says Dr Sessa. “They don’t eat anything, don’t sleep, maybe get a little bit of soup inside them on Sunday night – of course they feel like shit on a Monday morning.”
Ecstasy users’ experience of the comedown is primarily a response to a mix of alcohol and sleep deprivation
After finishing university, Sarah stopped taking drugs altogether. “Once I graduated and started working I couldn't schedule in the huge nights and long recovery times needed,” she explains. “Some of my friends are still committed to that lifestyle and struggling to hold down jobs.” Dr Sessa hypothesises that ecstasy users’ experience of the comedown is primarily a response to a mix of alcohol and sleep deprivation, and he says that he experienced no mood disruption after taking part in the treatment. However, he admits that this is an area where further research is required for more definitive answers. Vincent*, a 25-year-old sports coach, says he didn’t find his ecstasy use an exacerbating factor to his existing anxiety and depression. “They talk about 'suicide Tuesday' after a big weekend, but it was never really that bad for me,” he recalls. “The one time I've felt really bad on a comedown I'd broken up with my girlfriend of nearly two years the day before, so I don't think the drugs could be to blame.” All the experts I spoke to emphasised that every new medicine requires risk-benefit analysis. “There's no such thing as a medication that's 100% safe,” summarises Professor Murphy. “So the question is always if a drug can be used in a clinical setting under proper clinical management, do the potential benefits outweigh any serious risks with this particular patient?” “There is no medical treatment from sticking plasters to chemotherapy that is not in some way invasive,” adds Dr Sessa. “It's frustrating because it's as if the playing field isn't level when it comes to MDMA. Of course it's not 100% risk-free – nothing is.” For mental health information and support, visit Mind or call 0300 123 3393
*Names have been changed
*Names have been changed