Talk:MDMA/Archive 9

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Coherent article prose

Does anyone besides Doc James think it's a bad idea to cover each significant topic only once in the lead, or should we keep the coverage of medical use scattered and make the 1st and 4th lead paragraphs redundant? Seppi333 (Insert 2¢) 17:16, 28 September 2017 (UTC)

One is medical uses, the other is research. They are two separate topics and generally we keep them as two separate topics. It is a ongoing problem that people try to position tentative research as confirmed medical uses. Doc James (talk · contribs · email) 17:20, 28 September 2017 (UTC)

The 4th paragraph is discussing an expedited drug approval process which would result in an MDMA having an "accepted medical use". That's not research. Seppi333 (Insert 2¢) 17:24, 28 September 2017 (UTC)

That is an early step "setting it on a fast track for review and potential approval" per [1] That is NOT approval. There is always a lot of hype around research. We need to keep that separate from the more sedate world of actual medical uses or the lack of such as it is easy to have the hype around research mislead people.

If / when it is approved by the FDA, that will be a big deal and would than belong in the first paragraph as a medical use. Doc James (talk · contribs · email) 17:29, 28 September 2017 (UTC)

The two topics are connected though. It would only occur to the reader that MDMA might have medical use after being informed of its past use by therapists and the current clinical trials. We jump the gun by placing this information in the first paragraph. The medical use of a substance is a notable fact. The lack of medical use of a substance is not by itself notable because most substances do not have medical uses. It is only becomes a notable fact within a context that would lead the reader to believe it might have medical uses. Sizeofint (talk) 20:18, 28 September 2017 (UTC)

Re: what Sizeofint said. Seppi333 (Insert 2¢) 21:41, 28 September 2017 (UTC)

We could have a RfC I guess. Doc James (talk · contribs · email) 06:06, 29 September 2017 (UTC)

Sure. Options are to move para 4 above the current paragraph 2, move that sentence about medical use to the end of para 4, or keep it as is. Seppi333 (Insert 2¢) 17:41, 29 September 2017 (UTC)

• I would rather keep it as is. The sentence about medical use essentially functions as a clarification for the first sentence, which defines MDMA as a recreational drug. I imagine that the thought process of the first-time reader goes: while it may be used for recreational purposes, it has not been officially recognized for having any medicinal purposes (indications). ―Biochemistry🙴❤ 23:27, 4 October 2017 (UTC)

*Agree with Doc James; Keep 'recreational drug' and 'no medical use' in lead, keep the application to conduct a research study below. Rgr09 (talk) 00:48, 5 October 2017 (UTC)

• agree w/ Rgr09--Ozzie10aaaa (talk) 10:45, 5 October 2017 (UTC)

I would much rather have us initially set the scene for MDMA by explaining to readers that it's a recreational drug that has no medical uses. We have sources that support that on world-wide scale. It's on Schedule 1 of the United Nations Convention on Psychotropic Substances. Having research on its possible use against PTSD fast-tracked by the US FDA is an interesting fact in one country. It doesn't mean that the rest of the world is going to ignore the UN Convention, so there's still a long way to go before there's any possible legitimate medical use in sight. Much as the stoners would like our article to focus the slim possibility that one day, at some indeterminate point in the future, a putative medical use may be found and approved somewhere, the fact is that there is no accepted medical use right now, and Wikipedia is not a crystal ball. --RexxS (talk) 22:29, 5 October 2017 (UTC)

@Ozzie10aaaa, Rgr09, Biochemistry&Love, and RexxS: Just to be clear, this section isn't about moving the medical uses sentence down or removing it; it's about moving the current 4th lead paragraph above the current 2nd lead paragraph, since this is what Doc James reverted: edit–revert. In other words, the lead of the article would look like this instead of how it currently appears. This wasn't made clear in this section and it doesn't appear, based upon your responses, that you were aware of this. So, what are your thoughts on moving this paragraph? Seppi333 (Insert 2¢) 22:32, 5 October 2017 (UTC)

I'm having trouble seeing why this really makes a difference. --Tryptofish (talk) 22:44, 5 October 2017 (UTC)

(edit conflict) @Seppi333: Normally our leads summarise the content of the article in approximately the same order as the sections in the body of the article. It would be unusual to bring the research paragraph above the effects and uses paragraphs as it would – to me, at least – imply a greater importance for research to the reader than the topics of effects and usage. I haven't seen any case made that an unusual prioritisation is appropriate here. I'm pretty sure I have a slight preference for the "definitions" - "effects" - "usage" - "research" order over the alternative suggested. --RexxS (talk) 22:45, 5 October 2017 (UTC)

The history of the article is somewhat more complicated than I had realized. After looking at some of the issues that have arisen on the talk page in the past, I think the current lead structure, as described by RexxS, is preferable. I haven't yet found a category for 'recreational drugs', perhaps that could be considered? The closest thing is the article Recreational drug use. I don't see, however, that it lists 'hundreds' of articles on this subject. Rgr09 (talk) 01:02, 8 October 2017 (UTC)

@Seppi333: Thank you for the clarification! I agree with RexxS's conclusions. After reviewing the change, it doesn't make much sense to me to have the research placed in precedence to the effects. While the respective sections within the page could be moved as well, I think that moving the research section to the proposed place seems out of place.―Biochemistry🙴❤ 15:53, 8 October 2017 (UTC)

I vote for keeping it as is. (Since the lede is protected, I assume it will not change anytime soon, but just in case, I read the article as of the 14:28, 8 October 2017 revision.)

I suggest adding an endnote to the last sentence of the lede's 4th paragraph:

MDMA was granted breakthrough therapy designation by the FDA [endnote] for PTSD in August 2017.

Where the endnote would be a copy of, or very similar to, this sentence from the Breakthrough therapy article: "The FDA acknowledges that this designation is not intended to imply that the drug is actually a "breakthrough".[3] It allows the FDA to grant priority review to drug candidates if preliminary clinical trials indicate that the therapy may offer substantial treatment advantages over existing options for patients with serious or life-threatening diseases.[4][5][6]".

I realize that readers can click on the link to the Breakthrough therapy article, but how many will do that compared to how many will read the endnote? I don't know for sure, but I suspect that the endnote will garner more attention and alert at least some visitors to the (counterintuitive) meaning of "breakthrough therapy".   - Mark D Worthen PsyD (talk) 07:03, 9 October 2017 (UTC)

I've added the note that you suggested. Seppi333 (Insert 2¢) 08:41, 9 October 2017 (UTC)

Thank you Seppi333. :O) ... I really like how you phrased it, complete with footnotes.   - Mark D Worthen PsyD (talk) 08:14, 11 October 2017 (UTC)

No problem. Thanks for suggesting it; it was a useful clarification IMO. Seppi333 (Insert 2¢) 21:18, 3 November 2017 (UTC)

Pharmacokinetics, depletion

It says "The duration of action of MDMA is usually four to six hours, after which serotonin levels in the brain are depleted." citing https://www.ncbi.nlm.nih.gov/pubmed/27859780

This makes it sound as though serotonin levels were entirely depleted, which is not the case. It might even be understood as saying that the duration would be even longer, but is halted due to total serotonin depletion.

The source actually says: "The mean duration of action is 4–6 h, followed by a regeneration phase with substantial serotonin depletion" — Preceding unsigned comment added by 88.66.247.169 (talk) 18:26, 12 November 2017 (UTC)

Adverse effects

Generally go after uses. Thus restored prior order. Doc James (talk · contribs · email) 21:17, 8 December 2017 (UTC)

External links modified

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Possible source for updating this article.

Several sentences in this article say "As of 2017 ..." and I ran across the following article which indicates that the research status of MDMA is changing. I do not understand medical terminology much so maybe some who does can use this article as appropriate.

• https://theconversation.com/is-psychiatry-ready-for-medical-mdma-94105

172.88.134.103 (talk) 11:14, 31 March 2018 (UTC)

We would need sources as outline at WP:MEDRS

Yes MDMA is being studied but is far from approved. Doc James (talk · contribs · email) 00:37, 1 April 2018 (UTC)

I certainly understand the need for specialized sources, but surely if the FDA altered the drug's technical designation and approved it for special clinical studies those are significant facts that should be part of the article, yes? A quick Google search for [MDMA FDA "breakthrough therapy designation"] resulted in over 30,000 hits including numerous substantial articles in the Wall Street Journal, Forbes, and the FDA website itself just to name a few. I also see numerous medical publications on this matter but am unaware which of them are considered reliable sources. Obviously these studies have not yet come to conclusion but the article should reflect any substantial changes in the current state of affairs I would think. 172.88.134.103 (talk) 06:21, 23 April 2018 (UTC)

History

I don't think the history segment of this article should be placed as far into the article as it is. I think it's an important enough detail to be placed as the first subtopic of the article. I am amazed as to why it is as far into the topic as it is.

23:52, 22 February 2019 (UTC)

"sold mixed with other substances"

In the first part of the page is the following sentence: "It is often sold mixed with other substances such as ephedrine, amphetamine, and methamphetamine."

I think this used to be the case but I don't think it's generally, globally true today. The original source for this fact even states it less strongly than the article.

"Additionally, the illicit sale of Ecstasy makes it prone to being “cut” with other illicit and potentially toxic or deadly chemicals. Ecstasy tablets may contain other substances in addition to MDMA, such as ephedrine (a stimulant); dextromethorphan (a cough suppressant that has PCP-like effects at high doses); ketamine (an anesthetic used mostly by veterinarians that also has PCP-like effects); caffeine; cocaine; and methamphetamine."

What's problematic here is that we don't have globally reliable data, but we could state this of course.

I'd like to restate the sentence into the following.

"XTC pills or MDMA crystals/powder sometimes contain other psychoactive substances. To which degree this happens and which other substances are found depends strongly on the country in which the substances are sold."

Sources: https://www.ecstasydata.org/about.php https://www.projectknow.com/discover/jagged-little-pill/

Niels.bom (talk) 09:46, 3 July 2019 (UTC)

Mydriasis listed as an adverse effect

I have removed this twice but some editor keeps reverting me. Every time I explained my reason for removing it, but keep getting reverted with no real justification. Unless someone can explain why mydriasis would be an adverse effect, I say it's not to be listed there. --uKER (talk) 12:22, 25 July 2019 (UTC)

...'often' sold mixed... ?

Information to be added or removed: Remove 'often', replace it with 'sometimes' or 'may contain ...' Explanation of issue: The source does not say XTC is often mixed with other substances, it says it may contain those substances. References supporting change: https://www.drugs.com/illicit/mdma.html under "MDMA health hazards"

Done Raquel Baranow (talk) 03:16, 31 December 2019 (UTC)

Explanation for the term Bruxism

Also, I removed a layman's explanation for what Bruxism is. I find it very arbitrary to have an explanation for bruxism, when hyperthermia, trismus or anhedonia don't have it. --uKER (talk) 18:21, 26 July 2019 (UTC)

High doses causing lesions references not referencing studies, no data on lesion damage.

The claim that high dose MDMA causes brain lesions in humans and animals is not substantiated by references to actual peer-reviewed studies. Reference [2] simply states "MDMA has been proven to produce lesions of serotonin neurons in animals and humans." without providing reference to source studies. Reference [12] has no reference to lesions caused by MDMA.

Please remove the following or provide references containing proof of brain lesions: "Additionally, MDMA use at high doses, as distinct from high lifetime exposure, has been shown to produce brain lesions, a form of brain damage in the serotonergic neural pathways of humans and animals.[2][12]"

This might stem from a retracted study that showed lesions from methamphetamine use, which they thought initially thought was from MDMA, hence the retraction: https://www.ncbi.nlm.nih.gov/pubmed/12351788 — Preceding unsigned comment added by Pombrand (talk • contribs) 14:23 , 12 September 2019 (UTC)

 Done--Goldsztajn (talk) 21:47, 12 September 2019 (UTC)

Heart risk research?

Could please anybody with a better judgment on medical topics than I have validate if this is a real adversarial risk: https://thethirdwave.co/psychedelics-heart-risk/

The cited study is: https://www.ncbi.nlm.nih.gov/pubmed/19505264

Apparently excessive MDMA exposure can lead to problems with activating the 5-HT2B receptor, which in turn could lead to heart valve problems. This was new information to me, a lesser known potential side effect of MDMA use, I couldn't find it reflected in the current article. — Preceding unsigned comment added by 2A02:168:F789:0:49CA:3E4F:ADBF:247F (talk) 11:40, 31 December 2019 (UTC)

The mechanism in question here seems to be fairly well studied and is probably valid. They primarily cite this study which claims a preferential 5-HT_2B binding of MDA and MDMA... they then go on to say that MDA is primarily responsible for the high binding as an active metabolite and say that it is a "very potent" agonist. No values are listed for MDA. From this article, MDMA itself is effectively inactive at 5-HT_2B (>20,000nm), and MDA is measured at a ~850nM / 52% efficacy which is very roughly half that of (+)-Fenfluramine and not even in the same universe as (+)-Norfenfluramine... and that's for one of the two possible MDMA metabolites barring any of the original drug that's excreted.

Since the VHD issue had already been noted in the prescription medications they studied, presumably the point of mentioning MDMA at all was to bring up another less studied drug that had potential to cause VHD and preliminary data from other studies suggesting that MDMA might provide another study point (as well as an explanation of that) but even the authors conclude with, "Finally, the observation that MDMA may produce VHD deserves additional study, as this adverse effect may ultimately cause greater morbidity than the widely studied effects of MDMA on brain function." I'd want a more recent / direct study of this specific effect to take it seriously although I don't think the logic of this research paper is incorrect. A Shortfall Of Gravitas (talk) 02:33, 23 January 2020 (UTC)

hyponatremia not hyponatraemia

I think it should be hyponatremia not hyponatraemia in "A scheme for management of acute MDMA toxicity has been published focusing on treatment of hyperthermia, hyponatraemia, serotonin syndrome, and multiple organ failure" but the reference does state hyponatraemia not https://en.wikipedia.org/wiki/Hyponatremia so not sure what is hyponatraemia is it on Wikipedia? — Preceding unsigned comment added by InGearX (talk • contribs) 04:37, 7 October 2020 (UTC)

Semi-protected edit request on 31 December 2019

Under the headline "Adverse effects" and sub-headline "Long-term" in the first paragraph, the acronym "SERT" is used for the first time in the article without explaining what it means. A link should be added to the corresponding Wikipedia page and a parenthesis should be added after "SERT", so the text reads "...moderate to severe effects for SERT (serotonin transporter) reduction. Asbjoern o (talk) 12:25, 31 December 2019 (UTC)

 Done – Thjarkur (talk) 15:02, 31 December 2019 (UTC)

Source for addiction as a possible effect

I removed addiction as a possible effect of MDMA and got reverted. As I mentioned in my edit summary, the cited source only says the data regarding addictivity of MDMA is controversial. If no specific reason is provided for this being included, I'll remove it again. --uKER (talk) 18:17, 30 November 2020 (UTC)

The statement in the lede was summarizing the entire article, not just that single ref. I have removed it for that reason. Alexbrn (talk) 18:32, 30 November 2020 (UTC)

MDMA addiction/dependence

Could someone who understands DSM-IV classification and terminology check the rates of MDMA "abuse" and "dependence" (I'm not sure what is the difference between these terms). This MDMA article currently states "One study found approximately 15% of chronic MDMA users met the DSM-IV diagnostic criteria for substance dependence." This citation is based on this PMID 19893331 study, which claims within the abstract "One fifth of the participants were screened as potentially dependent." 1/5 is 20%, not 15%. Also, why does this PMC 2891907 study claim within table 1 that, according to DSM-IV classification, MDMA has "abuse" rates between 4.4-11.2% and "dependence" rates between 44.6-66.4% (way higher that "15%"). Latter is extremely high and DSM-IV clearly defines the word "dependence" in some other way than a psychology layman like me.

Additionally, substance addiction/dependence/use disorder/abuse (whatever is the difference between these terms, I dunno?) is a complex issue, it might be better to have aggregated rates for these % estimates from multiple studies so that the rates would be more valid internationally speaking instead of citing the results of a single study. 5-HT2AR (talk) 12:06, 12 December 2020 (UTC)

Names for different combinations of MDMA + other drugs

In the article, the combination of MDMA with LSD, psilocybin mushrooms or ketamine are all given the name "candy-flip". However, from experience on forums and such I have gathered that MDMA + LSD = Candy Flip, MDMA + psilocybin = Hippy Flip and MDMA + ketamine = Kitty Flip. Unfortunately I do not have concrete sources, since this is something I have encountered so often that listing all instances would be impossible, however the main forum I have encountered these names at is Reddit.com

Name

The phrase "commonly known as ecstasy (E) or molly" is misleading, given the reported increasing adulteration of illegally marketed drugs termed "ecstasy", which are likely to be "enhanced" with ketamine, caffeine, BZP, and other narcotics and stimulants.

I suggest a cautionary description would be better, i.e. "3,4-Methyl​enedioxy​methamphetamine (MDMA),[note 1] is a psychoactive drug primarily used for recreational purposes.[13] Drugs distributed as "ecstasy (E) or molly" are normally purported to contain MDMA, but are often adulterated by ketamine, caffeine, BZP, and other narcotics and stimulants." — Preceding unsigned comment added by Carusus (talk • contribs) 14:31, 10 February 2021 (UTC)

Evidence for PTSD efficacy

The research section currently states:

MDMA has been claimed to be useful in treating post-traumatic stress disorder, but such claims are not backed by good evidence.[181]

Source 181 actually states:

It has been suggested that MDMA, for example, possesses characteristics that make it uniquely useful for the treatment of PTSD [122]; the same has been argued for ibogaine in the treatment of SUD [42]. The high heterogeneity of the articles included in this review do not provide sufficient evidence to establish these relations

This is not the same thing. The study does not claim that the evidence of usefulness is limited, but that the evidence for unique usefulness is limited.

Moreover, a newer review that is more specific to the topic and includes more trials states the following:

The evidence for MDMA in combination with psychotherapy as a PTSD treatment was ranked "moderate"

I propose that the last sentence in the research section states:

MDMA in combination with psychotherapy has been studied as a treatment for PTSD, and four clinical trials provide moderate evidence in support of this

Juniusbrutus (talk) 04:10, 21 February 2021 (UTC)

 Done the newer review should also be cited, right? You didn't make that clear in your request, but if you think it should be cited in the article, feel free to re-open. Elliot321 (talk | contribs) 17:08, 21 February 2021 (UTC)

Semi-protected edit request on 22 February 2021

It is misrepresentative to state only that MDMA is primarily used for recreational purposes in the introductory sentence. Please change "primarily used for recreational purposes" to "primarily used for recreational and therapeutic purposes". It is also worth changing the end of the introduction: "MDMA is illegal in most countries and, as of 2018, has no approved medical uses." Afterwards, please add, "However, in 2017 the FDA granted breakthrough therapy designation for its use with psychotherapy for PTSD." 209.6.143.81 (talk) 21:23, 22 February 2021 (UTC)

 Not done. Please provide a reliable source showing that MDMA is actually used for therapeutic uses. Just a designation does not count. ◢  Ganbaruby!  (Say hi!) 08:17, 23 February 2021 (UTC)

Semi-protected edit request on 25 February 2021

MDMA was not first synthesized by Merck, it was first synthesized by Alexander “Sasha” Shulgin. 75.142.234.192 (talk) 06:25, 25 February 2021 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. – robertsky (talk) 08:58, 25 February 2021 (UTC)

Semi-protected edit request on 30 June 2021

In the last sentence of the summary, change "In the US the Food And Drug Association is currently evaluating the drug for clinical use.[23]" to "In the US the Food and Drug Administration is currently evaluating the drug for clinical use.[23]"

For clarity, "Food And Drug Association" should be "Food and Drug Administration"

Verified through cited article IsbenTakesTea (talk) 16:53, 30 June 2021 (UTC)

That whole sentence could do with a rewrite. It makes it sound like the FDA is driving the change when it's actually in clinical trial for therapeutic use. That source should instead be used to provide additional information in the Research and Medical sections. I plan on taking a closer look at this later, but if someone else patrolling edit requests wants to take a stab at it, go for it. Living Concrete (talk) 17:22, 30 June 2021 (UTC)

 Done typo fixed by Ignatios2000 ScottishFinnishRadish (talk) 17:50, 30 June 2021 (UTC)

References

Ttrrrrtt

Veery 2fvry — Preceding unsigned comment added by 157.119.49.74 (talk) 04:36, 31 December 2021 (UTC)

I'm sorry my translation program was not able to render your language into English. :^( Mark D Worthen PsyD (talk) [he/him] 19:41, 20 February 2022 (UTC)

Approved medical uses

The intro section says: | MDMA is illegal in most countries[15][22] and, as of 2018, has no approved medical uses.

That's true. But there are approved medical uses in Canada in 2022.

1. https://globalnews.ca/video/8497644/psychedelics-approved-for-medical-use-in-canada
2. https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/policy-regulations/policy-documents/subsection-56-1-class-exemption-conducting-activities-psilocybin-mdma-special-access-program-authorization.html

Bobagem (talk) 20:15, 8 January 2022 (UTC)

@Bobagem: Thank you. I updated the lead with your information (diff). The body of the article still needs to be updated, if you might be able to do that. ;^) Mark D Worthen PsyD (talk) [he/him] 16:28, 20 February 2022 (UTC)

Semi-protected edit request on 25 September 2021

Under title Research: Change - A 2014 review of the safety and efficacy of MDMA as a treatment for various disorders, particularly PTSD, indicated that MDMA has therapeutic efficacy in some patients;[62] however, it emphasized that issues regarding the controlability of MDMA-induced experiences and neurochemical recovery must be addressed.[62] The author noted that oxytocin and d-cycloserine are potentially safer co-drugs in PTSD treatment, albeit with limited evidence of efficacy.[62] This review and a second corroborating review by a different author both concluded that, because of MDMA's demonstrated potential to cause lasting harm in humans (e.g., serotonergic neurotoxicity and persistent memory impairment), "considerably more research must be performed" on its efficacy in PTSD treatment to determine if the potential treatment benefits outweigh its potential to harm to a patient.[14][62]

To: A Systematic Review and Meta-Analysis published in May 2021.

{https://www.cureus.com/articles/58217-the-efficacy-of-mdma-34-methylenedioxymethamphetamine-for-post-traumatic-stress-disorder-in-humans-a-systematic-review-and-meta-analysis#references} Findings show promising evidence for the potential therapeutic use of MDMA alongside psychotherapy in the treatment of PTSD. The pharmacological profile of MDMA may provide direction for future drug developments to treat patients with treatment-resistant psychiatric disorders.

Studies have shown the potential benefits in clinical trials for post-traumatic stress disorder (PTSD). A larger amount of data has been provided for the push in support of MDMA-assisted psychotherapy in these patients.

Studies on psychiatric treatments for mental illness have shown that there is a general dose-dependent benefit of MDMA in assisted psychotherapy, where the Clinician-Administered PTSD Scale (CAPS) total scores at the primary endpoint showed changes proportional to the dosage amount { https://dx.doi.org/10.1177/0269881118806297?utm_medium=email&utm_source=transaction} There are, however, adverse health effects with recreational use due to overdosing, such as hypertension, faintness, panic attacks, and, in severe cases, loss of consciousness and seizures [2]. There is still much to be learned about MDMA’s therapeutic dosing effect and its support with psychotherapy treatment of PTSD.

When patients are exposed to occurrences that trigger traumatic events while under the therapeutic treatment, this enables them to reactivate their fear response and work on separating these traumatic triggers from the conditioned response [3]. MDMA-assisted psychotherapy theoretically targets both the memory reconsolidation and fear extinction processes [4]. The term “memory reconsolidation” describes a type of neuroplasticity that involves the process of an established memory being reactivated, destabilized, and then modified or updated with additional information [5]. Hypothetically, when trauma memories are retrieved while under the influence of MDMA during therapy, a strong prediction error is generated by the unique internal state of MDMA-stimulated elevation of neurochemicals, hormones, and the supportive therapeutic setting [6]. This mismatch of experiences, such as recall of memory with strong fear/anxiety versus recall with emotions such as love or empathy, would allow for an update of the information through molecular mechanisms [https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-are-effects-mdma?utm_medium=email&utm_source=transaction ]. MDMA increases the release of dopamine (DA) in the striatum and midbrain. Dopamine positively correlates with prediction error, and therefore, MDMA-stimulated DA efflux may amplify and drive a prediction error related to the traumatic memory [7].

Clinicians have found that MDMA can be purified and used to facilitate the above-mentioned therapeutic effects [8]. MDMA promotes the release of dopamine, serotonin, and norepinephrine in the mesolimbocortical circuitry of the brain, as well as the neurohormonal signaling of oxytocin, cortisol, prolactin, and vasopressin [9]. The comprehensive effect of these neurochemicals has been shown to enhance therapeutic success as well as decrease nonresponse and dropout rates [10]. Long-lasting PTSD remission and a reduction in symptoms have been reported after only two to three MDMA-assisted therapy sessions [11].

The Meta Analysis dated 2014 to be removed. To replace with the information sourced from the meta analysis dated May 2021. the current data is redundant and contrary to more recent findings which clarifies all of the uncertainty and misinformation. Fredrickaltchwiezenbeurg (talk) 07:57, 25 September 2021 (UTC)

 Not done: Seems like a dubious journal, since it isn't included in MEDLINE ([12]) and has a very low impact factor (just above 1, which for medicine doesn't seem too convincing). Please see WP:MEDRS, this is unambiguously within the scope of that. RandomCanadian (talk / contribs) 12:23, 25 September 2021 (UTC)

Also, D-Cycloserine? The drug that's a second line tuberculosis treatment because of all the nasty neurological side effect is supposedly safer than MDMA? Do they wait until all the side effects kick in, then yell, "see? doesn't this make your previous problems seem so minor?" Although I guess alcoholism tends to follow PTSD around like a dog that just rolled in something foul and D-Cycloserine tends to cause seizures in alcoholics... usually the resultant disrupted thought patterns and constant memory gaps after a good ol' round of seizures makes you unable to focus on anything that was bothering you (or that you care about) for very long stretches of time after it's all said and done. Take it from me. Given the choice I'd have picked the MDMA and preferred that they started me off on the medications that weren't waking nightmares. At least they're not suggesting antipsychotics or large doses of ciprofloxacin, although I'm sure I just gave some federally sponsored lab the idea to feed both to a chimp then claim whatever happened was caused by the E. :P --A Shortfall Of Gravitas (talk) 04:30, 16 June 2022 (UTC)

Pharmacology section may need an overhaul:

Edit: I think the first study is badly mistaken (especially regarding SERT binding) and untrustworthy. 1A agonism is known to show biphasic activity where 1A autoreceptors can effectively counteract increased serotonin levels up to a certain point. MDMA's presumed ability to massively increase serotonin levels via mass reverse transport of serotonin as a 5-HT tranporter substrate compared to it's reputation of being ineffective at low doses (perhaps ~<50mg) or the relatively mild activity of SSRI inhibitors may be demonstrative of this biphasic relationship. MDMA is solidly linked to serotonin syndrome with MAOIs but not SSRIs and user reports of SSRIs rendering MDMA essentially impotent (presumably by binding to similar transporter locations and preventing reverse transport) further suggest this to be the case. /end — Preceding unsigned comment added by CloudBoy9001 (talk • contribs) 01:17, 20 July 2022 (UTC)

I'll let other editors evaluate the following first in case I'm mistaken but it appears to me that the mental effects of this drug are almost entirely a product of 5-HT2B agonism rather than SERT, 2A, 2C, etc binding.

From https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0009019: "It is also useful to present the npKi data of Fig. S2 in numerical format. In the listing below, the npKi values for each drug are arranged in decreasing order. A value of 0.00 means that the Ki value was measured as >10,000 nm. “ND” indicates that the data is not available. The 5-HT2A and 5-HT2C receptors are also highlighted in bold font for easier location. npKi values below about 2.0 should be imperceptible, while values above about 2.0 should be perceptible, and the higher the npKi value, the more perceptible a receptor should be ... MDMA: 4.00 Imidazoline1, 3.64 5ht2b, 3.26 Ca+Channel, 3.21 Alpha2C, 3.09 Alpha2B, 3.07 M3, 2.94 Alpha2A, 2.54 M5, 2.43 M4; 0.00: 5ht2c, 5ht1d, D2, 5ht1e, 5ht1a, 5ht2a, Alpha1A, Alpha1B, 5ht5a, 5ht6, 5ht7, D1, Beta2, SERT, DAT, NET, 5ht1b, H1, H2, D3, KOR, Beta1, M1, M2, D5, D4, CB1, NMDA, MOR; ND: DOR, Sigma2, CB2, Sigma1"

As well, knockout mice without functional 2B receptors demonstrated no MDMA induced hyperlocomotion and WT had MDMA induced locomotion abolished via a 2B antagonist: "Subsequent activation of postsynaptic 5-HT receptors by released 5-HT has been shown to be critical for the unique psychostimulatory effects of MDMA. In contrast, the effects of direct activation of presynaptic and/or postsynaptic receptors by MDMA have received far less attention, despite the agonist actions of the drug itself at 5-HT2 receptors, in particular the 5-HT2B receptor. Here we show that acute pharmacological inhibition or genetic ablation of the 5-HT2B receptor in mice completely abolishes MDMA-induced hyperlocomotion and 5-HT release in nucleus accumbens and ventral tegmental area. Furthermore, the 5-HT2B receptor dependence of MDMA-stimulated release of endogenous 5-HT from superfused midbrain synaptosomes suggests that 5-HT2B receptors act, unlike any other 5-HT receptor, presynaptically to affect MDMA-stimulated 5-HT release. Thus, our findings reveal a novel regulatory component in the actions of MDMA and represent the first demonstration that 5-HT2B receptors play an important role in the brain, i.e., modulation of 5-HT release." (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6670669/). CloudBoy9001 (talk) 23:45, 17 July 2022 (UTC)

Increased aggression after long term use

A small (260 people) 2007 study in Atlanta seems to show increased aggression in heavy users. Is this confirmed by other studies? (Reid, Elifson & Sterk, Violence & Victims Vol 21: Issue 1, quoted by the US DoJ.) — Preceding unsigned comment added by 36.11.225.146 (talk) 05:15, 18 July 2022 (UTC)

Add a non-human animal subsection to "Research" and mention a study on octopuses

Greetings, I would like to propose adding a subsection for non-human animals to MDMA#Research and describe the effects of MDMA on octopuses (see e.g. this study). Any objections or further suggestions? Plasmastate (talk) 18:04, 21 July 2022 (UTC)

Lead sentence

The lead sentence says "crystal form (molly or mandy)". This is correct, these are the most popular terms for the crystallized version of MDMA.

However, "Molly" is U.S. English, whilst "Mandy" is U.K. English. This was also made clear in the edit, however it is not clear in the article for the reader.

It should be made clear that "Molly" is the U.S. term, and "Mandy" is the U.K. term. Maybe with a footnote or similar? 89.8.217.46 (talk) 15:24, 28 August 2022 (UTC)

I agree that this sort of detail is appropriate for the article, but not sure about it being in the WP:LEDE. The second sentence of § Forms has it. DMacks (talk) 16:25, 28 August 2022 (UTC)

I agree to some extent; "Molly" might of originated in the United States, however, at this point I believe it has become more of a universal term, at least to some degree (see no:MDMA), and should therefore be prioritized. I only support the idea of adding "Mandy" to an explanatory footnote (EFN). 12u (talk) 23:08, 28 August 2022 (UTC)

Semi-protected edit request on 30 January 2023

Please take down my name, Mandy, from being associated with the illicit drug MDMA.

Thank you,

edit semi-protected|MDMA|answered=no}}

2601:C2:2:CBC:2911:8093:FEB0:9098 (talk) 06:25, 30 January 2023 (UTC)

MDMA Rescheduled in Australia

I propose that the Australian legal section be updated to reflect that the Australian Therapeutic Goods Administration has rescheduled MDMA to Schedule 8 (Controlled Drug) from Schedule 9 (Prohibited Substance) for certain uses. From 1 July 2023, MDMA can be prescribed for the treatment of post traumatic stress disorder.

https://www.tga.gov.au/news/media-releases/change-classification-psilocybin-and-mdma-enable-prescribing-authorised-psychiatrists Axe L Thief (talk) 00:43, 6 February 2023 (UTC)

I second this. This information in this section is at best incomplete/misleading, and will soon be plainly false. 121.200.4.151 (talk) 04:23, 1 May 2023 (UTC)

Semi-protected edit request on 7 March 2023

Effective January 31, 2023, possession of up to 2.5 grams of MDMA is decriminalized in the Province of British Columbia due to Health Canada mandate 104.250.78.239 (talk) 10:23, 7 March 2023 (UTC)

 Partly done: I have added info about this decriminalization to the section on legality in Canada, but I did not use the text provided as it suggests federal government forced this on the province, when the program was initialized by the province. GiovanniSidwell (talk) 22:59, 8 March 2023 (UTC)

References

Edit request 19 July 2023

"Endogenous" is used in the introduction. It's neither linked nor defined. It's a $5 word. A $0.50 word would be better. Failing that, it would be helpful if it were a link to something - Wiktionary or an appropriate Wikipedia page. Thanks! 108.64.118.44 (talk) 00:48, 20 July 2023 (UTC)

 Done --WikiLinuz {talk} 01:11, 20 July 2023 (UTC)

The BP in a medium vacuum should not be listed

The infobox currently lists the boiling point at 0.4 mmHg, which is a medium vacuum. It is not sourced, and it doesn't say whether this is the free base or what salt it is. This is nearly useless information and it isn't sourced, it should simply be removed. The melting points of the free base and any common salts, at atmospheric pressure, would be interesting data to add. Boiling point in a vacuum is silly. 209.6.225.254 (talk) 09:36, 24 November 2023 (UTC)

Is MDMA a psychedelic or not?

The best source for this claim is that there may be 5HT2A agonism, which "supposedly contributes" to "mild psychedelic hallucinations" caused by "high doses" of MDMA. That's a lot of words to say that its status as a psychedelic is pretty flimsy.

The other sources don't support that it is one, either, just that it's commonly referred to as one. This is similar to how cocaine is called a "narcotic," a legal stipulative definition that's quite different from the scientific one.

I'm not arguing that MDMA isn't a psychedelic, but if these are the best sources we have I think it should be removed from the lead. 2600:1017:B103:D814:CCC9:7381:FFDB:5A2D (talk) 17:51, 13 December 2023 (UTC)

MDMA is not in any way, shape or form, a classic psychedelic, meaning that it cannot be directly compared to LSD, psilocybin, or even mescaline, but it is somewhat closer to mescaline than many other things that people consider to have psychedelic properties, such as cannabis, ketamine, salvia divinorum, and even muscimol. The lead says it has "minor psychedelic properties", but that doesn't mean that it is a psychedelic. Perhaps we just need some clarification in the lead that while it has minor psychedelic properties, it is not technically a psychedelic. Thoric (talk) 18:35, 13 December 2023 (UTC)