Three-day blues after ecstasy/MDMA use: Evidence from a longitudinal and daily analysis in the European nightlife scene

Background: There is a lack of understanding of the nature of the post-acute affective response in the days after ecstasy/3,4-Methylenedioxymethamphetamine (MDMA) use and whether this is associated with ecstasy/MDMA use or circumstantial factors. In the three days following ecstasy/MDMA use, we evaluated whether a drop in mental well-being is observed and can be related to ecstasy use.

Methods: Data for this study were obtained from a longitudinal and momentary analysis in the European nightlife scene (ALAMA study). Using ecological daily assessment, participants were asked to complete a daily 3-minute questionnaire for 35 days. Young adults (age 18–34) from the United Kingdom (n = 120) and the Netherlands (n = 124) who use ecstasy/MDMA were recruited in the nightlife scene and using social media campaigns. Substance use, psychological well-being and pathology, sleep quality, harm reduction behaviours, and socio-demographics data were collected digitally through a smartphone app.

Results: Participants reported on average a significant drop in mental well-being in the three days following ecstasy/MDMA use (B=-0.14, SE=0.04, p < .001) even when accounting for other substance use, socio-demographics, applied harm reduction strategies, measures of depression, anxiety and sleep quality. For commonly used substances other than ecstasy/MDMA and cocaine, no significant associations with mental well-being in the three days following their use were found.

Conclusions: A drop in mental well-being in the three days following ecstasy/MDMA use was associated with ecstasy/MDMA use, in addition to other factors such as (co-)use of other substances, especially cocaine, sleep duration and quality in the days following use, and baseline levels of depression and anxiety.