Long-term neurocognitive side effects of MDMA in recreational ecstasy users following sustained abstinence: A systematic review and meta-analysis.
Hillary Ung, Gemma Mckeon, Zorica Jokovic, Stephen Parker, Mark Vickers, Eva Malacova, Lars Eriksson, Mark Daglish
Journal of Psychopharmacology November 19, 2025 DOI: 10.1177/02698811251389559 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Qualitative Peer reviewed |
|---|---|
| Population | Recreational MDMA users with at least 6 months of abstinence and MDMA-naïve comparison groups |
| Duration | Minimum 6 months of abstinence |
| Topics | MDMA |
| Keywords | 3,4-methylenedioxy-n-methamphetamine MDMA Neurocognition Abstinence effects Cognitive impairment Learning and memory |
| Citations | 1 |
| Key findings | Both current and abstinent MDMA users show similarly impaired learning and memory compared to non-users, with no evidence of recovery after sustained abstinence. |
Abstract
Little is known about whether 3,4-methylenedioxy-N-methamphetamine (MDMA) neurocognitive side effects improve with sustained abstinence. This study aimed to systematically review and synthesise the existing literature on the long-term neurocognitive side effects of recreational MDMA use after a minimum of 6 months of abstinence. We searched relevant databases utilising terms related to (1) MDMA and (2) neurocognition. A qualitative synthesis of study findings was organised with reference to the neurocognitive domains defined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM5). Fourteen articles met the inclusion criteria, assessing learning and memory (n = 8), executive function (n = 10), complex attention (n = 5), language (n = 2) and perceptual motor function (n = 1). Meta-analysis and assessment of bias were undertaken only for the domain of 'learning and memory' and included five studies. People with current and previous MDMA use had poorer learning and memory performance compared to people who were MDMA-naïve (Hedges' g = -1.06 and -1.37, respectively); there was no significant difference between current and abstinent MDMA users (Hedges' g = 0.03). A longer period of abstinence did not demonstrate greater improvements or recovery in learning and memory. There was limited evidence to conclude that MDMA use is associated with neurocognitive impairments in other domains. Overall, these conclusions are based on low-quality findings.
Comparable studies
Other systematic reviews and meta-analyses on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| A review of the acute subjective effects of MDMA/ecstasy | 2006 | Systematic review | |
| Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review Patients in clinical trials with MDMA or serotonergic psychedelics | 2022 | Systematic review | n = 598 |
| Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy Patients with PTSD | 2016 | Meta-analysis | |
| The neuropsychology of ecstasy (MDMA) use: a quantitative review MDMA users | 2007 | Meta-analysis | |
| Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review | 2022 | Systematic review |
Citations in the library
Cited by 2
Cites 47
- Memory impairment in abstinent MDMA ("Ecstasy") users Neurology December 1, 1998
- Altered Serotonin Innervation Patterns in the Forebrain of Monkeys Treated with (±)3,4-Methylenedioxymethamphetamine Seven Years Previously: Factors Influencing Abnormal Recovery Journal of Neuroscience June 15, 1999
- Reorganization of ascending 5-HT axon projections in animals previously exposed to the recreational drug (+/-)3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") Journal of Neuroscience August 1, 1995
- Hallucinogens in Mental Health: Preclinical and Clinical Studies on LSD, Psilocybin, MDMA, and Ketamine Journal of Neuroscience November 30, 2020
- Cortical Serotonin Transporter Density and Verbal Memory in Individuals Who Stopped Using 3,4-Methylenedioxymethamphetamine (MDMA or "Ecstasy") Archives of General Psychiatry October 1, 2001
and 42 more in the library