Three-day blues after ecstasy/MDMA use: Evidence from a longitudinal and daily analysis in the European nightlife scene.
Matthijs Blankers, Ruben Van Beek, Desirée Spronk, Wouter Den Hollander, Rosa Andree, Tom P. Freeman, Meryem Grabski, Helen Valerie Curran, Jon Waldron, Margriet Van Laar
Drug and Alcohol Dependence September 12, 2025 DOI: 10.1016/j.drugalcdep.2025.112881 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Longitudinal ecological daily assessment Peer reviewed |
|---|---|
| Sample size | 244 |
| Population | Young adults (age 18-34) from the United Kingdom and the Netherlands who use ecstasy/MDMA |
| Duration | 35 days of daily assessment, with focus on the three days following ecstasy/MDMA use |
| Topics | Anxiety MDMA |
| Keywords | Ecological daily assessment Ecological momentary assessment Mood Nightlife |
| Citations | 1 |
| Key findings | A significant drop in mental well-being occurs in the three days following ecstasy/MDMA use, even after controlling for other substances and confounding factors. |
Abstract
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. 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. 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. 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.
Comparable studies
Other observational and cohort studies on MDMA for anxiety, most cited first.