Cognitive functioning associated with acute and subacute effects of classic psychedelics and MDMA - a systematic review and meta-analysis.
Lukas A Basedow, Tomislav Majić, Nicklas Jakob Hafiz, Engi A E Algharably, Reinhold Kreutz, Thomas Riemer
Scientific Reports June 26, 2024 DOI: 10.1038/s41598-024-65391-9 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Qualitative Peer reviewed |
|---|---|
| Interventions | Psychedelics MDMA |
| Duration | At least 24 h after acute effects |
| Topics | MDMA |
| Keywords | Afterglow Subacute Psychedelics hallucinogens Entheogens Psychoactive substances Cognition mental processes Brain function Cognitive function Thinking Post-experience effects |
| Citations | 13 |
| Key findings | Acute cognitive performance is differentially affected: psychedelics impair attention and executive function, whereas MDMA primarily affects memory; sub-acutely, psychedelics may increase executive functioning and creativity. |
Abstract
Classic psychedelics and MDMA have a colorful history of recreational use, and both have recently been re-evaluated as tools for the treatment of psychiatric disorders. Several studies have been carried out to assess potential long-term effects of a regular use on cognition, delivering distinct results for psychedelics and MDMA. However, to date knowledge is scarce on cognitive performance during acute effects of those substances. In this systematic review and meta-analysis, we investigate how cognitive functioning is affected by psychedelics and MDMA during the acute drug effects and the sub-acute ("afterglow") window. Our quantitative analyses suggest that acute cognitive performance is differentially affected by psychedelics when compared to MDMA: psychedelics impair attention and executive function, whereas MDMA primarily affects memory, leaving executive functions and attention unaffected. Our qualitative analyses reveal that executive functioning and creativity may be increased during a window of at least 24 h after the acute effects of psychedelics have subsided, whereas no such results have been observed for MDMA. Our findings may contribute to inform recommendations on harm reduction for recreational settings and to help fostering differential approaches for the use of psychedelics and MDMA within a therapeutic framework.
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 16
- Supportive Touch in Psychedelic Assisted Therapy. The American Journal of Bioethics 2025
- Phenomenology of Psychedelic Experiences and Psychedelic-Associated Distressing Effects: Quantifying Subjective Experiences. Current Topics in Behavioral Neurosciences December 31, 2024
- Sporadic use of classic psychedelics and neuropsychological performance: A cross-sectional analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry April 2, 2025
- Psychedelics for Alcohol Use Disorder: A Narrative Review with Candidate Mechanisms of Action. CNS Drugs July 10, 2025
- Effects of LSD, DMT and psilocybin on cognitive and psychological functions: A systematic review of the literature Journal of Psychopharmacology February 16, 2026
and 11 more in the library
Cites 128
- Psilocybin induces schizophrenia-like psychosis in humans via a serotonin-2 agonist action Neuroreport December 1, 1998
- The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects. ACS Pharmacology & Translational Science December 10, 2020
- Acute, subacute and long-term subjective effects of psilocybin in healthy humans: a pooled analysis of experimental studies Journal of Psychopharmacology September 20, 2010
- The pharmacology of psilocybin Addiction Biology October 1, 2002
- Constructing drug effects: A history of set and setting Drug Science, Policy and Law 2017
and 123 more in the library