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, H Valerie Curran, Jon Waldron, Margriet W Van Laar
Drug and alcohol dependence September 12, 2025 Peer reviewed DOI: 10.1016/j.drugalcdep.2025.112881 via PubMed
Summary
Young adults experienced a significant drop in mental well-being in the three days after using ecstasy/MDMA, with an average decrease measured at B=-0.14. This decline was linked to ecstasy/MDMA use itself, as well as factors like sleep quality and baseline depression and anxiety levels. Other substances did not show significant associations with mental well-being during this period.
Study at a glance
| Design | longitudinal and momentary analysis |
|---|---|
| Sample size | 244 |
| Population | young adults aged 18-34 from the UK and the Netherlands who use ecstasy/MDMA |
| Key finding | Participants reported a significant drop in mental well-being in the three days following ecstasy/MDMA use. |
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.