The medial temporal lobes (MTLs) are specifically involved in how MDMA works in the brain, though more research is needed to understand how the drug's characteristic subjective effects emerge from its modulation of spontaneous brain activity.
MDMA (ecstasy) makes recalling favorite autobiographical memories feel more vivid, emotionally intense, and positive, while making recall of worst memories feel less negative. In a double-blind, placebo-controlled fMRI study with 19 participants who had prior MDMA experience, 100 mg of MDMA altered brain activity during memory recall: it increased activation in the fusiform gyrus and somatosensory cortex for favorite memories and decreased activation in the left anterior temporal cortex for worst memories. These neural changes suggest MDMA creates a positive emotional bias, which may explain why it helps patients revisit traumatic memories during psychotherapy for PTSD.
Acute recreational use of MDMA (ecstasy) increases perceived trustworthiness of faces and cooperative behavior in economic games. In a study comparing 17 ecstasy users tested on the night of drug use and again three days later with 22 controls, users rated faces as more trustworthy and showed more cooperation on dictator and ultimatum games while intoxicated. By day three, no group differences remained on these tasks. Self-ratings showed typical acute effects such as euphoria and energy, with negative effects like reduced empathy and increased distrust emerging on day three. The findings suggest a single dose enhances aspects of empathy, which may contribute to its recreational popularity and potential therapeutic use.