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 (Oxford, England) November 19, 2025 DOI: 10.1177/02698811251389559 via PubMed
Summary
AI-generated from the abstractA systematic review and meta-analysis examined whether cognitive side effects of recreational MDMA (ecstasy) improve after at least six months of abstinence. Fourteen studies were reviewed; five were included in a meta-analysis of learning and memory. Both current and former MDMA users showed poorer learning and memory than people who never used MDMA (effect sizes of -1.06 and -1.37, respectively). There was no significant difference between current and abstinent users, and longer abstinence did not correlate with cognitive recovery. Evidence for impairments in other cognitive domains was limited. The authors note these conclusions rest on low-quality evidence.
Study at a glance
| 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 finding | 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.