MDMA floods the brain with serotonin, producing short-lived openness, trust, and reduced fear. Its main serious use is as a catalyst given a few times alongside structured talk therapy for severe trauma, showing large symptom improvements in many people. Risks include heart strain, overheating, low blood sodium, and contaminated street supply. (Full Review)

Protocol

Supervised Model

3 dosing sessions

Full-day sessions ~3–5 weeks apart, each embedded in preparatory and integration psychotherapy with a two-therapist team

Dose

75–125 mg

Initial dose with an optional smaller supplemental dose (~half) roughly 1.5–2 hours later; recreational redosing avoided

Best Time of Day

Morning

Dosed so the 4–6 hour acute effects and comedown occur during daytime, minimizing sleep disruption

Time to effect

PTSD Improvement

~12 weeks

Meaningful symptom improvement assessed over the full course of typically three sessions, not after a single dose

Acute Onset

30–60 min

Acute mood elevation, reduced anxiety, and increased sociability begin after an oral dose

Acute Duration

4–6 hours

Acute effects last 4–6 hours, often followed by a transient low-mood comedown over subsequent days

Benefits

High: Reduction of post-traumatic stress disorder (PTSD) symptoms

Medium: Increased sociability and reduced social fear; acute anxiety reduction and positive mood elevation

Low: Reduction of anxiety in life-threatening illness; reduction of alcohol and substance use (conflicted)

Speculative: Enhancement of couples and relational therapy; longevity or healthspan extension

Contraindications

Monoamine oxidase inhibitors (MAOIs) (phenelzine, tranylcypromine, selegiline, linezolid)

Significant cardiovascular disease (uncontrolled hypertension, recent myocardial infarction, arrhythmia, structural heart disease)

Severe hepatic impairment (Child-Pugh Class C)

Personal or family history of psychosis or bipolar I disorder

Pregnancy

Key Interactions

SSRIs and SNRIs (fluoxetine, sertraline, venlafaxine, duloxetine)

Other serotonergic agents (dextromethorphan, tramadol, triptans, St. John's wort)

CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion, ritonavir)

Stimulants and sympathomimetics (amphetamines, cocaine, pseudoephedrine)

Supplements with additive effects (5-HTP, tryptophan, St. John's wort, high-dose caffeine, synephrine, yohimbine)

Alcohol and other depressants

Risk & Side Effects

High: Acute cardiovascular strain; transient psychological and somatic side effects

Medium: Hyperthermia and hyponatremia; serotonin syndrome (with serotonergic drugs); potential serotonergic neurotoxicity (conflicted)

Low: Abuse and dependence potential; contaminated or adulterated supply

Speculative: Long-term mood or cognitive effects from therapeutic use; worsening of underlying psychiatric conditions

Monitoring

Marker	Target	Why
Blood pressure	<120/80 mmHg at baseline	Screens cardiovascular risk; MDMA raises it acutely
Heart rate / ECG	60–80 bpm; normal sinus rhythm	Detects arrhythmia risk before acute stimulant load
Serum sodium	135–142 mmol/L	Identifies baseline and tracks hyponatremia risk
Liver enzymes (ALT, AST)	ALT <25 U/L (men), <20 U/L (women)	MDMA is hepatically metabolized; impairment slows clearance
CYP2D6 genotype (where available)	Normal (extensive) metabolizer	Flags poor metabolizers at higher toxicity risk
Body temperature	36.5–37.2 °C	Tracks hyperthermia, a leading acute danger

Cadence: Vital signs (blood pressure, heart rate, temperature) at baseline and periodically throughout each 6–8 hour session; psychiatric symptom scales at baseline, after each session, and at follow-up (commonly at 2 months and longer-term).

Qualitative Assessment

Sleep quality in the nights following a session
Mood and energy levels during the post-dose recovery period
Cognitive clarity and concentration in the days after dosing
Subjective sense of emotional openness, reduced fear, and (in PTSD contexts) reduced intrusive symptoms
Quality of therapeutic engagement and the ability to revisit difficult material without overwhelming distress

MDMA for Health & Longevity

Protocol

Benefits

Risk & Side Effects

Monitoring

Qualitative Assessment