Ecstasy / Molly

MDMA (“ecstasy”) is a psychoactive drug that strongly alters brain chemistry by acting as a monoamine releaser—it drives large increases in serotonin, and also increases norepinephrine and dopamine by interacting with their transporters and related presynaptic machinery. Because it can massively raise serotonin and sympathetic activation, acute risks include serotonin toxicity/serotonin syndrome, hyperthermia, hyponatremia, and serious cardiovascular complications—harms that are well recognized in medical and regulatory discussions of MDMA exposure.

In the context of PFS/PSSD/PAS, MDMA is generally a bad idea because it can cause a dramatic serotonergic “shock” to an already sensitized system, and there’s also evidence that repeated/heavy MDMA exposure is associated with lasting changes in serotonergic function in some users (1). While you may see fewer widely circulated community stories of “permanent worsening” from MDMA compared with SSRIs/SNRIs, that’s not strong evidence of safety—it may reflect different usage patterns and under-reporting, and the acute risk profile is still real. Bottom line for your site: avoid MDMA with these conditions, and especially avoid it with other serotonergic drugs (SSRIs/SNRIs/MAOIs) due to markedly increased risk of serotonin toxicity (2).

(1) https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1151061

(2) https://www.fda.gov/media/178986/download

Crash Anecdotes:

https://www.reddit.com/r/PSSD/comments/18ob89v/pssd_mdma/

My Personal Risk Ranking:

Moderate Risk of Permanent Worsening (for PFS/PSSD/PAS):
If you have PFS/PSSD/PAS, MDMA (“Molly”) isn’t commonly reported to cause permanent worsening in community anecdotes, but it can trigger strong flares/crashes and is still considered a moderate-risk, avoid substance. Because it causes a major serotonergic and nervous-system surge, reactions can be unpredictable in sensitized individuals—even if symptoms may later improve after stopping.