In brief
- A Johns Hopkins University team surveyed 497 people with MDMA experience online. Of them, 74.5% said they had experienced negative effects in the following days, the familiar “comedown,” at least once.
- According to the abstract, symptoms began roughly 24 hours after ingestion and lasted an average of about 40 hours. The most frequent were fatigue, difficulty concentrating, restlessness and headache.
- Among those who had experienced a comedown, 14.6% reported passive and 6.2% active suicidal ideation. This is a cross-sectional study based on self-reported data; this article is based solely on the published abstract.
MDMA is being studied as an aid to psychotherapy, but among recreational users the malaise of the following days is almost a cliché. How much truth there is to it remains debated: according to the authors of a new paper, there is no consensus on how often these post-acute effects occur or what they involve. A survey from the Center for Psychedelic and Consciousness Research at Johns Hopkins University, published online on October 17 in Psychopharmacology, sets out to describe them.
How it was done
The paper is authored by Sean P. Goldy, Kelcy A. Klein, David B. Yaden and Sandeep M. Nayak. It is a cross-sectional online survey of 497 people who had previously taken MDMA, recruited through the Prolific platform. The questionnaire asked about the frequency, onset and duration of aftereffects, side effects and emotional changes, suicidal ideation, and the deliberate use of supplements or antidepressants to manage symptoms. The authors also compared side effects between people who had ever had a comedown and those who never had, although the abstract does not report the results of that comparison.
What they found
Three in four participants (74.5%) reported at least one episode of negative effects after use. These began roughly 24 hours after ingestion and lasted an average of about 40 hours. The most commonly reported symptoms were fatigue (88.1%), difficulty concentrating (85.7%), restlessness (82.9%) and headache (79.7%).
The most sensitive finding concerns suicidal ideation: among those who had experienced these effects, 14.6% described passive ideation and 6.2% active ideation. The abstract does not state how long it lasted, how severe it was, or whether participants had a prior history of mental health problems. If this happens to you or someone close to you, Spain’s 024 line offers free, confidential support around the clock; elsewhere, contact your local crisis line or emergency services.
As for coping strategies, 30.3% had used supplements, mainly N-acetylcysteine, acetyl-L-carnitine and magnesium, and 5.1% antidepressants. Participants rated them as moderately helpful. That perception is not proof of efficacy: in this cross-sectional survey, perceived helpfulness was not tested in a controlled trial. The abstract also does not report the safety of these practices. Combining MDMA with drugs that act on serotonin can lead to interactions, so it is advisable to check with a healthcare professional.
What this means
The authors conclude that post-acute effects appear common among recreational MDMA users, with fatigue, negative mood and suicidal ideation as prominent features, and they call for further research. The findings call for caution. The data depend on participants’ recall and on an online sample that is not necessarily representative of all users. The abstract does not indicate that pill or powder contents or doses were verified, and does not say whether factors such as alcohol, other substances or sleep loss were taken into account. For these reasons, the study cannot attribute the malaise to MDMA alone.
Even with those limits, putting numbers on such a widely discussed experience helps people make better-informed decisions and plan for the days afterward. Our guide to harm reduction and responsible use and our page on MDMA and empathogens offer general context. On related ground, we previously covered a national U.S. survey on adverse effects attributed to MDMA and other psychedelics.
Sources
- Goldy SP, Klein KA, Yaden DB, Nayak SM. What goes up must comedown: prevalence rates, characteristics, and coping strategies concerning MDMA aftereffects. Psychopharmacology, published online October 17, 2026 (DOI 10.1007/s00213-026-07187-5; PMID 42891831). The full text of the published version was not consulted.
- Bibliographic record and abstract on Europe PMC, accessed October 20, 2026. This article is based solely on the abstract and metadata; the full text was not consulted.
Ecstasy tablets photographed by the U.S. DEA; illustrative image not taken from the study. Photo: DEA / Wikimedia Commons (public domain, U.S. federal government work; Public Domain Mark 1.0).
Educational content written from a harm reduction perspective and with respect for individual freedom. It is not a substitute for advice from a healthcare professional and is not intended to encourage or condemn any drug use.
