Part 2

Macro-Level Physiological Effects

The increase in Dopamine, Norepinephrine, and Serotonin caused by MDMA causes Central Nervous System (CNS) stimulation that can raise body temperature, heart rate, and blood pressure. It can also cause increased sweating and perspiration, insomnia, nausea, and diarrhea, all of which contribute to dehydration. These comprise Normal Risk #2 family. The fact that MDMA use is often associated with excessive dancing, hot environments, and limited access to water and electrolytes (such as at raves, music festivals, concerts, etc.) compounds these risks. So, if a person has no cardiovascular issues, is mindful of these risks, stays hydrated, ensures not to drink too much water without electrolytes, and keeps their heart rate and body temperature in check, most of these risks can be avoided. However, for anyone with cardiovascular issues (even ones they don't know about) this becomes Edge-Case Risk #3

Other/Unknown-Mechanism Psychological Effects

MDMA is a psychotropic drug. As such, it has the possibility of triggering latent psychological disorders such as Bipolar Disorder, Depression, epilepsy, and Schizophrenia just the same way that LSD, emotional stress, and head trauma do. The mechanism behind this phenomenon is still unknown. This is Edge-Case Risk #4 (I am also not as familiar with this area as most of the others, so I encourage you do to some independent research here.)

MDMA has also been documented to cause acute psychosis. The authors of the case-studies I have read dismissed the idea of there being a latent psychological disorder that was simply triggered because none of the typical milder early symptoms were present before ingestion of MDMA. A clinical psychiatrist that I know also confirmed to me that sometimes these psychotic episodes just happen in conjunction with psychotropic drugs. This is Edge-Case Risk #5 It should be noted that this is considered a rare event.

MDMA has also been observed to cause seizures, though this is rare. It is unknown whether this can be fully-attributed to dehydration, drug interactions, drug adulterants, or undiagnosed epilepsy. However, I have personally seen two people have seizures while on MDMA, so take from that what you will. This is Edge-Case Risk #6

And finally, long-term psychological side-effects such as insomnia and sleep disturbances, anxiety, depression, anhedonia, irritability, and memory-impairment have been found in epidemiological studies (and reviews of such studies) of MDMA users. Unfortunately, epidemiological studies only show correlation, not causation, and many of the results could be attributed to self-medication. Human prospective studies and clinical trials are extremely limited with MDMA due to its legal status and ethics constraints, meaning that the majority of the published information on effects of MDMA is either animal studies, or is epidemiological and typically skewed toward chronic MDMA users. However, that correlation does exist which is at least weak evidence that MDMA use can cause these long-term effects. This is Normal Risk #3

Disclaimer: I am not a doctor. This is not medical advice. This is not intended to encourage or enable any illegal activity. I have posted this information in the interest of harm reduction and scholarly interest alone. If you do anything stupid or if any harm comes to you based on this advice, it's not my fault.

If you found this valuable, leave me a comment. I'd appreciate it. And if you have any followup questions, feel free to ask. Cheers all.