The Promising Role of MDMA in Enhancing Relationships and Intimacy

MDMA: Unlocking Emotional Barriers and Strengthening Bonds (Dr. Bartlik’s Valentine’s Day blog post)   

In time for Valentine's Day, I would like to tell you about a drug that opens the heart: 3,4-methylenedioxymethamphetamine (MDMA). Also known as Ecstasy or Molly, MDMA was popular at electronic dance parties called raves in the late 1980s. MDMA is not yet available legally. It is now in Phase III clinical research trials, which is the final phase before FDA approval of a new medication. Results show that MDMA is successful in helping veterans and victims of sexual violence with PTSD, and the effects appear to be lasting. Studies show that individuals with autism, social anxiety, and anxiety related to life-threatening illnesses also benefit from MDMA. Some individuals have found that MDMA is transformative and helps them overcome deep-seated, life-long shame, making them feel as though a burden has been lifted. To the dismay of those suffering from these conditions who desperately want new therapies, the FDA declined the approval of MDMA in August 2024. Accordingly, at this time, its use outside of research studies is illegal. 

MDMA used at raves is often adulterated with other substances, which is dangerous, mainly when a person dances for hours, becomes dehydrated, and drinks alcohol. Abusers pass out, have potentially lethal cardiac issues, and require trips to the emergency room. These situations give MDMA a negative and dangerous reputation, but when used properly, MDMA is quite safe. However, it's important to note that, like any drug, there are potential risks associated with its use. Other common substances of abuse are far more likely to cause medical incidents. A 2010 study by David Nutt in the United Kingdom published in the prestigious journal The Lancet ranked twenty drugs of abuse in order of dangerousness to users and society. It was conducted before the fentanyl epidemic. Alcohol was number one, causing the most harm, followed by heroin, crack cocaine, methamphetamine, cocaine, tobacco, amphetamine, cannabis, gamma hydroxybutyrate (GHB), benzodiazepines, ketamine, and methadone. MDMA was low on the list at number 17, followed by LSD, buprenorphine, and mushrooms. Now that marijuana is legal in most states, many individuals use it for insomnia and pain management and to enhance their sexual experience. 

When used sensibly, pure MDMA is safe and can help individuals overcome emotional challenges and relationship problems. The drug is a stimulant that causes a surge of norepinephrine, oxytocin, and serotonin in the brain and induces euphoria, happiness, intense love, openness, and connection. Users often report emotional warmth and a desire for physical closeness and intimacy, which can benefit couples therapy. Their surroundings look more vivid, especially when in nature. Unlike LSD, frank hallucinations and loss of control are uncommon. Users can communicate effectively. They often want to cuddle and be held by their significant other or someone nearby. They may make love and, when doing so, may achieve higher levels of intimacy and pleasure. However, the majority of people find MDMA to be more of a love than a sex drug, and some cannot perform sexually while on it. Anecdotally, some couples on the brink of divorce found new understanding, resolved their issues, and stayed together after using MDMA. Others discover while under the influence that they should not be together and separate amicably. To simplify, MDMA’s effects on love, sex, and partner relationships can be complex, but enhanced feelings of love and openness often lead to new, deeper understandings that positively affect people’s lives afterward.

MDMA has the potential to be a powerful tool in couples therapy and the treatment of certain sexual issues. Many seniors who experimented with drugs in their youth use MDMA to foster personal growth and intimacy in their marriages. This underscores the transformative potential of MDMA for those seeking to enhance their relationships. 

Brooklyn psychoanalyst Charley Wininger has written a compelling memoir about his experiences with MDMA, entitled “Listening to Ecstasy: The Transformative Power of MDMA.” He and his wife, Shelley Wininger, both septuagenarians, have explored these experiences together. The book tells you everything you need to know about taking MDMA safely. I spoke with Charley and Shelley on Dr. Tranquility’s Valentine’s Day podcast at the link below. 

As of now, MDMA is illegal outside of research studies, which has driven its use underground. Individuals and groups use MDMA alone and in combination with other substances, such as the hallucinogenic mushroom psilocybin. However, anyone not experienced with these substances should never use them together. Not surprisingly, MDMA and psychedelics are more widely used in California than in the Northeast United States. MDMA is an empathogen that helps people forgive and develop themselves. Many would benefit psychotherapeutically from the uses and effects mentioned above if it were legal and more widely available. Therefore, MDMA studies should continue until the criteria needed for FDA approval are met.