The Promising Role of MDMA in Enhancing Relationships and Intimacy

By Barbara Bartlik, MD      /     Edited by: Regina Manser, Ph.D

3,4-methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy or Molly, has gained attention for its potential therapeutic benefits, particularly in fostering emotional connections and enhancing intimacy. Initially popularized in the late 1980s at electronic dance parties, MDMA is currently undergoing Phase III clinical trials, the final stage before possible FDA approval as a treatment for certain psychological conditions. Early research indicates that MDMA can be effective in treating post-traumatic stress disorder (PTSD) in veterans and victims of sexual violence, with results suggesting that its benefits may be long-lasting. Additionally, individuals with autism, social anxiety, and anxiety linked to life-threatening illnesses have also experienced positive outcomes from MDMA treatment.

In some cases, individuals have described transformative experiences using MDMA, particularly in overcoming deeply ingrained feelings of shame. For many, this sense of emotional release can feel as though a significant burden has been lifted. Despite these promising findings, the FDA declined to approve MDMA for medical use in August 2024. As such, the substance remains illegal outside of research studies.

While MDMA's use in recreational settings—such as at raves—has earned it a reputation for being dangerous due to its potential adulteration with other substances, the drug itself, when used correctly, can be relatively safe. The risks associated with MDMA at raves often arise from the combination of dancing for prolonged periods, dehydration, alcohol consumption, and the presence of impurities in the substance. This can lead to serious medical incidents, such as cardiac issues and the need for emergency care. However, when used responsibly and in pure form, MDMA presents fewer risks compared to many other common substances of abuse. In a 2010 study by David Nutt published in The Lancet, MDMA ranked 17th in a list of 20 drugs of abuse, far lower than substances such as alcohol, heroin, and crack cocaine, which are considered far more dangerous.

MDMA is a stimulant that works by releasing norepinephrine, oxytocin, and serotonin in the brain, producing effects of euphoria, happiness, and intense emotional connection. Users often report a sense of warmth, a desire for physical closeness, and enhanced emotional openness, which can be particularly beneficial in the context of couples therapy. Unlike LSD, which can cause hallucinations and a loss of control, MDMA tends to promote effective communication and emotional intimacy. Many users describe a desire to cuddle or engage in intimate physical contact, which can lead to enhanced sexual pleasure, though some individuals may find that they are unable to perform sexually under its influence. For some couples, MDMA has facilitated new understandings and resolution of relationship issues, leading to strengthened partnerships, while others may decide to part ways amicably after gaining clarity about their relationship.

MDMA’s impact on relationships and intimacy demonstrates its potential as a powerful tool in couples therapy, especially in addressing sexual and emotional difficulties. Older adults, many of whom experimented with drugs during their youth, are increasingly using MDMA to foster personal growth and intimacy in their marriages, highlighting the substance’s transformative potential for those seeking to enhance their relationships.

Charley Wininger, a Brooklyn psychoanalyst, has chronicled his experiences with MDMA in his memoir, Listening to Ecstasy: The Transformative Power of MDMA. Along with his wife, Shelley, Wininger has explored the therapeutic potential of the drug, and the book provides practical guidance for those interested in using MDMA safely. The couple discussed their experiences in an interview on Dr. Tranquility's Valentine's Day podcast.

Currently, MDMA remains illegal outside of research studies, which has led to its use in underground settings. Some individuals combine MDMA with other substances, such as psilocybin mushrooms, to enhance their experiences. However, experts caution against using MDMA in combination with psychedelics, particularly for those without prior experience. MDMA and other psychedelics are notably more widely used in states like California compared to the Northeast U.S. As an empathogen, MDMA has the potential to help individuals process emotional challenges, forgive past hurts, and promote personal growth. Were it more widely available and legal, many people could benefit from its therapeutic uses. As such, ongoing research is crucial to determine whether MDMA can meet the criteria for FDA approval and become a recognized treatment option.

References:

•  Multidisciplinary Association for Psychedelic Studies (MAPS) – MDMA-assisted Therapy for PTSD

• This source provides detailed information about the clinical trials and ongoing research surrounding MDMA, particularly its use in treating PTSD in veterans and sexual trauma survivors. MAPS is a leading organization in researching MDMA as a therapeutic tool.

• Reference: "MDMA-Assisted Therapy for PTSD" MAPS website

•  Nutt, D., King, L. A., & Phillips, L. D. (2010). Drug harms in the UK: A multicriteria decision analysis. The Lancet, 376(9752), 1558-1565.

• This study ranks various drugs based on their harm to users and society.