The "high" people experience at recreational doses can take any number of forms depending on the circumstances. Enjoyment of repetitive music is certainly among them, and so is intense enjoyment of borderline-sexual behaviour. But even in a club setting, many people tend to get intensely open about their feelings. I'm no expert on PTSD, but I believe therapy is almost always limited by our reluctance to open up, especially about personal issues that we consider embarrassing, shameful, or that could be considered vulnerabilities.

The really interesting thing is that these effects somehow persist beyond the acute trip. The experience seems to include learning, i.e. the patient experiences positive emotions while (and possibly because of) connecting with people, and sees that any fears they may have had do not materialise (i.e. judgement). As a consequence they tend to become more open in everyday life, and especially with the therapist they shared this experience with.

I'd love to read some therapists' experiences. For them, it must be quite an exhilarating experience as well–just imagine how you'd feel if you suddenly became 10x as effective as your job.

>just imagine how you'd feel if you suddenly became 10x as effective as your job.

I wish I could feed my laptop a pill that would make it write better code for me

> The really interesting thing is that these effects somehow persist beyond the acute trip

This is why I am so glad to see this approach tightly coupling carefully controlled monitoring and talk therapy alongside administration of the drug. I myself had a great experience of 'opening up' at a rave once upon a time, but the comedown was horrible and I felt much worse afterward than before. It was like rising out of purgatory, getting a glimpse of heaven and then having to go live in hell, with a strong sense that heaven had only been an illusion.

A later experience was better. Which reminded me that as with anything else that's strongly psychoactive, set and setting are absolutely key.

Thanks for writing this. I think that you're second paragraph helps to explain the life-altering, and permanent, behavioral changes I experienced after taking MDMA at a rave when I was 19.

Neurotoxicity is probably also related to people overheating and overexerting themselves while on the drug - I've seen people sweating profusely and not noticing while rolling a few too many times.. which generally results in me giving them water, salty crackers, and nudging them to consider taking a quick break.

Indeed - the more visible research papers about amphetamine-related neurotoxicity in rodents reported most effects when the temperature in the brain exceeded 40 degrees - contributing towards massive oxidative stress.

Is oxidative-stress the only mechanism of neurotoxic action, or are there other effects at work, such as dopamine-downregulation or exhaustion?

125mg. Should be "rolling face".