Three-day blues after ecstasy/MDMA use: Evidence from a longitudinal and daily analysis in the European nightlife scene

Matthijs Blankers; Ruben van Beek; Desirée Spronk; Wouter den Hollander; Rosa Andree; Tom P. Freeman; Meryem Grabski; H. Valerie Curran; Jon Waldron; Margriet W. van Laar

doi:10.1016/j.drugalcdep.2025.112881

Three-day blues after ecstasy/MDMA use: Evidence from a longitudinal and daily analysis in the European nightlife scene

Matthijs Blankers, Ruben van Beek, Desirée Spronk, Wouter den Hollander, Rosa Andree, Tom P. Freeman, Meryem Grabski, H. Valerie Curran, Jon Waldron, Margriet W. van Laar

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Abstract

Background: There is a lack of understanding of the nature of the post-acute affective response in the days after ecstasy/3,4-Methylenedioxymethamphetamine (MDMA) use and whether this is associated with ecstasy/MDMA use or circumstantial factors. In the three days following ecstasy/MDMA use, we evaluated whether a drop in mental well-being is observed and can be related to ecstasy use. Methods: Data for this study were obtained from a longitudinal and momentary analysis in the European nightlife scene (ALAMA study). Using ecological daily assessment, participants were asked to complete a daily 3-minute questionnaire for 35 days. Young adults (age 18–34) from the United Kingdom (n = 120) and the Netherlands (n = 124) who use ecstasy/MDMA were recruited in the nightlife scene and using social media campaigns. Substance use, psychological well-being and pathology, sleep quality, harm reduction behaviours, and socio-demographics data were collected digitally through a smartphone app. Results: Participants reported on average a significant drop in mental well-being in the three days following ecstasy/MDMA use (B=-0.14, SE=0.04, p < .001) even when accounting for other substance use, socio-demographics, applied harm reduction strategies, measures of depression, anxiety and sleep quality. For commonly used substances other than ecstasy/MDMA and cocaine, no significant associations with mental well-being in the three days following their use were found. Conclusions: A drop in mental well-being in the three days following ecstasy/MDMA use was associated with ecstasy/MDMA use, in addition to other factors such as (co-)use of other substances, especially cocaine, sleep duration and quality in the days following use, and baseline levels of depression and anxiety.

Original language	English
Article number	112881
Journal	Drug and Alcohol Dependence
Volume	276
Early online date	12 Sept 2025
DOIs	https://doi.org/10.1016/j.drugalcdep.2025.112881
Publication status	Published - 1 Nov 2025

Data Availability Statement

The data that support the findings of this study are not publicly
available for third parties due to privacy and ethical restrictions. The
corresponding author can be contacted for data requests that are
intended to be used for scientific research projects. Considering these
privacy and ethical restrictions, the authors will consider each request
and decide whether and which data can be made available for this
purpose.

Funding

This study was funded by ZonMw / ERANID European Research Area Network on Illicit Drugs - Towards integrated European research in illicit drugs. The UK data collection and delivery of participants’ rewards was funded by the National Institute for Health Research (NIHR) Policy Research Programme (project ref. PR-ST-0416–10003), again within the ERANID network. The funders had no role in the design of the study and during its execution, analyses, interpretation of the data or the decision to submit results.

Funders	Funder number
National Institute for Health Research	PR-ST-0416–10003

Keywords

Anxiety
Ecological daily assessment
Ecological momentary assessment
Ecstasy
MDMA
Mood
Nightlife

ASJC Scopus subject areas

Toxicology
Pharmacology
Psychiatry and Mental health
Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.drugalcdep.2025.112881

250904 - Three day blues - DAD-R2-clean-ACCEPTEDVERSIONAccepted author manuscript, 312 KBLicence: CC BY

Cite this

Blankers, M., van Beek, R., Spronk, D., den Hollander, W., Andree, R., Freeman, T. P., Grabski, M., Curran, H. V., Waldron, J., & van Laar, M. W. (2025). Three-day blues after ecstasy/MDMA use: Evidence from a longitudinal and daily analysis in the European nightlife scene. Drug and Alcohol Dependence, 276, Article 112881. https://doi.org/10.1016/j.drugalcdep.2025.112881

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abstract = "Background: There is a lack of understanding of the nature of the post-acute affective response in the days after ecstasy/3,4-Methylenedioxymethamphetamine (MDMA) use and whether this is associated with ecstasy/MDMA use or circumstantial factors. In the three days following ecstasy/MDMA use, we evaluated whether a drop in mental well-being is observed and can be related to ecstasy use. Methods: Data for this study were obtained from a longitudinal and momentary analysis in the European nightlife scene (ALAMA study). Using ecological daily assessment, participants were asked to complete a daily 3-minute questionnaire for 35 days. Young adults (age 18–34) from the United Kingdom (n = 120) and the Netherlands (n = 124) who use ecstasy/MDMA were recruited in the nightlife scene and using social media campaigns. Substance use, psychological well-being and pathology, sleep quality, harm reduction behaviours, and socio-demographics data were collected digitally through a smartphone app. Results: Participants reported on average a significant drop in mental well-being in the three days following ecstasy/MDMA use (B=-0.14, SE=0.04, p < .001) even when accounting for other substance use, socio-demographics, applied harm reduction strategies, measures of depression, anxiety and sleep quality. For commonly used substances other than ecstasy/MDMA and cocaine, no significant associations with mental well-being in the three days following their use were found. Conclusions: A drop in mental well-being in the three days following ecstasy/MDMA use was associated with ecstasy/MDMA use, in addition to other factors such as (co-)use of other substances, especially cocaine, sleep duration and quality in the days following use, and baseline levels of depression and anxiety.",

keywords = "Anxiety, Ecological daily assessment, Ecological momentary assessment, Ecstasy, MDMA, Mood, Nightlife",

author = "Matthijs Blankers and \{van Beek\}, Ruben and Desir{\'e}e Spronk and \{den Hollander\}, Wouter and Rosa Andree and Freeman, \{Tom P.\} and Meryem Grabski and Curran, \{H. Valerie\} and Jon Waldron and \{van Laar\}, \{Margriet W.\}",

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doi = "10.1016/j.drugalcdep.2025.112881",

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T2 - Evidence from a longitudinal and daily analysis in the European nightlife scene

AU - Blankers, Matthijs

AU - van Beek, Ruben

AU - Spronk, Desirée

AU - den Hollander, Wouter

AU - Andree, Rosa

AU - Freeman, Tom P.

AU - Grabski, Meryem

AU - Curran, H. Valerie

AU - Waldron, Jon

AU - van Laar, Margriet W.

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AB - Background: There is a lack of understanding of the nature of the post-acute affective response in the days after ecstasy/3,4-Methylenedioxymethamphetamine (MDMA) use and whether this is associated with ecstasy/MDMA use or circumstantial factors. In the three days following ecstasy/MDMA use, we evaluated whether a drop in mental well-being is observed and can be related to ecstasy use. Methods: Data for this study were obtained from a longitudinal and momentary analysis in the European nightlife scene (ALAMA study). Using ecological daily assessment, participants were asked to complete a daily 3-minute questionnaire for 35 days. Young adults (age 18–34) from the United Kingdom (n = 120) and the Netherlands (n = 124) who use ecstasy/MDMA were recruited in the nightlife scene and using social media campaigns. Substance use, psychological well-being and pathology, sleep quality, harm reduction behaviours, and socio-demographics data were collected digitally through a smartphone app. Results: Participants reported on average a significant drop in mental well-being in the three days following ecstasy/MDMA use (B=-0.14, SE=0.04, p < .001) even when accounting for other substance use, socio-demographics, applied harm reduction strategies, measures of depression, anxiety and sleep quality. For commonly used substances other than ecstasy/MDMA and cocaine, no significant associations with mental well-being in the three days following their use were found. Conclusions: A drop in mental well-being in the three days following ecstasy/MDMA use was associated with ecstasy/MDMA use, in addition to other factors such as (co-)use of other substances, especially cocaine, sleep duration and quality in the days following use, and baseline levels of depression and anxiety.

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KW - Ecological momentary assessment

KW - Ecstasy

KW - MDMA

KW - Mood

KW - Nightlife

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JO - Drug and Alcohol Dependence

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Three-day blues after ecstasy/MDMA use: Evidence from a longitudinal and daily analysis in the European nightlife scene

Abstract

Data Availability Statement

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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