Debunking the myth of ‘Blue Mondays’: No evidence of affect drop after taking clinical MDMA
In an open‑label study of 14 participants with alcohol use disorder, clinically administered MDMA produced no post‑acute mood declines ('Blue Mondays'); participants maintained positive mood in the week after dosing, reported improved sleep at 3‑ and 6‑month follow‑ups, and none sought illicit MDMA. These results support the safety and tolerability of therapeutic MDMA and suggest previously reported come‑downs are likely due to illicit sourcing and recreational settings rather than clinical use.
Authors
- David Nutt
- Valerie Curran
- Ben Sessa
Published
Abstract
Background
Incorporating 3,4-methylenedioxymethamphetamine (MDMA) as an adjunct to psychotherapy has shown promise in recent years for treating various mental health conditions, particularly those involving trauma. However, concerns about declines in mood and cognition during the days following dosing, also known as ‘Blue Mondays’, have been raised as limitations to its clinical use. Although these changes have been well-documented among recreational users, there are critical confounds to these reports that limit generalizability to clinically administered MDMA.
Aims
Here, we aimed to evaluate the evidence basis for the negative side effects associated with MDMA as well as inform our understanding of the drug’s post-acute effects in a clinical context with an open-label study.
Methods
The current open-label study examined MDMA therapy for alcohol use disorder (AUD; N = 14) and measured mood, sleep quality, illicit MDMA consumption and anecdotal reports after the acute drug effects had worn off.
Results
Participants maintained a positive mood during the week following drug administration in a clinical context. Relative to baseline, self-reported sleep quality improved at the 3- and 6-month follow-ups. Finally, no participants reported using or desiring to use illicit MDMA, and the anecdotal reports indicated that they perceived the treatment favourably.
Conclusion
The results support the overall safety and tolerability of clinically administered MDMA and, importantly, suggest that the ‘come downs’ previously associated with the substance may be explained by confounds in research relating to the illicit sourcing of the drug and specific environmental setting for recreational consumption.
Research Summary of 'Debunking the myth of ‘Blue Mondays’: No evidence of affect drop after taking clinical MDMA'
Introduction
MDMA (3,4-methylenedioxymethamphetamine) is being investigated as an adjunct to psychotherapy for conditions such as post-traumatic stress disorder and alcohol use disorder. However, public and scientific concerns about harms—including alleged neurotoxicity, potential for misuse and post-acute cognitive or affective impairments commonly referred to as 'come downs' or 'Blue Mondays'—have impeded clinical research. The authors argue that many of these adverse-effect narratives derive from studies of recreational use, where illicit drug adulteration, polydrug use and adverse environmental conditions (dehydration, overheating, sleep loss) confound causal attribution to MDMA itself. Sessa and colleagues set out to examine post-acute effects of clinically administered MDMA in a controlled therapeutic context. Specifically, the study evaluated mood during the week after dosing, longer-term sleep quality, subsequent illicit MDMA use or cravings, and participants' anecdotal experiences in an open-label within-subject trial of MDMA-assisted therapy for people with alcohol use disorder (AUD). The intent was to test whether the negative post-acute effects reported in recreational settings would be observed when MDMA purity, dose and context were controlled.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- Authors
- APA Citation
Sessa, B., Aday, J. S., O’Brien, S., Curran, H. V., Measham, F., Higbed, L., & Nutt, D. J. (2022). Debunking the myth of ‘Blue Mondays’: No evidence of affect drop after taking clinical MDMA. Journal of Psychopharmacology, 36(3), 360-367. https://doi.org/10.1177/02698811211055809
References (10)
Papers cited by this study that are also in Blossom
Bershad, A. K., Mayo, L. M., Van Hedger, K. et al. · Neuropsychopharmacology (2019)
Carhart-Harris, R. L., Murphy, K., Leech, R. et al. · Biological Psychiatry (2015)
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Passie, T., Benzenhöfer, U. · Journal of Psychoactive Drugs (2016)
Sessa, B., Nutt, D. J. · British Journal of Psychiatry (2015)
Sessa, B., Higbed, L., Durant, C. et al. · Journal of Psychopharmacology (2021)
Vollenweider, F. X. · Neuropsychopharmacology (1998)
Wolfson, P. E., Andries, J., Feduccia, A. A. et al. · Scientific Reports (2020)
Cited By (3)
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Aday, J. S., Mcafee, J., Conroy, D. A. et al. · Frontiers in Pain Research (2025)
Vizeli, P., Studerus, E., Holze, F. et al. · Translational Psychiatry (2024)
Breeksema, J. J., Kuin, B. W., Kamphuis, J. et al. · Journal of Psychopharmacology (2022)
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