E for Ecstasy by Nicholas Saunders
Appendix 1: Reference Section

26 Phenomenology and Sequelae of MDMA use by Dr. Mitchell Liester, Dr. Charles Grob et al., Journal of Nervous and Mental Disease, 180/6 1992.

A study of the immediate, short-term and longer-term effects of MDMA on 20 psychiatrists. The 20 psychiatrists were administered MDMA and then evaluated for side effects, insight gained, pleasure, and the intensity of the experience, taking into account the influence of set, setting and dosage.

The psychiatrists were selected for their prior knowledge of the drug. They all came from Southern California and had an average of six years practice. All had used MDMA at least once. Effects noted during the session (expressed in terms of the percentage of subjects who experienced a given effect) were:

Altered time perception (speeded up or slowed down) 90% Increased
ability to interact with or be open with others 85% Decreased defensiveness
80% Decreased fear 65% Decreased sense of separation or alienation from
others 60% Changes in visual perception 55% Increased awareness of emotions
50% Decreased aggression 50% Speech changes 45% Aware of previously unconscious
memories 40% Decreased obsessiveness 40% Cognitive changes 40% Decreased
restlessness/agitation 30% Decreased impulsivity 25% Decreased compulsiveness
20% Decreased anxiety 15% Altered perception of spatial relationships 15%
Decreased desire for sleep 10% Increased libido 10% 

Afterwards one member of a couple "focused on how they were defensive with each other" while the other "saw love underneath" actions which they had thought implied that the other partner didn't care. There was a shift away from materialistic values and toward interpersonal relationships. Aftereffects lasting up to a week (observed by at least two subjects):

Decreased sleep 40% Decreased appetite 30% Increased sensitivity
to emotions 25% Decreased ability to perform mental or physical tasks 20%
Decreased desire to perform mental or physical tasks 20% Increased ability
to interact with or be open with others 20% Decreased defensiveness 20%
Fatigue 15% Decreased aggression 15% Decreased fear 15% Cognitive changes
15% Depressed mood 10% Decreased obsessiveness 10% Speech changes 10% Increased
restlessness/agitation 10% Altered perception of time 10% Decreased anxiety
10% Decreased libido 10% Trismus 10% Effects lasting more than a week Improved
social/interpersonal functioning 50% Changes in religious/spiritual orientation
or practice 46% Changes in values or life priorities 45% Improved occupational
functioning 40% Increased ability to interact with or be open with others
35% Decreased defensiveness 30% Changes in ego boundaries 30% Decreased
desire to use alcohol 25% Decreased fear 20% Increased sensitivity to emotions
15% Increased desire to use hallucinogenic substances 15% Improved family
relationships 15% Change in career plans 15% Decreased restlessness 10%
Decreased obsessiveness 10% 

It was also found that there were no changes in the effects of the drug with repeated use, contrary to popular belief. Over half said they believed the drug had a "high potential for use as an adjunct to psychotherapy, particularly in regards to its capacity to enhance empathy".

In conclusion, the drug induced an alteration in consciousness that most subjects felt was pleasant and valuable.

The paper refers to Dowling's report on 5 deaths in which MDMA was detected in the victims' blood, and it is pointed out that in each case there were other potentially lethal medical factors, implying that MDMA may not have been the cause of any of the deaths. The clinical implications of changes in serotonin levels are unclear "inasmuch as there have been no documented clinical cases of MDMA-induced serotonergic toxicity". Fenfluramine "has a significantly greater degree of neurotoxicity."