I realise this is quite an old post but is written in an authoritative manner and knowing a bit about the subject, I know it's not all correct. I should say I totally agree with the harm reduction sentiment but some of what you have said isn't quite right. I also think there are some important additions that can be made.
I have cribbed the parts that I disagree with and I'll explain why:
1. Never mix MDMA with SSRIs, MAOIs or any kind of other anti-depressants. This can cause serotonin syndrome which can be fatal. MDMA releases a lot of serotonin (also dopamine, adrenaline, oxytocin and many more). The combination of anti-depressants and MDMA is potentially lethal, as there could be way too much serotonin released and not broken down. It's also not okay to stop your SSRIs for a day and take MDMA the next. SSRIs have a long-lasting effect, even after use is stopped. I figure most of you who take anti-depressants for your tinnitus know this, but it can't hurt to mention this.
MAOIs - agree 100%. I have no personal experience with these but they seem to require careful monitoring of what you ingest and I doubt that MDMA is a great idea. I would also say that prescriptions to MAOIs are not handed out lightly due to the risk / side effect profile. They tend to be a last resort which suggests a level of psychiatric discomfort where MDMA use might be distressing at a dose that is actually going to do anything.
SSRIs - unlikely to cause Serotonin Syndrome at anything like a normal dose of both drugs. That's if you have been taking SSRIs for a period of time. If you're new to SSRIs, you shouldn't be going anywhere near a psychoactive substance unless your doctor approves - and even at that you should think twice.
The biggest reason not to take MDMA while taking an SSRI, though, is you're not likely to get a lot out of the experience. MDMA does quite a lot but is actually an SSRI itself as well as a Serotonin releasing agent. Well, if you're already taking a medication with an SSRI action, you're already swimming in a pool of extracellular Serotonin and neuroadaptation has occured. This seems to induce a blocking action to MDMA's desired effects. Serotonin Syndrome is much more likely to occur when an individual who doesn't regularly take serotonergic agents proceeds to take too much or combines two serotonergic drugs which has a multiplicative (and unpredictable) effect.
SSRI medication (Sertraline) actually caused my tinnitus about 3 years ago. It took me a long time but I believe I know the mechanism behind this and I'm going to start a new thread because I think there are people in the same boat. I'll say here that I think they are a horrible class of medication and leave it at that.
2.
Don't mix MDMA with benzodiazepines. Benzos have a depressing effect on the CNS and MDMA has a stimulating effect. It's almost always a bad idea to combine "uppers" with "downers". See the infamous
speedball.
Again, the biggest reason not to do this is the nullifying effect that benzos will have. There's not much point. If MDMA makes you anxious, consider that you might be dosing too high. If you are dosing sensibly and you still feel anxious, I'd leave it alone in future.
BUT, this mix is not especially dangerous for somebody with a healthy heart. For somebody with heart problems, MDMA is a terrible idea on it's own anyway. If you overdose or have a bad reaction to MDMA and land in hospital, you'll be given a benzo 99% of the time. The danger with mixing uppers and downers is mostly dose related. Because of the nullifying effect, you might take more than you should of one or both. Then, when one drug wears off before the other, you find you are too stimulated or too sedated. It's pretty hard to overdose on benzos as the only downer even for a benzo naive individual so really the biggest risk is taking too much MDMA. Even at that, the acute risk isn't major since even the shorter acting benzos will affect the CNS for a longer duration. Nobody can be certain of the long term effects of dosing too high or too frequently and this surely varies from person to person. What we do know is that MDMA is neurotoxic and dosing too high and/or too frequently increases the damage. MDMA + benzo hardly compares to a speedball. Heroin is a much more powerful CNS depressant than benzos are and crack cocaine is a more potent stimulant so the effect I talked about earlier is much more of a pressing concern. Further, there is a much greater chance of cardiac trauma for even a healthy heart, because the components of a speedball each have a greater effect on heart rate pulling it in very different directions. The elevation of heart rate from MDMA is comparable to a brisk 10 minute walk (YMMV, but you get the idea) so this is only an issue with MDMA + benzo if you think that moderate exercise + benzo is dangerous.
On the face of it, the advice above seems harmless even though incorrect. However, it might lead to somebody who is dependent on benzos holding off to try MDMA. That would be more dangerous than taking your normal dose. MDMA lowers the seizure threshold and so does benzo withdrawal. Seizures can be fatal. I am dependent on benzos (not ideal, but it is what it is) but I enjoy MDMA 3-4 times a year and have done it twice since being benzo dependent. The experience is certainly dulled but far from worthless. I take diazepam, which is a long acting benzo. If I know I am going to take MDMA, I will take diazepam about 24 hours before. No danger of withdrawals but not dampening the experience too much.
Mythbusting here... downer + downer is the most dangerous combination, generally speaking. Prince and Michael Jackson are two celebrity examples that immediately spring to mind. They depress the CNS through different modes of action and even experienced users get caught out. Upper + upper is pretty bad too for similar reasons. Regular amphetamine + MDMA (an amphetamine itself) is known to be particularly neurotoxic too.
5. Take precautions. I assume most of you would want to try this at home (or are you going to a loud party to cure your tinnitus?), so overheating is not that big of a risk. Don't dress warm and drink a little every once in a while. A glass of water per 1,5h should do it if you are not in a hot environment. Don't drink too much, as MDMA causes the body to produce ADH. This makes you hold water, so when you drink liters of water it can be potentially fatal. This is not an issue if you don't drink incredible amounts. If at all possible, have a sober friend be with you.
To add to this, the neurotoxic effects of MDMA can be mitigated with antioxidants. Vitamin C is a fantastic antioxidant which can be taken before and after use. I prefer supplementing because it packs a greater punch than, say, a glass of orange juice. No reason not to both take a supplement and consume food/drink rich in Vitamin C. Magnesium is great too and will help you relax in the comedown. Beware though, not all Magnesium supplements are equally. Magnesium Oxide, for example, is not easily absorbed and tends to cause diarrhea which will strip the body of vitamins and minerals which is the opposite of what you want. Chelated Magnesium Glycinate is what you need for this purpose - it is absorbed at 90%+ compared to less than 10% for Magnesium Oxide. 500mg is enough for both Vitamin C and Magnesium. More doesn't hurt. You might not feel like eating but if you manage to eat a banana on the comedown, you'll certainly feel better for it the next day.
7. Don't redose! The neurotoxic potential of MDMA is overrated, but re-dosing MDMA is definitely a bad idea. Take a single dose and leave it at that. Many studies show that single use of MDMA has no ill effects. It is frequent use, with high doses and re-dosing that can cause brain damage. While the effects of brain damage are greatly overstated (thanks war on drugs!), it's definitely possible to hurt your brain. Do not take MDMA more than once every 3 months.
I would encourage the first time user to dose very conservatively. Bad reactions are rare but they do happen. If one doses conservatively, there is no harm in boosting after a couple of hours if the drug is well tolerated. You'll get slight diminishing returns but if the first dose is small, this effect is negligible. 50mg to test the water is good, if the water is fine after 2 hours, go ahead and take 100mg more. To the person who is not naive, I'd tend to agree. Take one dose and enjoy. 150mg is my sweet spot. Much less is underwhelming and much more is a waste and really not healthy. This is actually a reasonably strong dose but consensus seems to be that it is not reckless. Redosing would be reckless, though. Plenty of people take more and they may have a good night but are almost certainly doing themselves harm. They might also turn a good night into a bad one by becoming too stimulated which can be uncomfortable or even fatal.
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