Observational Study Finds Association Between Adolescent Use of MDMA and Anxiety in Adulthood

There is a positive association between the use of 3,4-methylenedioxymethamphetamine (MDMA) and mental health conditions. However, causal associations remain problematic given the lack of longitudinal prospective data on the long-term effects of MDMA exposure. Researchers analyzed a subset of data from the Victorian Adolescent Health Cohort Study (Australia), following a cohort of students from age 15 to 35 (waves 2-10). They examined the association between any young adulthood MDMA use, frequency of use, and persistence of use with development of depression and anxiety at age 35.* To address confounding in estimating causal relationships, researchers used doubly robust inverse probability treatment weighting (IPTW) methods.

• Of 1329 participants, 55 percent were female; 25 percent reported any young adulthood MDMA use (5 percent classified as “frequent” and 10 percent as “persistent”).
• By age 35, 12 percent of the cohort had depression and 11 percent had anxiety.
• Any MDMA use compared with no MDMA use during young adulthood raised the odds of past 12-month adulthood anxiety by age 35 (adjusted odds ratio [aOR], 1.73). “Frequent” and “persistent” use also increased the odds of adulthood anxiety (aOR, 2.56 and 2.05, respectively).
• There was limited evidence of an association between any category of young adulthood MDMA use and depression in adulthood.

* MDMA use was categorized as “any,” frequent” (greater than monthly), and “persistent” (across two or more waves).

Comments: The use of IPTW methods is a newer statistical approach for observational data that uses propensity scores to attribute the outcome of interest to exposure. These results highlight the value in prospective longitudinal data collection and analyses to guide public health messaging and awareness around MDMA use and longer-term outcomes.

Ximena A. Levander, MD

Reference: Bryant Z, Morley K, Kerr JA, et al. The relationship between 3,4- methylenedioxymethamphetamine (MDMA) use in young adulthood and anxiety or depressive disorders in the mid-30s: findings from the Victorian Adolescent Health Cohort Study. Addiction. 2025;120(12):2448–2464.