Reports and studies of long-term effects of ecstasy use are reviewed and considered in this paper. The paper begins with a history of MDMA, and contians sections on serotonergic neurotoxicity, cognitive changes after ecstasy use, psychiatric changes after ecstasy use, adverse events reported after ecstasy use, and imaging studies of ecstasy users, and two sections addressing whether adolescents face greater risk from ecstasy use and whether chronic ecstasy use has long-term neuropsychiatric consequences. Overall, the review seems to suffer from disorganization and a tendency to list study findings without any effort at analysis or weighing the significance of all findings. For instance, all findings of cognitive deficits associated with ecstasy use are listed at once, without noting that most findings have been with respect to verbal recall. The same holds true for psychiatric problems after ecstasy use, wherein anxiety and psychotic features, and not depression, are more often reported. In describing acute drug effects, the authors do not refer to any of the human clinical trials with MDMA, and their list of effects seems to be derived from retrospective reports only. At times this list of effects seems to resemble those associated with amphetamine and methanphetamine, and not MDMA. The authors tend to overstate the certainty of conclusions drawn from study findings, though they do elaborate on methodological flaws and difficulties in studies of ecstasy users. For instance, after reviewing studies comparing cognitive function in ecstasy users with non-ecstasy using controls, the authors state that these findings are consistent with findings of serotonergic damage in non-human animals, but do not note that findings memory or learning impairment in non-human animals given MDMA are rare. There are many errors of fact throughout the section detailing the history of MDMA, among them the predictable (that MDMA was patented as an anorectant) and the more surprising (that intentional recreational MDMA use predated use in psychotherapy). The tables in this paper are poorly constructed. For instance, the chart supposedly differentiating effects of chronic MDMA use from other conditions merely marks a reported instance of a symptom, a method that leads to the overrepresentation of MDMA-related adverse effects, as diagnostic markers for the other conditions are used rather than case reports. It is not at all helpful to conclude that someone displaying every psychiatric symptom known to humankind is liable to be a chronic MDMA user. Like many other papers, this review uncritically accepts the interspecies scaling equations offered by Ricaurte. Overall, the review is too disorganized, overgeneralizes too often and has too many errors of fact to make for a good review of the area of ecstasy research. The authors do not add any value to the list of studies they have compiled, thus reducing the usefulness of such a comprehensive review. Furthermore, references do not appear to be correctly associated with papers, as when claims of evidence for serotonin neurotoxicity after a single dose of ecstasy in a human is attributed to the Rodgers study of memory, wherein no such claims about the data are made.