> While doing MDMA in excess is a bad idea, it's worth noting that these studies have a lot of potential confounders. > > One example is that PTSD also causes "confusion, depression, anxiety, paranoia, and impairment of memory and attention processes." And it's likely that some people with PTSD are self-medicating with MDMA.

The longer-term effects of MDMA are actually fairly well-established, in part because the mechanism of action is known and the relevant effects can be directly measured. It's not just a matter of symptomatic evaluation.