I used a lot of MDMA 20+ years ago. I was immediately aware, on trying it, that it was neurotoxic. I don't know how I knew that, but I did. However, after I quit I saw no evidence of permanent damage. As a fairly high-level software developer, I'm pretty sensitive to the state of my brain, and I don't recall ever experiencing difficulty working more than 2 or 3 weeks after taking MDMA.
Also, I only heard about this right before I quit, but a lot of the toxicity can be averted by taking 20mg of fluoxetine 3 to 4 hours into the experience. (It diminishes the drug effect, so you don't want to take it too soon.) The theory I heard is that MDMA or, more likely, one of its metabolites, binds to serotonin receptors and damages them. Taking something else that binds to the receptors, then, can help protect them. I tried it once and it seemed to help. St. John's Wort might work too, and is easier to get.
All that said -- I agree that people should be more careful with it. It's a potent psychoactive drug that's harder on the body than most of them, dehydration being a real risk.
You're correct in saying that fluoxetine (prozac) can reduce the ability of the chemical that causes MDMA neurotoxicity (whatever it is) to get inside the axon and cause damage. However, in doing so fluoxetine reduces MDMA’s ability to work (as you stated).
People regularly dosing with SSRIs may be safe from neurotoxicity, but they usually don’t feel the normal effects of MDMA either. The idea of using SSRIs to prevent neurotoxicity is something of a catch-22: If you take the SSRI after coming down from the MDMA, it’s probably too late to do a lot of good. On the other hand, taking an SSRI before-hand tends to reduce the desired effects of MDMA, making it more logical to simply take less MDMA in the first place.
All things considered, it’s unlikely that taking an SSRI before or after MDMA is a very useful prevention strategy. Since SSRIs have their own side effects and potential risks, the practice should probably be avoided.
Also, I only heard about this right before I quit, but a lot of the toxicity can be averted by taking 20mg of fluoxetine 3 to 4 hours into the experience. (It diminishes the drug effect, so you don't want to take it too soon.) The theory I heard is that MDMA or, more likely, one of its metabolites, binds to serotonin receptors and damages them. Taking something else that binds to the receptors, then, can help protect them. I tried it once and it seemed to help. St. John's Wort might work too, and is easier to get.
All that said -- I agree that people should be more careful with it. It's a potent psychoactive drug that's harder on the body than most of them, dehydration being a real risk.