MDMA can take effect between twenty to forty minutes after taking it. It produces very little rushes of pleasure that could be accompanied by nausea. The user feels the greatest effect sixty to ninety minutes after taking the drug, and the effects usually last for three to six hours. Low to moderate dosages users report that MDMA produces a heightened understanding and acceptance of others. Users feel as if barriers disappear, that they feel less inhibited about showing emotion and less sexually pent-up. Psychological effects include confusion, depression, sleep problems, drug desire, severe anxiety and psychosis. These effects generally occur weeks after taking MDMA.