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I consider MDMA a very safe and benign substance, if you take certain percautions, such as preloading on 100mg of tryptophan daily, for a couple of days before rolling, and the day after. Take vitamin C before and after the roll. Gingko bilboa herbs are really nice. Eat healthly and exercise. Moreover, it is essential to find the one tablet that works best, and the one that contains only MDMA and not MDE, MDA, DXM, ephedra, etc. In this way, many have virtually eliminated tolerance, and are able to roll several days in a row with the same dose.
Any tests in animals, which use around 20 mg per kg body weight, (whereas a standard human dose is ~120 mg) show certain amounts of neurotoxicity, but that is entirely due to the huge overdoes, which basically overworks the 5-HT neurons and releases too much dopamine. All of this can be pretty much allieviated by taking anti-oxidants such as Vitamin C. SSRI's after the roll will help, though during the roll they will only ihibit the effects of MDMA.
Many consider MDMA much safer then alchohol. If all the above percautions are taken the only things to take into consideration are overworking your heart and not drinking too much, and generally not hurting yourself, developing an eating schedule, since it kills appetite for a while.
Like many of you said, the experience depends mostly on what you make of it. Bad trips usually result from a bad state of mind coupled with bad preparations. If you've been a constant user for a while, stop for a month or two, then start again with those percautions in mind and you should be fine. 
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