I know this thread is old, started on the same year that I joined this site but I just want to share my opinions on this fascinating subject as they have changed a lot over time.
Firstly, like the OP, I used to believe amphetamines were a one-way ticket to permanent brain damage and the inability to feel pleasure even at low doses. then I discovered, as others have mentioned here, people have been using stimulants for years with little to no consequences apart from withdrawals which disappear over time. of course, this doesn’t take away from the fact amphetamines can be neurotoxic especially when used long-term at high doses. dopaminergic neurotoxicity is thought to play a role in long-term dopamine depletion as the nerve terminals that release dopamine can become dysfunctional and takes a long time to recover. however, other factors that contribute to long-term amphetamine tolerance and possibly depressive symptoms may include dopamine receptor down regulation and changes in glutamate receptor expression, which aren’t linked to neurotoxicity/Neuron damage.
So what does this mean for amphetamine related mental disorders?
Well, along with the above, we also need to consider the effect of The amphetamine induced dopamine flood on other brain circuits and neurotransmitters. this is because dopamine actually works by modulating The release of chemicals like glutamate and GABA as well as the expression and conductance properties of their postsynaptic receptors. I won’t give specific examples as this post will become an essay, Though I will happily reply with examples if requested. nevertheless, it is these effects, combined with its influence over almost all brain circuits that make dopamine Central to mental functioning. When it’s levels fluctuate unpredictably and wildly from unnaturally low to super high, it’s no surprise that cognitive functions, mental agility and natural reward function can suffer.
How may amphetamine neurotoxicity contribute to psychosis?
No one is really sure, but it probably depends. for brief, short term psychotic episodes, neurotoxicity is probably irrelevant and instead over stimulation of D2 receptors is likely temporarily messing with cortical networks. this should resolve after a bit of sleep and stopping amphetamine use. on the other hand, long-term psychosis that lasts for months and doesn’t resolve after amphetamine use it’s probably due to neurotoxicity but not where you may think. rather than dopaminergic neurotoxicity, it is more likely that damage has occurred to A group of cells called the Parvalbumin containing GABA interneurons. they are found in many brain regions and their job is to stabilise and fine-tune neural networks to make sure they are processing both internal and external information properly. if damaged, brain networks become too excitable and likely screw up external information from the environment whilst also generating internal nonsense as well. psychotomimetic NMDA antagonists are also thought to temporarily switch off these interneurons.
On second thoughts, this post could become huge so I might continue my ideas as part of a blog post.