I have a bit of experience to offer...
First, Renz is right - benzos are BAD for long-term use.
There is no way around this truth.
They are remarkably safe for short-term use, even when acute reactions to other drugs (like MDMA, meth, crack) are suspected. They increase GABA in the brain which directly opposes the excitatory neurotransmitter glutamate.
But the brain attempts to maintain homeostasis by slowly increasing glutamate.
When the benzo is withdrawn or a dose is missed, glutamate levels can SOAR.
Many people have minor freakouts after short-term use, and some long-term users have such severe panic attacks that they feel like they are having HEART ATTACKS. And sometimes they do.
The overuse of benzos became an obvious problem, with ER visits among benzo users exceeding those of ALL illegal drugs in 2008!
In The Dark Side forum you can find threads by long-term benzo users that make recovery from other drugs look like a CAKE WALK.
I have read literature and anecdotal reports on the recovery process from many different drugs, and let me tell you that NOTHING scares me as much as benzos or cocaine. Even MDMA, heroin, and meth users with severe problems display a trend towards recovery of normal function within 1-3 years.
But cocaine (crack?) users redose SO often that they obliterate their central reward pathways and they demonstrate a loss of executive function exceeding that of other drugs up to FIVE YEARS. And that is just how long they are followed for, not when they improve.
Anecdotes on benzo users describe an utter lack of emotion.
For 3-5 years in extreme cases.
We are talking a hollow, empty, NON-HUMAN existence.
They talk about not even having the emotion to kill themselves.
Again - it is the length of time that truly sets these two drugs apart from the rest.
Long-term sufferers can exist with many drugs, of course.
Marijuana for example can set off a life-long bout with schizophrenia.
But the point is that benzos have solid documentation that shows a profound risk to long-term users.
What is going on?
High levels of glutamate must be removed from neurons or it literally excites them to death!
Benzos can cause such major increases in glutamate that certain brain regions fall victim to a toxic cascade known as apoptosis.
One such area of the brain is the hypothalamus, which is vulnerable to glutamate toxicity.
This is one reason that MSG, or mono-sodium glutamate, is NOT recommended as a meat tenderizer.
Sure, it does a great job of softening meat cells...
Glutamate toxicity is part of the toxicity of MDMA and it is even suspected as a possible cause of schizophrenia.
But a very important finding from rat studies is that hypothalamic neurons can regenerate after injury.
This is not a known site of adult neurogenesis, but it was shown that after glutamate toxicity stem cell proliferation was seen in this region. How these new cells are integrated into existing circuits, or if they are, could not be determined. Nonetheless it is an exciting example of possible neurogenesis outside of known regions.
Panic attacks and glutamate go hand in hand.
Especially when chest pain occurs - this is a sign of hypothalamic injury.
The HYP controls many autonomic functions such as digestion, body temperature, and heart-rate.
It also serves as the command center for the entire endocrine and adrenal system.
Known as the HPA, or hypothalamic-pituitary-adrenal axis, this structure serves as the connection between our body, thoughts, and emotions. The HPA is the target of all anti-depressants, especially SSRIs (and even ECT).
Altered HPA function is seen with severe depression, psychotic disorders, and during recovery from drug addiction.
Or following a toxic dose.
The hypothalamus sits at the front of the brainstem just before the cortex.
Serotonin nerves extending from the raphe nuclei into the frontal lobes travel through the hypothalamus.
Serotonin is the 'brain-gut' circuitry and it primarily is found in the intestines.
But in the brain, serotonin makes up the most dense neurotransmitter system and it interacts with dopamine and diverse brain functions in ways that escape our understanding. But it is known that serotonin activity in the highest brain regions, such as the prefrontal cortex just behind the forehead, causes significant improvements in mood and HPA axis function. Potentially through targeting dopamine into specific brain circuits, including one that connects to the nucleus acumbens in the limbic system (reward circuitry).
Of course these serotonin nerves travel through the hypothalamus and thus derive their impact upon the pituitary, the master endocrine gland, and the adrenal glands that sit atop your kidneys. And both MDMA and LSD rely on serotonin for their magical effects.
LSD is an agonist, or activator, of 5HT (5,hydroxytryptamine or serotonin) 2A receptors in the PFC.
And MDMA is a system-wide serotonin releasing agent that also targets the PFC.
The serotonin nerves in the prefrontal region are the furthest from their point of origin in the brainstem.
It is here that they are thinnest and most fiber-like.
Not only does this make them more vulnerable to toxicity but they are the LAST to recover during drug abstinence.
And serotonin releasers like MDMA are indeed 'toxic' to higher cortical axons.
Fortunately the serotonin cell body itself is highly resilient and some axons will recover, but former MDMA users show signs of reduced serotonin axonal density in the frontal lobes and PFC. And primate studies also strongly suggest this is the case.
Can you guess where these missing axons go?
Back to the relay station - the hypothalamus.
In fact some studies suggest that serotonin axons that resprout in the first few months of recovery from acute MDMA toxicity will collapse in the frontal lobes and target the HYP instead. At 18 months abstinence, the hypothalamus was seen to have twice the normal density of serotonin.
And this is presumed to be a permanent outcome.
It is notable that the serotonin nerves that do survive in the frontal lobes experience some compensatory proliferation.
Is the hypothalamus redistributing the limited supply of serotonin across the higher brain?
And are panic attacks a sign of glutamate toxicity, perhaps designed to kill and regrow hypothalamic neurons?
That is my theory, and I'm stickin' to it.
Some former MDMA users describe severe panic attacks and anxiety for YEARS.
And my experience on BL suggests that those who combine MDMA with the powerful 2a agonist LSD exhibit the greatest signs of long-term HPA dysfunction. Including panic attacks, altered thermal regulation, digestion problems, lack of appetite, and sexual dysfunction such as low libido or ejaculatory anhedonia.
You wanted to know what the cause of your problem was and whether or not taking MDMA again would be an ok idea...
You would be very unlikely to get this much information from a doctor, unless you are talking to a neurologist that has experience with MDMA users.
Yes, your ongoing panic attacks and chest pain are due to 'brain damage' to your serotonin network.
The connection between your gut and your brain has a powerful impact on both emotions and heart-rate.
And serotonin is known to inhibit dopamine and normal neuron activity - so hyperinnervation of the hypothalamus could alone cause such severe problems.
Taking klonopin may protect hypothalamic neurons in a limited short-term fashion, but long-term use (even if only taken weekly) could spell a much higher level of toxic glutamate. And make for more powerful panic attacks and chest pains.
I HIGHLY recommend you abandon the klonopin for at least a year.
There is no other way to rule it out as a cause, although I am certain that the real cause is the collapse of higher serotonin axons from heavy MDMA use. The kpins are an ongoing contributor to the problem.
If your use is more substantial than once per week, it is VERY important that you SLOWLY taper off of them.
Abrupt discontinuation of a benzo can be very dangerous, even lethal.
Seizure are just one concern; brain damage and 'years' of no emotion is another.
Make sure you involve your doctor if you need to taper, but don't allow them to talk you out of it.
As long as you are still having panic attacks and chest pain, the klonopin is suspect.
I imagine you have worse panic attacks the day after taking them...
Should you take MDMA?
The best answer is NO.
Based on your description and that of MANY others on BL, even years of abstinence will not prevent a very uncomfortable and possibly terrible experience. I have read accounts of four years of abstinence not fixing the problem, and the user experiencing NO euphoria while suffering chest pain and tachycardia/cold sweats for HOURS.
Doesn't sound like fun does it?
If you insist on trying, I highly recommend taking Piracetam beforehand.
It is widely used by MDMA users on BL that experience 'loss of magic'.
They often describe piracetam as a miracle, restoring much of the original experience.
It preferentially increases both serotonin and dopamine into the PFC - probably redistributing it from the hypothalamus!
During my own recovery from Serotonin Syndrome, I have found piracetam to be the most incredible supplement even in TINY doses.
The effect it has on me is beyond description - a cognitive enhancer that is not draining like a stimulant.
It restores emotions and increases digestion considerably.
And if I were to EVER try and roll again, there is NO doubt that Piracetam would be a pre and post load.
But I should mention that it needs to be taken at least 4 hours prior to MDMA, as it must take effect on the PFC first.
It taken at the same time it will be a wasted dose.
Some people, like Bsiren, claim it must be taken the night before AND several hours prior to MDMA.
I agree with this advice based on the fact that it always effected me more the second day than the first - a sign to me that it must permeate the entire length of the GI.
The only way you should even consider rolling again is with Piracetam.
No 5-HTP or tryptophan supplements!
Any other serotonin increasing agent is a MAJOR risk for you.
You are already tempting fate on this one.
At best you may experience an improvement in emotions that you haven't felt in years.
But it will not last past the experience and you may well experience a very hard crash.
You should expect a very bad comedown.
And even if the experience is decent, you have to remember that your higher brain is simply incapable of exerting the same effect upon the HPA now.
And if the experience is negative, it can be powerfully negative.
You think you have panic and chest pain now?
What do you expect from increasing serotonin content in the hypothalamus even more?
Now you see why piracetam is so crucial.
And so is exercise.
Working out releases BDNF, a serotonin nerve growth factor.
This will also increase axonal density in the frontal lobes - but not permanently.
Only permanent exercise routines can have a lasting impact.
But I highly recommend exercising for several days before and after any drug experience.
Consider yourself lucky that opiates work ok for you.
I have had very bad reactions to Tramadol in the last year and one BL member (Altered Perception) describes tachycardia and fevers from opiates, alcohol, and cannabis TEN YEARS after a near-death experience on MDMA!
What I really recommend is that you focus on living as healthy as possible, eating right and exercising DAILY for a year.
And drop the kpins for good.
This should improve your panic attacks and chest pain significantly, and if it does THEN you can consider taking MDMA again.
But not until then.
Be smart.
Final advice - if you do it with my exercise/piracetam regimen...
You should also use a TRIAL dose that is VERY small.
Like a fourth of a pill just to see what happens. That way if you react poorly you haven't doomed yourself to hell.
And CONTROL YOUR BODY TEMPERATURE.
Even if you don't feel a fever happening, force yourself to roll in a cool environment with few clothes on.
Having a lower core temperature directly prevents serotonin toxicity!
I hope all of this helps.
Let me know if you have any more questions.
And come back to let us know what you decide, and how you turn out.
FBC
