Hi ihatenotfeeling. It seems long but please read it, I took half an hour out of work to compile this for you quickly, so read it and get back to me as I had this experience myself years ago and also I am doing my Masters dissertation this year in Nero-Psychopharmacology so I have the biological, chemical, pharmacological, pharmacokinetic and pharmaceutical/drug knowledge to help you. Send me a friend request and I will only be glad to help you with info in any way I can, okay so here goes.
Yes, 6-12 months of a daily regimen dose of 20mg Fluoxetine HCL should sort out anything that was precipitated and caused by the MDMA. Fluoxetine HCL has been the stock standard, most medically used and most reliable Selective Serotonin Re-uptake Inhibitor that we have access to today. It is also the most researched and studied of all the SSRI's and the most research journals on any SSRI has been written or quotes it as the best. We know the most about its effects, pharmacology, pharmacokinetics, symptoms, what to expect etc. than any other SSRI.
MDMA is a Serotonergic, Dopaminergic (very little effect actually) and Norepinephren (very little effect actually) re-uptake inhibitor but has the highest affinity with the Serotonergic-involving neurons and more importantly the neurons that only produce and release SERT.
Now what happened when you took the MDMA it was metabolized into MDOH, DHA, MDP2P, MDA and Hmma. After initial first phase metabolism the resulting broken down chemicals entered your bloodstream and quickly crossed the blood-brain barrier and starts doing their jobs. For 30-45 minutes it a amplifies the Serotonin production exponentially by entering the Monoamine cells, fooling them by mimicking the natural known molecules that are let through the very selective membrane transport proteins and there the MDMA metabolites are in competition with normal endogenous Serotonin re-uptake inhibition and overpowers there neurotransmitters into reversing/and or halting their action potential to re-uptake SERT and not let the re-uptake receptor sites let any SERT or its analogues through, it is like they are being lied to that SERT is something unknown and won’t be accepted into the cell as to protect the Mitochondria from harm.
Okay so most of the SERT (and obviously the other Serotonin analogues, 5-HT2 etc.) production in your brain has been on overdrive building trillions and trillions of more SERT-type and structurally similar neurotransmitters by extracting the basic building blocks of SERT, Melatonin, 5-HT etc. from the surrounding cells. Also through this entire time about 80-90% of the SERT neurotransmitters transmitted out of the pre-synaptic cleft is now just chilling and floating around, without any re-uptake, into the post synaptic cleft and no breakdown or whatever it doesn’t have anything else to than to just float and bounce around in a space that is 50 millionths of a millimeter wide.
When the MDMA metabolites have been successful and SERT production has reached its final peak at around 30-45min. ALL of those trillions and trillions and trillions of extra SERT neurotransmitters are released out of the pre-synaptic cleft and is stuck in the synaptic space between cell connections because their normal re-uptake by the post-synaptic SERT re-uptake sites have been temporarily overpowered and can't do their job, and this is what gives you the MDMA effect, it is countless trillions and trillions and trillions of SERT neurotransmitters floating within the synaptic cleft between the two dendrites and they can't go anywhere or be broken down. They just float there for 5-6 hours causing total and utter bliss. Dopamine and Epinephrine is also doing this but to a very weaker degree. So now you have hundreds of times more SERT neurotransmitters floating around that your brain has ever produced or experienced.
Okay good, now that's the trip of MDMA and we get to the 6 hour mark. The MDMA analogues have done their job and it not doing fuckall anymore and also now the re-uptake sites on the dendrites' post-synaptic cleft is starting to work again and absorbs the SERT neurotransmitters as per usual for re-use or recycling. Now you’re coming down MDMA and its metabolites are on the one-way highway to your bladder for expulsion and most of the MDMA’s effects have subsided, the euphoric feelings have faded and now you are left with not one single fucking SERT neurotransmitter in your entire brain (remember only in the brain, Serotonin is found and has used in many other places in your body, your spinal fluid, you’re intestines and stomach and the list goes on). The building blocks of SERT has been depleted also, all of the SERT that already existed has been taken back out of the synaptic left and recycled into hundreds of random molecular structures . ALL OF THE BRAIN's, I SAY IT AGAIN, ALL OF YOUR BRAIN’s SEROTONIN HAVE BEEN COMPLETELY DEPLETED. I MEAN THERE IS FUCKING NOTHING LEFT AT ALL IT IS GONE, the brain must now from scratch rebuild Serotonin and the molecules that makes up Serotonin. This depletion in causing the depressive states, moods and the other negative reactions to be expected on a MDMA comedown.
Some (pseudo) Research done on rats (I mean fuck we are mammals but you can’t compare effects comparatively on both) into the breakdown of MDMA says that Serotonin levels reach normal capacity and normal functioning again within 24-48 hours again after the trip. Hahahaha!!! WTF? Bull Fucking Shit Man. It is comparative to a very skinny guy with no body fat and weighs that 60kg goes to a gym for a weekend and walk out of there looking like a bodybuilder or a rugby player that weighs 120kg. That is utter bullshit and the researcher was lazy and made up a time frame. It takes MONTHS for normal SERT levels to be present and evident enough to be considered neuro-pharmacologically normal and at any normal natural states.
It takes 1-2 months for the protein kinase A and protein kinase C to completely reverse the anti re-uptake inhibitory affects the MDMA had on the re-uptake sites and having them absorbing free floating SERT into the cell body again. It takes 2-3 months for the VMATs neurotransmitters to completely accept Serotonin as a familiar molecule that they must interact with and do their job again to transport SERT to the release site and it takes anywhere from 3 months to a full year for normal monoamine oxidase inhibitors to reach normal levels where they can break down SERT again.
What a year on 20mg daily Fluoxetine is going to do for you is it is going to "do the work, or take some load off" of the affected molecules, chemicals and receptor sites and extends the time for re-uptake of SERT on the other end and thusly leaves more active SERT within the synaptic cleft for a few hours and causes the brain to have the experience of being in possession of normal amount of SERT it is used to and you feel normal again. All that Fluoxetine does is IT FOOLS YOUR BRAIN INTO THINKING IT HAS MORE SERT THAN IT ACTUALLY HAS. The result of this is that everything implicated in the MDMA experience is given a lighter job and takes less time to return to their normal functions and levels in order for them to naturally supply your brain with normal SERT levels experienced prior to the trip.
Take the Fluoxetine, take a load off your hard working brain cells to get back to what state they normally operated on and everything should return back to baseline. After a year or whatever you take less and less Fluoxetin, get off it slowly and the brain will realize the subtle changes in its own bio-chemical state and will be like "oh shit I've been actually chilling for a while as something did a job for me that I usually take care of". Even if takes more than a year on Fluoxetine it's fine. SERT levels WILL regulate back to normal pre-trip states and levels and functioning that it always had according to your unique physiology, biological make up etc.
Take it and give it time to work. It did for me and it will for you. I took Fluoxetine for 1-2 years after all my MDMA trips so what I tell you comes from first-hand experience. Please also tell the doctor you want Fluoxetine specifically, but it he wants to give you another antidepressant you must be adamant though and be assertive about this p-particularity, it also HAS TO be a FIRST GENERATION SSRI, also not any other class of anti-depressants such as SDNR or ones that re-uptakes epinephrine, or antagonizes adrenergic neurotransmitters or tampers with anything else in your brain , no Monoamise Oxidase Inhibitors, no anti-depressants with Ketone related chemistry, nothing of the sort, the doctor will try to be innovative and with the “in” crowd that prescribe every new chemical that has some remote anti-depressant effects or he would have an under the table deal with some pharmaceutical company to prescribe their products and generics. IT HAS TO be a Selective Serotonin Reuptake inhibitor with high affinity for ONLY SERT and doesn't work on any other neurotransmitter than specifically Serotonin, because this is what MDMA’s primary action and function is, this is the primary neurotransmitter and function that we are working on. Nothing else. The minimal influence MMA's metabolites' effect had on Dopamine and Norepinephrine sorts itself out, that is a given, 2 weeks to a months and they are where they were. If he wants to put you on another brand of SSRI's or a generic of Prozac like Nuza, Rezak, there are many, they would all be it's fine also, there are many other first generation SSRI’s that would do the exact same thing, Citalopram is a common one too. But YOU MUST STRESS and be assertive that the pill’s primary focus is to Selectively Inhibit the Re-uptake of Serotonin and NOTHING else. Just one pill that is only a SSRI. Full Stop.
You'll be fine. Trust me. Friend request me and I will even go through this with you