A short but detailed update on my situation, written primarily for my benefit but I know others derive value for comparison's sake.
I decided to start taking ~7.5mg Mirtazapine daily a week and a half ago. It seems to give me a mood boost whereas without, as of late, my mood seems more distant and my relationship to both internal and external worlds is fainter, which I am comfortable enough with but it makes the social aspect of life difficult and I have enough responsibilities to be unable to forgo the luxury of 'toughing it out' entirely soberly.
Although I haven't done hard drugs since it began. I have smoked cigarettes occasionally and drank less than ten pints of beer in the past year. I drink a lot of both English and Green tea and generally have a few coffees in a week. Thankfully, nothing seems to set me back for longer than a few hours.
I've had less than 3/4 of the two 28 tablet 15mg packets of it since it was first prescribed a year ago. It has lasted this long because I was taking it sporadically, by using it now and then to try and gauge progress based on my responsiveness to the drug rather than seeking its long term benefits. I've also been on two trials of Sertraline; the first one in December 2016 for two weeks and another week long in January. Both, but particularly the first seem to have had lasting universally positive effect. So I'm (reluctantly) taking Mirtazapine daily now after persistent suggestion by professionals and close friends that I should take it consistently. I don't like doing this because I can't tell where I'm 'at' au naturel; my superstition is that the more my brain acclimatizes to a regular supply, the less likely it's going to stand steadily on its own two feet which is my long term goal. I certainly don't intend to become dependent on an antidepressant for more than a year. This thought makes me deeply concerned.
The most salient symptom currently is a limited sensory experience. It's as if only the lower half of my brain is active. This is a lot better than it was in November when I couldn't detect any kind of activity at all and I had around 95% pleasure specific/anhedonia (I could still experience a very cerebral and abstract sense of joy). Now I would say that I can experience a kind of blunted unrefined pleasure which is restricted to a particular region of my brain. I am very grateful to have this feeling back however the omitted region evidently contributes more to daily life than merely pleasure. It's as if a whole level of sensory experience and also therefore a layer of my personality is missing which is hard to come to terms with. I've not been able to enter the deepest level of sleep since this began. Upon waking my brain feels 'stuck' in the deepest level of relaxed slumber it's capable of, which isn't anywhere near as 'deep' as it used to be; rather, it is highly evident that it is unable to relax as much as necessary for proper sleep. On a similar note, my yawns also reflect the picture: when I open my mouth, the air enters and I get some satisfaction but it's as if it tapers off prematurely in the shape of the bend in the letter 'n'. Rather than dispersing out more widely. These might seem like strange and insignificant nuances but they make parts of a whole. The result in full is more devastating; sometimes I feel trapped in a sort of bubble of flatness and it seems impossible to escape this experience. All of the negativities are more pronounced at the end of the day when I'm more tired and oftentimes my personality just disintegrates, experience breaks down into its constituents (sight, sound, touch.. etc.) and I experience a constant dull ache in my brain. At this point, instead of experiencing natural drowsiness and relaxation, providing relief, I am just as awake as before and even more excruciatingly conscious of my symptoms. At this point it's simply a case of determined mindfulness (interestingly it does always eventually change into something more bearable) or sleep which I am able to achieve merely by virtue of being overwhelmed. However like I already mentioned, it seems to be a lighter sleep indicated by my state upon waking which is substantiated by a restlessness torrent of vivid, memorable and ultimately 'potent' dreams.
I shift on a daily and sometimes hourly basis between being utterly horrified by my symptoms, their persistence, and what limitations impose on me and might continue to do so for the rest of my life, and a sense of gratefulness for the ones I'm not experiencing/(perhaps in remission) and a kind of blessed gratitude for everything I do have. So I can go from pessimistic states of despair and desperation, believing in the absolute finality of my symptoms to positive, hopeful and even dismissive of their significance. These states of mind sometimes arise from the physical symptoms and other times are independent of and more in my control.
Things I have been doing to help: weekly therapy, mindfulness at least around half of the time, long Vipassana sits and working on just about every other aspect of my life. Lots of heavy reading. Increasing my compassion and selflessness. I also believe in a God now, on my own terms.
DP/DR is completely gone however it tends to sneak back in and is influenced by the environment and company. For instance, I had friends over recently and it was as if specific areas of the brain i.e. a network, was 'straining' to cope with the degree of social energy 'in the air', so to speak. And after only four hours, I was exhausted and close to being DP/DRd into oblivion. The conscious anxiety which manifests in fear, trembling or panic, I've heard about from others, I've not experienced and doesn't seem to be a character of my affliction, although my dreams definitely indicate, perhaps unconscious, equally gripping anxiety.
Throughout this whole thing almost nobody can relate to me. I have drawn a correlation between several members of this forum and I know those who are in this mess from MDMA have enough of a sense of relevance to empathize. Another handful of people I aquaint with who seem to have been to different dark regions also can relate. Therapists seem to have cultivated enough skill and compassion to at least listen and provide useful reflection. And definitely some spiritual leaders I have met with have a broad enough understanding to talk about it with. My family provide the time and space for me but ultimately it seems their ties to me are too close and resulting biased suggestions generally too superficial to help. My friends are utterly hopeless and some of them just pretend I'm doing good/most just don't check up on me. Others, some also past MDMA users even seem dismissive that my symptoms have anything to do with the drug. This is pretty infuriating. I have kept a open mind throughout and I'd actually prefer to believe that the symptoms were only mental, or at least psychosomatic as I'd have more hope but given the duration of their effect, their apparently random variability and other solely physical symptoms including TMJ disorder, indicate that it's definitely as a result of MDMA. In fact, the sheer amount of unadulterated pleasure and bliss I experienced almost every time I took it, makes me absolutely not surprised I'm in this hell hole. However, what I am surprised about is how suddenly it began and how long it's gone on for. I wouldn't be in the slightest surprised if I'm stuck like this forever, but equally so I wouldn't be surprised if I return to normal in the next 6 months. So much confusion and suffering.