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MDMA Recovery (Stories & Support - 5)

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Vent all you like, that's what the thread is for ;)

There is a lot of discussion in the mental health field about biological vs. psychological, or internally vs. externally caused mental illness (https://en.wikipedia.org/wiki/Endogenous_depression https://en.wikipedia.org/wiki/Biopsychiatry_controversy)

First I should point out that an extraordinary number of people around the world end up developing MDD without any clear cause. But while I'm sure its reasonable to assert that we would never have found ourselves in quite this predicament or a similar one without some inciting event, be it an intensely traumatic event that lead to PTSD or whatever, whether or not the mental illness is from external factors, entirely genetic or some combination, these various therapies (cognitive and biological) should all be viewed as input -> output.

So even though severe MDD is regarded as intensely biological, with findings of various inflammation and differences in volumes of brain regions etc when it is longstanding, CBT can still be effective and it is widely considered the first line treatment because it really does affect your biology. If MDD pathology causes a shift towards activation of the self-referential/rumination circuits in some people, then cognitive based therapies can still be the input that helps them calm and normalize those networks.


"Where can a psychologist help here where so many symptoms seem to be mediated by the disturbance. For example there isnt any long term conditioning response to work on. What can they do to cure me? And if I followed a strict therapy regimen weekly can I expect to be cured in 6-8 weeks or is this setting myself up for disappointment?"

I know people around here talk a lot about wanting to be 100% recovered, but medical practitioners seem to always emphasize improving quality of life as much as possible, and that's what I would focus on as well. I've heard a lot of people concede that they would be happy with a guaranteed 50% recovery and that sort of thing. I think its going to be much more than 50% with enough time and proper navigation, but getting frustrated that you're not at 100% isn't helpful unfortunately :/

The other thing to consider as a main tenant of medicine is risk vs. benefit ratio. We can assess what the risk vs. benefit ratio of cognitive therapy is, but it would be pertinent to point out that the risk/negative effects of therapy would probably be mostly related to us getting frustrated if participating in the therapy didn't 100% cure us right away, but that sort of cognitive phenomenon is ironically what CBT would try to address.

I would read through that page on endogenous depression, see for example

"Endogenous depression occurs as the results of an internal stressor—commonly cognitive or biological—and not an external factor. Potential risk factors include these cognitive or biological factors. Patients with endogenous depression often are more likely to have a positive family history of disorders and fewer psychosocial and environmental factors that cause their symptoms

~ This type of depression often occurs due to biological reasons. Since symptoms are due to an internal phenomena, prevalence rates rend to be higher in older adults and more prevalent among women
Individuals suffering from endogenous depression require treatment plans that focus on the internal, cognitive thought processes since internal stressors are the root of somatic symptoms. Individual cognitive therapy (ICT) is therefore a common treatment used to gain insight to the individual's internal conflicts or thoughts that are motivating their distressing symptoms.[14]

Once the cause of the symptoms are identified, sessions are used to develop new coping skills, behavior modification, and changes in beliefs. As preventative measures, pharmaceuticals such as SSRI's and antidepressants may also be utilized to avoid further development or progression to Major Depressive Disorder"


Now I know what people are thinking, take a quote like "Individuals suffering from endogenous depression require treatment plans that focus on the internal, cognitive thought processes" - our first thought here might be "But it was the ecstasy" and so forth, but the thing to consider is that ecstasy, like all other drugs, functions by affecting our cognitive thought processes. So targeting the cognitive thought processes by whatever means necessary is still valid to improve our quality of life, and allow our recovery to take place.

And again keep in mind, this therapeutic target shouldn't be viewed as a 100% cure, but a therapeutic target to improve quality of life, and especially to decrease the chance that someone will develop other neurosis while they give the recovery time.
 
Well sure but at the same time I sort of "know" intuitively that my thought patterns and stuff aren't normal *right now* in the LTC. A lot of the LTC or Whatever we want to call it has biology which sets me up for those thought patterns. I can try to cognitively shift the thought patterns but in the beginning at least the biological force will be stronger than the cognitive force and thats where the discouragement with CBT etc occurs. Sometimes it does make me think that I am causing my anxiety and im responsible for it completely.

Ive picked up CBT or MBCT books at the library just to give a quick skim and find that not everything in them is necessarily applicable. As a lot of them talk about low self esteem for example. I know intuitively that I-the real me- don't really have low self esteem but that I have low confidence and anxiety *right now* as a *symptom*.

Another example I saw was anxiety over school or tests. Well I know I didn't have that before but I have a bit now as an LTC *symptom* but its a huge stretch to say thats causing the anxiety which is what some of these self help CBT workbooks seem to imply.
I can try to modify my cognitions to help in the moment but there is still a question as to why a situation that previously generated no anxiety generates thought patterns of anxiety now. On an fMRI lets say if that was hypothetically done before and after there would be a shift in these regions but the fMRI wont say why there is a shift.

Hard to explain really but I really think the medical establishment hasnt gotten the whole cause/effect thing properly investigated. Cause unlike those whose problem really did start with cognitively based anxiety, I feel like mine did begin with biologically based anxiety. So when somebody like a therapist or friend asks why am i anxious I am not able to give a clear cut answer.

I guess what im saying is why don't we target the mechanisms causing the endogenous MDD (or anxiety--im not that depressed right now) rather than targetting the symptoms of endogenous MDD. What even causes MDD we dont even really know.

It just seems like a half assed treatment the way its done now...
 
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The prior causes that lead to our current state are subjectively mysterious to us - I certainly wouldn't blame yourself. For example, we aren't truly responsible for the thoughts that randomly appear in consciousness. We would have to think our thoughts before we thought them for that to be the case.

In other words, it would be just as reasonable to blame yourself for having an LTC as it would be to blame yourself for being your height. But input - output still applies to the thoughts that appear in consciousness. Maybe sitting on a beach in Hawaii (an input/stimulus) is more conducive to a state where less thoughts pop into consciousness.


I imagine a lot of the self help books are just authors needing a meal ticket, but hopefully there is a gem or two in there. Even just exposing yourself to a resource enough can get you thinking about that topic enough to have a more appreciable impact.

For example, if you went on a mindfulness retreat and made lots of memories, those memories would randomly pop into your brain more often when you return home, and then you'd say "Oh shit I've been lost in thought again".

There was a guy who had a lot of anxiety after MDMA and he went on a meditation retreat eventually, but the interesting thing was that there was a delay between the retreat and his recovery (the retreat itself didn't go so well).

He did have a great recovery later on, but it could have just been due partly to the memory of the retreat influencing his thought patterns back home, rather than any real progress he made at the retreat itself (essentially that it's not like he entered some zen state and was cured right then and there)


"So when somebody like a therapist or friend asks why am i anxious I am not able to give a clear cut answer."

Yup, I think there is definitely a lot of "how was your childhood?" type people out there, and while those aren't unreasonable questions, a more relevant question may be something like "What is your consciousness like when going about your day?", and then working backwards from there using cognitive/pharmacological techniques.

Ideally these techniques would ooppose those states of neural activity if we think they are no bueno states. Both no bueno in terms of causing issues in the short term and causing issues in the long term (if that neural state continues on long enough it could cause issues that are not seen with that state in the short term).
 
So from what i understand CBT is a "fake it to make it" approach if your mood is driving your cognitions. Basically they say that you should try to reframe the thoughts anyways despite the fact that it doesn't make you feel better right now and that doing this can "trick" the brain into a more normal physiology.

Is my understanding correct? So if I sign up for a mindfulness course AND do this should I fully recover after the course? Should I just try it and see what happens? Sucks that I dont really have any MBCT/MBSR in person classes in my area. Maybe a class based setting vs on your own is better though to be able to ask questions and talk to other ppl etc.
 
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I wouldn't say CBT is all about faking anything in the moment until you see change much later on, but rather it's about changing thought/behavior patterns that aren't helpful.

An example would be thoughts like "I can never stop drinking", or I'll always be a failure so I might as well get drunk tonight" - these thoughts tend to be self fulfilling prophecies. Unhelpful core beliefs are also important to address in CBT. But there is honestly a lot to CBT, and I'm sure that different psychologists approach it differently, not to mention that some psychologists don't end up jiving with certain patients too.

https://en.m.wikipedia.org/wiki/Cognitive_behavioral_therapy

If you're thinking about doing a mindfulness and or CBT therapy, I wouldn't go into it thinking "If I'm not 100% cured after 8 weeks the therapy was a complete failure", I would view it as a learning experience that may have some immediate benefits and some delayed benefits. But for many of these therapies, if your mind fights it, it's going to be less successful.

Neurofeedback is a great example of a therapy that won't work as well if you're fighting it, and it's certainly another therapy to consider if you have access to it. It's essentially technology assisted meditation.
 
Well sometimes CBT does feel silly though cause of all the examples they give are either really cheesy in some way or have "real life" situations (divorce, job loss, etc) that aren't related to the LTC. I tried this online one called MoodGym recently (not sure if you have heard of it) and most of the time doing it I was just so bored out of my mind and didn't connect with it very well. A lot of the situations demonstrate how somebody previously healthy can end up with depression or anxiety over time with those kinds of thought patterns.

Ive seen very few if nothing on thought patterns that *result* and *originate* from depression/anxiety itself due to (not fully known) causes such as this LTC.
 
If someone doesn't have any particular environmental stimulus driven symptoms that they want to focus on, then I would think of CBT as less about the internal response to external stimuli, but rather think about it as dealing with the internal activity that could be a resonating consequence of either many bad years in a crappy environment, many years of crappy genes acting on their biology, or one bad night (or some combination that wouldn't have resulted in issues with any one thing in isolation).

In other words, people say things like "Well if I felt better I wouldn't ruminate", and although the inverse is likely true as well, it seems like some over-analytical people get caught up in the chicken or the egg debacle, rather than focusing on what is within their control in the moment and giving it time.

An example would be addressing an unhelpful core belief or something like rumination, but the issue therein is that those beliefs/thought patterns can often interfere with the therapy itself, so it does take time, patience/acceptance, and an open mind.

CBT is individually tailored and thankfully isn't one size fits all (once again, quality of CBT is dependent on the specific therapist and how they jive with a specific patient) but I think I should point out that while I think everybody stands something to gain from successful CBT, some people's minds may interfere more than others with the therapeutic process, and it may take some more time and a better therapist to cognitively account for this phenomenon and compensate/correct for it.


As far as the self-help stuff and the genre in particular of over-analytical humans (and there are a fair number of over-analytical LTC sufferers that I've talked to), I think its interesting to point out that the self help books probably don't work very well in people who ruminate https://www.ncbi.nlm.nih.gov/pubmed/19875102

"participants who were high in rumination and experienced stress exhibited significantly greater levels of depressive symptoms after completing the traditional cognitive skills workbook than after completing the other two workbooks. This pattern of results held post-intervention and 4 months later.

These findings indicate that rumination may hinder ones ability to identify and dispute negative thoughts (at least without the help of a trained professional). The results underscore the importance of identifying individual difference variables that moderate intervention efficacy. They also raise concerns about the potential benefits of self-help books, an industry that generates billions of dollars each year."

So that is something interesting to keep in mind and watch out for.
 
Well that is certainly interesting and if you are overanalytical would CBT be a potentially "wrong" therapy for some depending on how its done? There are of course different forms but some of them try to get people to analyze even more. I think some of that is intended towards those non drug induced individuals who are like "Wow I have been depressed but never even knew it!"

Anyways I don't think its the chicken/egg thing so much as the TEMPORAL relationship. As in the time it takes for results in one direction of the arrow is faster than the other but its just harder to do.

Ex) Feeling better stops rumination in an almost "linear" way lets say with no delays it happens nearly simultaeneously

Stopping ruminating doesn't lead to feeling better right away and there is some unknown delay in between and then this delay becomes its own source of rumination and that is more challenging than if the former were possible.

I hope the psychology researchers focus more on this "delay" time.
 
I wouldn't say that CBT would be a bad therapy for somebody with rumination or an over-analytical type thing going on, but the therapist would have to be on the lookout for that and treat that in and of itself (whereas there would be no checks/balances for an over-analytical person using a self help book).

We can now ruminate about anti-ruminating advice written in a book, what a time to be alive lol


The temporal relationship between onset of therapies (be it SSRIs or CBT or cardio) and improvement certainly needs more investigation - while Amml is an exception, most people take 8 weeks to a few months to improve on antidepressants (assuming they have MDD) because it's the downstream structural changes and "synaptic remodeling" that take time to occur. In other words, the benefits are from increasing serotonin signaling in and of itself.

Synaptic remodeling is probably a major feature of many therapy modalities, including cognitive ones like mindfulness and CBT that depend upon functional neuroplasticity. But because it takes time for synaptic reorganization and other effects to take place, there is a lag between treatment onset and effects on the condition.

For example, CBT has been shown to increase brain volume - but this certainly won't happen overnight. Theoretically, you could do 12 CBT sessions in 3 months, and then the volume increase could only start to occur months later as you accrue the benefits of the change in neural function.
 
Hi cotcha
i was picking up my youngest brother when I noticed that my floaters when looking at the sky have faded, they were really prominant a few months ago now I barely notice them. Is this actually possible or are they just not bothering me as much so they appear reduced?

Also a a really important question, do you think I'll ever have smooth vision again, when I keep my eyes fixed on an object everything is smooth, it's just When I move my eyes up and down side to side they jerk, there is no movement just images. It's the one thing that is really getting me down. My eyes are in a lot of pain, similar to eye strain. Any ideas or suggestions?
 
You know what is very strange is that somehow my LTC has shifted in the last month or so to being more "anxiety" oriented. I don't really feel that depressed. But prior to that I was complaining more about the depression aspect so I really wonder wtf happened.

I mean ok I kind of prefer this over the depression but still makes me wonder if I was set to recover and somehow the brain "overshot" the recovery point.

Anyways I feel like the anxiety is easier to treat anyways and I wanna maybe try Clonidine or Guanfacine type med to see what happens but I just get so afraid about it affecting anything in the tinnitus/visual snow domain.

And I am also afraid that being in this anxiety prome mode right now that id psych myself out into thinking it made it worse even if it didnt actually make it worse. "nocebo" effect. I feel like a lot of anxiety sufferers have trouble with this "Nocebo" phenomenon.
 
I've always maintained that people probably have non-linear recoveries, so when people go to a new symptom phase (have heard of this happening before), it could just mean that one part of the brain has normalized but because another circuit had compensated for that wacky circuit, this new circuit is going to be out of balance for a while until it normalizes.

So with that in mind I would actually keep your chin up. It makes sense that as the depression lifts and your activity in some circuits increases that you would have some problems with anxiety until that circuitry normalizes.
 
HPPDOFF said:
Hi cotcha
i was picking up my youngest brother when I noticed that my floaters when looking at the sky have faded, they were really prominant a few months ago now I barely notice them. Is this actually possible or are they just not bothering me as much so they appear reduced?

Also a a really important question, do you think I'll ever have smooth vision again, when I keep my eyes fixed on an object everything is smooth, it's just When I move my eyes up and down side to side they jerk, there is no movement just images. It's the one thing that is really getting me down. My eyes are in a lot of pain, similar to eye strain. Any ideas or suggestions?
Click to expand...

I would recommend ruling out issues with the anterior neck muscles like SCM/scalenes by stretching them a good couple times a day every day. If you have forward head posture, that's another thing to fix. Eye pain can be caused by issues with neck/head posture funnily enough. There is a youtube massage video somewhere up above where myofascial release of the SCM is demonstrated.

Nothing wrong with seeing an eye doc as well and making sure you don't need new glasses, but even issues with eye pain after reading can be partially due to musculoskeletal issues. Moderation helps me personally, making sure to read things (especially on the phone) at a far enough distance, and to relax and uncross/unfocus my eyes and look across the room occasionally.

But I personally took quite a while to get the fluidity of my eye movement back, and it still continues to improve. Although keep in mind, I'm pretty sure nobody can really move their eyes fluidly, us humans tend to look from a specific point to a specific point, although we're good at tracking a particular moving object.

As far as the visuals and stuff, I wouldn't be surprised if your HPPD is improving and hence you get even less visual artifacts from traditionally non-HPPD sources of HPPD genre symptoms like the blue sky phenomenon.
 
Cotcha Yankinov said:
I've always maintained that people probably have non-linear recoveries, so when people go to a new symptom phase (have heard of this happening before), it could just mean that one part of the brain has normalized but because another circuit had compensated for that wacky circuit, this new circuit is going to be out of balance for a while until it normalizes.

So with that in mind I would actually keep your chin up. It makes sense that as the depression lifts and your activity in some circuits increases that you would have some problems with anxiety until that circuitry normalizes.
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Alright thanks! Maybe its a good thing then and means I passed some recovery checkpoint.
 
I don't think any of my circuits have normalized. I abused mdma, K, Coke, GHB for years mostly mdma and K. Then I had cancer, radiation treatment to my head and neck plus chemo. I'm a walking chemical reaction. I'm somehow alive, have a great job, married with 2 kids but it's a struggle. I have terrible insomnia, wild dreams when I do rest, burst of anger and irritability and quick onset depression I feel mainly caused by mdma abuse.
 
Gothmog said:
I don't think any of my circuits have normalized. I abused mdma, K, Coke, GHB for years mostly mdma and K. Then I had cancer, radiation treatment to my head and neck plus chemo. I'm a walking chemical reaction. I'm somehow alive, have a great job, married with 2 kids but it's a struggle. I have terrible insomnia, wild dreams when I do rest, burst of anger and irritability and quick onset depression I feel mainly caused by mdma abuse.
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that's because it's a horrible drug. Sorry man I really am, sorry about your cancer as well. Did you have insomnia before MDMA?
 
Gothmog said:
I don't think any of my circuits have normalized. I abused mdma, K, Coke, GHB for years mostly mdma and K. Then I had cancer, radiation treatment to my head and neck plus chemo. I'm a walking chemical reaction. I'm somehow alive, have a great job, married with 2 kids but it's a struggle. I have terrible insomnia, wild dreams when I do rest, burst of anger and irritability and quick onset depression I feel mainly caused by mdma abuse.
Click to expand...

How long since you stopped using mdma?
 
ADubbs you're right it's a vile drug. I loved my life and more importantly I loved myself before that one night with MDMA. Now I'm so lethargic, lazy, no confidence. Lost my ability to just look around. Everything is just grey, fuzzy and horrible. I feel ill as a person, it really hard to describe, headaches, eye strains, neck pain, everyday constantly. I'm really down, very very angry about myself. Knowing that I've damaged myself, maybe physically who knows, but defentlu as a person, because of one stupid mistake! The irony is that I chose MDMA because I couldn't be arsed with a hangover.
 
@Cotcha

Something I found very interesting re SSRI and neurosteroids particularly since I believe you had once mentioned small "pediatric dosing". It says the dose needed to increase neurosteroids is very very small and less than what is needed for any action on serotonin itself.

They even propose the term "selective brain steroidogenic stimulants SBSS"

http://link.springer.com/article/10.1007/s00213-005-0213-2
 
I think there is still a lot to learn about the antidepressants we've been using for decades.

The role of the 5-HT2B receptor in SSRI response still needs more investigation as well, these antidepressants bind directly to 5-HT2B and that seems to be important for antidepressant response (and 5-HT2B is critical in mediating MDMA's effects)
 
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