A New HPPD/MDMA adverse effects theory

[Cotcha Yankinov]

This thread will explore the role that musculoskeletal compression of the vertebral and carotid arteries could be playing in various Long Term Comedown symptoms and HPPD symptoms, especially in particular people.

Lightheadedness, vertigo/dizziness, visual disturbances that worsen upon standing including akinetopsia, tinnitus, headaches and eye pain, weird head sensations, musculoskeletal pain, neuropathy and numerous neuropsychiatric/neurological issues are all pretty common with LTCs and can be explained via musculoskeletal compression of the arteries that supply the brain.

I had really bad dizziness and balance issues, when I tilted my head or when objects where close to my eyes which caused dizziness. I'm 6.5 months in also. Mine has substantially got better. It's still there but it's reduced to the point where it's no longer a problem. Mine only stared to get better when I started to weightlift 3/4 a week

Moving my head produces dizziness that kind of feels like the high when I was on MDMA but like if I'm walking up the stairs when I'm feeling particularly bad I'll sometimes lose track of the steps and nearly miss one because I'm so light headed, if I concentrate the room will breathe as well.

I see visual snow sometimes after standing up from sitting or laying down, lots of little white stars that zip all around

I usually have a "light headed" feeling, feels like I'm floating and bobbing. It's worse when I don't sleep well.

My tinnitus is still present and in full force, basically the same for my floaters and face tingling

I have dp/dr,brain fog and pressure in the head. Floaters, star bursts and visual snow. Inability to exercise also.

i have visual snow, after images, insomnia, constant head sensations, memory issues, brain fog

This was just after a brief search in the latest MDMA recovery thread - there are some people from long ago that appeared to have Thoracic Outlet Syndrome.

There are these numerous reports that are indicative of cerebrovascular issues that can worsened upon standing and/or are posture-dependent. Two conditions that can produce these various LTC symptoms come to mind: Thoracic Outlet Syndrome (TOS) and Bow Hunter's Syndrome.

Lets talk about the scalenes and TOS for starters. The anterior and medial scalenes are neck muscles that are in a prime position to cause all sorts symptoms and be activated with stimulant use, anxiety and physical exertion.

The scalenes attach to the 1st rib and serve to expand the ribcage during times of stress to assist in inhalation. During anxiety/chest breathing, these muscles are activated and can cause issues with the relevant arteries and nerves. Please note that TOS is primarily a hand/arm neuropathy, but head symptoms are extremely common in TOS patients and are relieved with scalene blocks (lidocaine/botox).


"TOS can be related to cerebrovascular arterial insufficiency when affecting the subclavian artery.^[5] It also can affect the vertebral artery, in which case it could produce vision disturbances, including transient blindness,^[6] and embolic cerebral infarction.^[7]

TOS can also lead to eye problems and vision loss as a circumstance of vertebral artery compression. Although very rare, if compression of the brain stem is also involved in an individual presentation of TOS, transient blindness may occur while the head is held in certain positions.^[8]

If left untreated, TOS can lead to neurological deficits as a result of the hypoperfusion and hypometabolism of certain areas of the brain and cerebellum.^[9]"

https://www.ncbi.nlm.nih.gov/pubmed/10064369 - "Neck and brain transitory vascular compression causing neurological complications"

I personally have had TOS with cerebrovascular issues after ecstasy, and one LTC sufferer had the peripheral hand/arm symptoms of it.



Now on to Bow Hunter's Syndrome -
"the patient began to complain of transient visual changes, presyncopal (fainting) spells, and dizziness upon turning his head to the left."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934473/
"Some other symptoms, including positional tinnitus, nausea, headache, presyncopal sensation, near loss of consciousness, hemiparesis and numbness were also reported. Rastogi et al. [3] observed that vertigo and syncope were present in 28 and 26% of the cases, respectively, and these were the most prevalent symptoms noticed in patients with BHS in their review."

A particular adverse effects suffer (Suedonym) is a likely candidate for something akin to Bow Hunter's Syndrome or Chiari Malformation - right around the particular night of his MDMA use, he was looking up at the sky a lot (star gazing) which could have messed up his neck http://bluelight.org/vb/threads/771746-MDMA-and-MS?highlight=suedonym (Ignore my sleep deprivation induced posts please)

I have nearly every presenting symptom for MS but my brain MRI came back clear, that's all I can tell you. I'm much more starting to believe I possibly have a chiari malformation as Cotcha proposed, that was harshly worsened by the MDMA. That my symptoms are so much worse when I bend or put pressure on my neck would indicate that, and the symptoms do overlap somewhat."

- Constant pins and needles all over, occasional burning and numbness, itching, sometimes feels like a whole body vibration
- Occasional tremors and twitching
- Gradual reduced sexual sensitivity culminating in near-impotence
- Initially delayed cognitive processing - stunted speech, hazy mind etc. though this has seemingly largely died down
- Difficulty chewing, swallowing, dry mouth, bad breath, unusual taste in mouth
- Difficulty getting to sleep, reduced length of sleep and often waking up with a racing heart, sweating
- Bodily pain and cramping lying in certain positions
- Intermittent aching pressurised feeling in both upper and lower back

Serotonin is implicated in breathing mechanics (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988959/figure/Fig1/) and there is often physical stress and heavy breathing during psychostimulant use, not to mention during bad trips. The scalenes and other muscles could get blown up during drug use (including inhaling from a pipe) and they may remain in spasm and hypertrophy.

Serotonin dysfunction and anxiety on the comedown post-MDMA could lead to altered breathing/neck muscle mechanics and hence scalene hypertrophy/dystonia with delayed symptom appearance (often reported with LTCs) https://www.ncbi.nlm.nih.gov/pubmed/26659645

"Spinal afferents such as nociceptive afferents and group III-IV muscle afferents are known to exert an acute excitatory effect on breathing when activated. Here, we report the surprising existence of latent spinal afferents which exerted tonic inhibitory influence on breathing subliminally in anesthetized rats, an effect which was reversed upon activation of serotonin-1A receptors (5-HT_1ARs) in lumbar spinal cord"



SSRIs and benzodiazepines could alleviate stress and hence calm the scalenes/chest breathing, and benzos could reduce muscle tension directly while activation of the aforementioned 5-HT1A receptors via SSRI administration may assist in inhibiting scalenes. Benzos and SSRIs are both known to help with LTCs and HPPD.

I theorize that issues with artery compression related to the scalenes and other muscles could be playing a (large) role in some LTC/HPPD sufferer's symptoms.


One diagnostic tool could be anterior scalene injections - lidocaine (and other local anesthetics) can numb the muscle for a few hours, while botox can paralyze the muscle for about 3 months. TOS patients very often receive great relief of their head symptoms with botox into the anterior scalene, and there are cases where injection into the medial scalene is helpful as well.


Comments on the role that serotonin plays in respiration are welcome.


TL;DR Neck muscles can compress arteries and cause neurological symptoms resembling an LTC and HPPD

 

[checktest]

This is an interesting physical theory for some of the complaints of HPPD and serotonergic overuse/abuse. Thoracic outlet syndrome can be overlooked in considering a range of symptoms. Actually, I have TOS, with sharp/biting mid-back pain and numbness of the 4th and 5th fingers. (Some sort of clavicle and first rib abnormality, along with years of bad posture.) Certainly have had vision disturbances, especially when my entire neck has tensed up. Orthostatic hypotension as well, although that was from Parnate.

It just seems strange to have mainly presentations of arterial and venous compression *without corresponding neurogenic symptoms. It might be expected that if these drugs influenced positions that led to TOS, there would be at least some greater amount of pain and arm symptoms. Checking for a pulse when turning the head to one side or the other is an easy tool.

Additionally, why aren't there more presentations of HPPD along with other stimulant abuse? Excessive and prolonged physical action, with abnormal positioning, certainly aren't uncommon with other drugs - i.e. methylphenidate, cocaine, amphetamine. Anxiety and physical tension are highly reported with these drugs, but the incidence of HPPD is less.

Great post though, Cotcha Yankinov. Always good to look for other factors, and thoracic outlet syndrome is often overlooked.

 

[Cotcha Yankinov]

It just seems strange to have mainly presentations of arterial and venous compression *without corresponding neurogenic symptoms. It might be expected that if these drugs influenced positions that led to TOS, there would be at least some greater amount of pain and arm symptoms. Checking for a pulse when turning the head to one side or the other is an easy tool.

A physiatrist has told me of one of his patients who had a fluttering eye that resolved with a scalene block - although the patient did not have any other symptoms. I do think its possible to selectively have head issues with scalene dysfunction.

That being said, a lot of the MDMA/E users do report symptoms into the hands - whether this is due to respiratory alkalosis/anxiety or not is up in the air, but its interesting to note that anxiety does predispose one to TOS because of the breathing issues. I personally have had TOS as long as I've had adverse effects and another adverse effects sufferer likely had TOS as well.

Additionally, why aren't there more presentations of HPPD along with other stimulant abuse? Excessive and prolonged physical action, with abnormal positioning, certainly aren't uncommon with other drugs - i.e. methylphenidate, cocaine, amphetamine. Anxiety and physical tension are highly reported with these drugs, but the incidence of HPPD is less.

This is the difficult one to reconcile, but there are some possibilities. First, we may differentiate between visual disturbances seen with hypotension like visual snow and "full blown HPPD" from LSD etc.

1. The catabolic effects of METH abuse could be protective against scalene hypertrophy -> arterial compression.

2. Some of the MDMA/E adverse effects reports are borderline overdose reports, people having taken almost 1g MDMA/E in a night and such - its possible that some people were really drifting into the serotonin syndrome spectrum, and abnormal muscle tone was an issue.

Assuming that the incidence of visual disturbances with primarily NE/DA releasing stimulants is significantly lower than that of primary SRAs, one thing to consider is that the serotonergic drugs could be uniquely positioned to cause respiratory dysfunction on the comedown as well as abnormal scalene tone during the trip.

3. Its an observational issue, and classical stimulant users do have issues with visual disturbances.

When hearing about the adverse effects from MDMA/E users, its often the case that these people had no prior mental health issues, and had very little drug experience. It could be that they are much more likely to report these rare adverse effects compared to a serious drug abuser. There could also be mental deterioration with ie METH users that leads to decreased awareness of visual changes.


But its possible that either drugs that lead to large increases in 5-HT, or drugs that deplete 5-HT, have particular effects on the scalenes/respiration.

https://www.ncbi.nlm.nih.gov/pubmed/20217357 "Chemical control of airway and ventilatory responses mediated via dorsomedial medullary 5-HT2 receptors."

https://www.ncbi.nlm.nih.gov/pubmed/25937361 "Serotonin-mediated modulation of hypoxia-induced intracellular calcium responses in glomus cells isolated from rat carotid body."

"The frequency and magnitude of hypoxia-induced [Ca(2+)]i changes observed in the glomus cells were enhanced in the presence of 5-HT, and this response was inhibited by the 5-HT2 receptor antagonist, ketanserin."

Perhaps scalenes are vulnerable to developing fibrosis with 5-HT2B activation, or post-synaptic 5-HT2B in the brain bears some relationship to respiration/musculature. Jaw pain is also common in TOS (relieved with scalene blocks) and MDMA is notorious for its effects on clenching - although clenching/grinding is common with other stimulants as well, I don't think it's as enigmatic as the MDMA-jaw stuff. Maybe effects on the jaw can lead to increased scalene tone.

I'm not able to find much on the relationship between 5-HT and respiration though. I get the feeling that monoamines generally lead to an increase in respiratory drive, but maybe serotonin releasing agents in particular have potent effects on these "inhalation muscles" like scalenes.



In addition, low blood pressure after MDMA use could increase the likelihood of hyperventilation/using these assisted inhalation muscles. This may not be seen with the traditional stimulants. This could further increase hypoperfusion of the brain.

http://www.bluelight.org/vb/threads/204192-low-blood-pressure-after-ecstasy-use (From Fastnbulbous on low blood pressure after MDMA)

"It's most likely due to metabolites such as alpha-methyldopamine (3,4-dihydroxyamphetamine) which act as false neurotransmitters. There is a drug on the market for treating high blood pressure calde alpha-methyl DOPA, which is metabolized (by decarboxylation) to alpha-methyldopamine - same metabolite as from MDA/MDMA.

It also has a high incidence of depression when used clinically - starting to sound similar to the Tuesday blues? That's 'cause it's the same final metabolite"

 

[d1nach]

I get visual disturbences i just do things like walk at 1.5iles per hour changing incline or speed very slightly every four seconds and reading while walking and roating eyes in a circle, head, alternating circle left right left right over and over, reading while moving phone all over constantly having to reajust. For jaw i practice rapping like eminem or whoever trying to perfectly as possible match not jist the words bit the rthym pitch tone emphasis ect.