[ AAP - AMPH ] - Help me make sense of my current dopamine regulation

[terminal_VELOCITY]

Hi,

I recently posted this on r/aboutDopamine. Figured I'd give Bluelight a try aswell.


Hope someone can help me pin-point the current state of my dopamine receptor activity.


I only have a basic understanding of neurology, if anyone would like to help me out, explaining your assumptions to me as if I'm an outsider to the field would be hugely appreciated.


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At 18 I was diagnosed with schizophrenia and put on antipsychotic medication and was for the following six years up until three months ago. I've been through 4 different medications, all of them prescribed at the maximum daily dosage. factor 1

• Amisulpride -> Quetiapine -> Olanzapine -> Aripiprazole

I started biweekly sessions with a psychologist in start December following two months extensive abuse use of cocaine freebase. Before abusing that it was amphetamine sulfate almost every weekend the previous year. factor 2


I got clean following the first session and was completely abstinent from all substance abuse, even alcohol. This followed until two months ago factor 3


After four months of sessions while clean, my psychologist breaks it to me that throughout our consultations - getting to know me, my challenges, cognitive profile and level of function so on so forth - I have not displayed any symptoms, positive or negative. There have been no indication of disordered, paranoid thought process or otherwise possessing the psychotic cognitive break that would have my thoughts spiraling out of control without the ability to distance from them. That I'm actually pretty adept at reflecting and rationalizing, have good insight, am coherent and collected.


The only thing left is deficits in executive functions. Showing as poor task initiation, impulse inhibition, processing pace, self-organization, resulting in low ability to perform low-practical task. She tells me this points towards ADHD, not schizophrenia. This marks the day that I stopped having a chronic sensation of being lost. I researched ADHD and everything now makes sense, in retrospect I've experienced these symptoms for all my life. factor 4


I decided not to get my monthly injection of Abilify from then on. Again, this is three months ago. factor 5


I am currently waiting for a diagnostic reevaluation. During the initial assessment I used cannabis daily, in form of hashish with high concentration of THC. This of course clouded the evaluation. Also being only 18 at the time, a lot of the psychological terms used in questionnaires and interviews, I simply didn't know the meaning of, so I always answered based on assumptions.
The last appointment I had with my psychiatrist, he tells me a diagnostic reevaluation is not possible before six months abstinence of antipsychotics. That they need to leave my system, in that time also without a relapsing psychotic episode.


I can see where he is coming from and all, but I still find it bothersome. It's clear at the current time that I have been misdiagnosed with what Robert Sapolsky of Stanford University called "one of the most horrific ways biology can go wrong". To say the least, the diagnosis destroyed any hopes I had for the future. Now it seems like I don't even have it - and I can't get screened for ADHD before six months?


I couldn't wait that long. I started self-medication with illegally sourced methylphenidate two months ago. It went alright for about a month, in that month my productivity and cognitive ability took a quantum leap. It raised my quality of life immensely. For the first time in my life, I did not feel handicapped. Happiness was a genuine feeling now.


But then the addict that I share my body with took over, after one night accepting a line of cocaine. I then proceeded to abuse a whole month worth of methylphenidate (2x 20 mg daily) over the course of three days.


Methylphenidate being expensive on the street, I resorted retrying the self-medication with street-speed; racemic amphetamine sulfate. Went well for three days or so. Then it turned into abuse. A lot of abuse actually. Binged for days, then slept for days, binged again. Then found the road to moderation. At least a point where I actually slept at night, though I dosed moderate- to heavy recreational dosages in the morning. The abuse have been going on for about a month and a half. I have gained tolerance, but I do not know exactly how much. The speed I abuse is from different unknown suppliers, unknown purity and lastly I don't even have a scale to weigh the dosages taken. factor 6


I'm not even productive anymore when on it. I am faced with distractions all over again. The ADHD is back, now my minds internal pace is just speeding away.



So to recap what I have been exposed to:


(1) - 6 years of max dose antipsychotics
(2) - weekend stimulant abuse 1 year before, daily cocaine freebase for two months, stopped early December
(3) - complete abstinence from (2) untill two months ago
(4) - diagnosis now assumed ADHD, meaning (1) on a dopamine regulation that was already very low
(5) - quit (1) completely cold turkey three months ago
(6) - relapse to heavy AMPH abuse ongoing for around a month and a half


Honestly, the subjective effect of all this - and I'm not even sure it's related - is the state of my ego. It is left in a state of two options: off and on - punctured vs over-inflated. I'm either in a state of; being nothing vs. being a whole whole lot. I can't stand any of them.


The questions left with are:

How fucked is my dopamine regulation by now? (plasticity, down/up-regulation)
What could six years of antipsychotics have done to an already dopamine deprived brain?
What would be the best course of action by now?
Having (assumed) ADHD co-morbid with substance abuse disorder with a preference for stimulants, how do I go about not abusing the hell out of them?


Hope someone can help me with this, it's puzzling to me.
Thanks

 

[Coolwhip]

Approaching your issues like this is going to lead nowhere, even if your dopamine signalling is directly involved, or primarily responsible(big if), you won't find effective solutions by zeroing in on it. The brain is much, much, much more complex than that. Just the idea of a dopamine deprived brain is silly to me(if it were as simple as that, you never would have noticed a problem thanks to the many different homeostatic mechanisms within the CNS), there are so many different types of dopamine receptors/neurons, 1-5, S/R/L, forming heterodimers with many different signalling systems, many of which even have opposing actions. It's nowhere near as simple as too little dopamine, in fact the drugs you have taken have probably done more to change signalling than actual levels.

Are you bi-polar? Have you ever considered the use of mood stabilizers, with antidepressants? WIth a history of stimulant abuse, you should forget about trying to use them to treat any possible ADHD.

 

[terminal_VELOCITY]

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"I only have a basic understanding of neurology, if anyone would like to help me out, explaining your assumptions to me as if I'm an outsider to the field would be hugely appreciated."

Thank you for your response, I'm sorry however you choose to focus on slaughtering my worry's inaccurate presentation evident in my naive reductionist approach to the matter, completely ignoring the statement quoted above; ultimately leaving my eyes directed in an upwards position looking into my own skull.
I will try asking another way: What would six years of antipsychotic medication do to a brain thought to present WHATEVER seems to be the problem seen in ADHD patients? I hope this time the answer will not be presented in an arrogant and condescending manner, leaving me no wiser in any regard.
Your reading comprehension also seems to suffer a fair bit. I have stated I have a schizophrenia diagnosis, but believe it wrong and ADHD to be the case however. It says so in my post. No I'm not manic-depressive. As we are assuming medical conditions over a narcotics forum I'll ask you; is your cranium always stuck up your lower intestinal rectal cavity? Have you considered the use of laxatives?

 

[Seppi]

Having (assumed) ADHD co-morbid with substance abuse disorder with a preference for stimulants, how do I go about not abusing the hell out of them?

Give your prescription bottle to someone you trust and have them manage your intake.