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Advice required regarding MDMA recovery

8BitTrip

8BitTrip

Bluelighter
Joined
Mar 2, 2016
Messages
64
Hi,

So I spent the past 1.5 years using MDMA quite heavily without any real issues when all of a sudden in January I was hit with a cascade of symptoms which I identify as a long term comedown, the most salient of which is emotional numbness.

Since then I have taken the advice of Bluelighters and therapists alike and implemented it, namely; abstinence from drugs, healthy eating, exercise and mindfulness. Over the past 4 months I have been seeing improvements, sometimes small and incremental and other times drastic and sudden.

However I am still quite far from feeling okay and life is quite a battle to stay motivated against my lack of chemical reward for all things which previously gave pleasure.

One of my main difficulties is falling asleep and I had been taking a sedative anti-histamine to large success. Once I ran out, I went back to the doctor who recommended I instead try a small (15mg) dose of the anti-depressant Mirtazapine every day.

I had been reluctant to go on anti-depressants due to my determination to recover back to full health and I saw the best way to do this was naturally.
Though after 4 months of hell, I have lost a lot of patience and so I gave in and tried the Mirtazapine. I was told I'd need to take it every day and may only notice benefits after a sustained dose after a week or more. In reality, I felt almost immediately better and close to 'normal' after only 30mg. The following few days I decided I'd see how I'd feel coming off it, so I discontinued use and was close to being back to where I was beforehand, if not worse given the contrast.

My question is whether anyone would recommend I continue to take Mirtazapine or whether I should hold out and battle through the gloom without its aid. My concern is that if I do take it, I'm further impairing the serotonin system which is already either fragile, or downright damaged.

Please advise and thank you in advance.
 
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Continue taking your medication, there is no need to come off Mirtazapine if it is working for you. Antidepressants are created to help people with mental and emotional illness. If the medication doesn't cure your underlying condition it will at least help you cover the symptoms as your body balances itself. The minimum course of treatment should be no less than 6 months as i was informed by my psychiatrist.
 
Okay, I'm just not convinced that it's only masking the problem and perhaps worsening it underneath. Also it was prescribed based on a description of my problem but I intentionally neglected to mention it was drug use which led to this state. I have read elsewhere on forums that Mirtazapine is okay for this purpose. I'm just a little skeptical about using drugs to cure a problem which was brought about this way in the first place. Though I very much appreciate your input and I am taking all angles into consideration. Thanks for your reply.

Anyone else?
 
The unfortunate thing about mirtazapine is that with dose escalation it can start to cause insomnia (at above 60mg for some). It's mostly an antihistamine at lower doses.

There are other options for sleep like Clonidine that don't work via a serotonergic mechanism - they tend to block adrenaline instead. There will be rebound adrenaline when you come off them as well though.

Seeing as it's only been a couple months and that your use before that was prolonged, a trial of 5-HTP would be good to try. MDMA impairs an enzyme that makes serotonin called tryptophan hydroxylase, so the theory is taking 5-HTP bypasses the enzyme that normally converts dietary L-tryptophan into 5-HTP (from which the brain then makes serotonin). So I would try 50mg 5-HTP for a couple days, see how you react, and then raise it to 100mg once a day for a while, then twice a day, then 100mg three times a day. If you were on traditional SSRIs I would be much more cautious with 5-HTP but not nearly as cautious with mirtazapine. But be aware some people rarely get anxiety and restlessness and such. A lot of people get sleepy though (anecdotally).

Keep up the mindfulness and do your best with cardio. I think sleep is the most important thing to address. At some point if your sleep issues persist you should consider a sleep study to check for sleep breathing disorders, especially if you don't breathe very well through your nose or have been known to snore.

Most long term comedowns take about a year to really get better. Hang in there. Any questions are welcome.
 
Thanks for your highly informative post, Cotcha.

That's interesting. I had been taking 100mg 5-HTP in the second month of the comedown however it seemed to have little to no effect. Through assumption alone, it felt like my brain was simply quite incapable of housing serotonin. In the first two months, I was very bizarrely aware of my brain, or some abnormality about it which can only be described as a feeling of emptiness. This would equate well with it lacking serotonin. I have a single 100mg 5-HTP dose left so I will try this now and if it helps I will order some more.

I cant thank you enough for the advice and support. I feel so isolated by those around me, despite my friends' and doctor's best efforts, they still have no idea of my predicament and are therefore completely unable to give relevant and valuable advice so to get some real understanding is a big relief.
 
hmmm, the emotional numbness/anhedonia, and the lack of ability to fall asleep...

Let me ask you, have you experienced any headaches of late ?
How are you socially ?

My theory is a bit complex, but i think you may have high glutamate, low GABA, low serotonin, and high acetylcholine

If this is the case, memantine, would be a good medication
 
Bare in mind with 5-HTP that we aren't certain that it can make it to the brain normally, so it could be useless. Apparently taking it with around 400mg EGCG (green tea extract) might be able to help it reach the brain, so could be worth a shot to see if that works any better. I've also previously found St John's Wort to be helpful with LTC symptoms. Though honestly, the only real cure I've found is time, a hell of a lot of time. Also, be careful taking things like 5-HTP or SJW to ensure they don't interact with other medications you're on (don't take those two together either).
 
8BitTrip said:
hmmm, the emotional numbness/anhedonia, and the lack of ability to fall asleep...

Let me ask you, have you experienced any headaches of late ?
How are you socially ?

My theory is a bit complex, but i think you may have high glutamate, low GABA, low serotonin, and high acetylcholine

If this is the case, memantine, would be a good medication
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I haven't had any headaches. Terrible socially, lack of serotonin makes it hard to click with anything - I don't seem to have a natural reaction to things which are said to me.

Okay, thanks for your suggestion!
 
8BitTrip said:
Bare in mind with 5-HTP that we aren't certain that it can make it to the brain normally, so it could be useless. Apparently taking it with around 400mg EGCG (green tea extract) might be able to help it reach the brain, so could be worth a shot to see if that works any better. I've also previously found St John's Wort to be helpful with LTC symptoms. Though honestly, the only real cure I've found is time, a hell of a lot of time. Also, be careful taking things like 5-HTP or SJW to ensure they don't interact with other medications you're on (don't take those two together either).
Click to expand...

Yes, I have a feeling it is a bit redundant for me, though perhaps others will see more benefit.

Thanks for the ideas, terarc.
 
I'm approaching up to 4 months soon as well, and I can sometimes relate to not having much of an emotional reaction to what people say you. I often find myself having to pretend to look pleased or happy about good news being given to me. It fluctuates between me feeling alive and sociable at the best of times, to me being numb and withdrawn at the worst of times. Memory is still foggy and derealisation is very much still present too, the severity of it changes during the course of the day.

I'd be interested to see how the Mirtazapine works out for you if you decide to keep taking it? You should come back in a month or two and let us all know, it would be good to hear from you.

As always, stay well and hang in there.
 
PillsAndKills said:
I'm approaching up to 4 months soon as well, and I can sometimes relate to not having much of an emotional reaction to what people say you. I often find myself having to pretend to look pleased or happy about good news being given to me. It fluctuates between me feeling alive and sociable at the best of times, to me being numb and withdrawn at the worst of times. Memory is still foggy and derealisation is very much still present too, the severity of it changes during the course of the day.

I'd be interested to see how the Mirtazapine works out for you if you decide to keep taking it? You should come back in a month or two and let us all know, it would be good to hear from you.

As always, stay well and hang in there.
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I can relate to the fluctuation. I seem to drift in and out of reality across the course of the day. When it's bad everything seems distant and I think to myself 'oh God what have I done' but when I'm good I can barely notice the issue.

Sometimes I feel almost baseline but when I select the network of my brain which comes to life during the MD experience, as the object of my attention, it is clearly affected. The odd thing is my affliction feels simultaneously completely devastating though entirely benign. I mean this in the sense that, there is no pain, I can get by in daily life by acting normal, I know it can only get better and yet it still causes me plenty of suffering; not having a natural reflex to a lot of things which I previously did. Feel like I took it all for granted and for the sake of a handful of nights out.

My despair arises when I imagine not ever being to use this brain network for its basic utility ever again. I've recovered from about what I would call about 20% functionality to around 70% (on anti-d estimate) in 4 months.

Thanks for your continued support, PillsAndKills. So far so good with the Mirtazapine. I've opted to taking 8mg/day and perhaps even 4mg in a week's time until I ween myself off it completely.

I've definitely gained a lot of knowledge on my way so I'm looking forward to being able to offer advice and support to others - though only once I've made it safely to the other side myself first.
 
I say this with all honestly and I am a medical worker..
More drugs will not help your recovery from drugs. It may be a temporary fix but can do more damage in the long run. Ride this out naturally. It may be hell but you will recover.
 
patientnurse said:
I say this with all honestly and I am a medical worker..
More drugs will not help your recovery from drugs. It may be a temporary fix but can do more damage in the long run. Ride this out naturally. It may be hell but you will recover.
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Okay, thanks - this is what my intuition tells me too. Your post has tipped me over into deciding not to take them this weekend and I'll see how I am on Sunday night.

As for your predicament, it sounds rather unpleasant. I recommend mindfulness. It's more of an anti solution than anything else. But if it's anxiety you're dealing with, let it be only that. I personally believe the best way to deal with anxiety is to observe it as it passes over you. Dunno, just my two cents.

Anyone else think I should/n't take Mirtazapine in my recovery?
 
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So I guess I'll play devils advocate and cite schizophrenia as an example of a disease that has better outcomes when you medicate early on - that being said your disease and the possible treatments are completely in your case so it may not apply.

My actual advice is be sober as long as you can take it - it's the best chance you have at letting things normalize. It's much better to deal with the anxiety etc. sober and let that motivate you to practice mindfulness rather than just covering up your symptoms with a pill that does not actually change disease progression (the anxiety will still be there if you stop the pills).

SSRIs have a better chance at actually altering disease progression for the better - so if you do feel the need for medication someday I would try Citalopram.
 
Cotcha Yankinov said:
So I guess I'll play devils advocate and cite schizophrenia as an example of a disease that has better outcomes when you medicate early on - that being said your disease and the possible treatments are completely in your case so it may not apply.

My actual advice is be sober as long as you can take it - it's the best chance you have at letting things normalize. It's much better to deal with the anxiety etc. sober and let that motivate you to practice mindfulness rather than just covering up your symptoms with a pill that does not actually change disease progression (the anxiety will still be there if you stop the pills).

SSRIs have a better chance at actually altering disease progression for the better - so if you do feel the need for medication someday I would try Citalopram.
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This has got me thinking. I started looking at the Wiki page on Schizophrenia to find out whether it's primarily a psychological or physiological affliction because I've always seen it as the former whereas mine the latter.

However, there is definitely interplay between them both. My mental health is better on the anti-depressant but perhaps not my brain health. I guess its a case of striking the balance. Like you and patientnurse have said, it seems that the less the better.
 
Schizophrenia is definitely a disease of biology, excess synaptic pruning is probably the main cause. It's hard to seperate psychology and biology because it's the biology that produces the psychology but I would say that when neuroplasticity comes into play things can be more psychological, if you can change your thought patterns with mindfulness you will strengthen or weaken different connections in your brain.
 
Cotcha Yankinov said:
Schizophrenia is definitely a disease of biology, excess synaptic pruning is probably the main cause. It's hard to seperate psychology and biology because it's the biology that produces the psychology but I would say that when neuroplasticity comes into play things can be more psychological, if you can change your thought patterns with mindfulness you will strengthen or weaken different connections in your brain.
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I agree. For me, it's a catch 22 because though I'm trying to stay positive and continuing to make the right decisions (going out with friends, eating healthily and exercising) it's very difficult to maintain due to my chemical imbalance and the length of time it's taking to restore.

For example, I abstained from the Mirtazapine this weekend and now the anhedonia is back in full force. I think I'm going to have to try to embrace it. // Or am I mentally strong enough to handle daily life on such little serotonin? The immense suffering it's causing is bearable. On the basis of extremely precious memories I owe partially to MDMA and the profound insight it has granted me. But only on the confidence that sometime in the near future (read: 1-2 years) I will recover back to normality. Right now it feels unlikely. And I have not one source of information I feel I can depend on.

It's so frustrating that the scientific research on the subject of these sustained & adverse effects of MDMA is thus far inconclusive. All I want is to be able to make a final and informed decision on how to go about handling my predicament yet evidence from both sides conflicts and muddles the picture. Even then, proponents of certain theories are precarious and still remain theories due to flawed data.

Therefore I seek advice from those Bluelighters with real LTC experience. (without devaluing any form of advice/support regardless)

TLDR; I'm still struggling and desperately need guidance; help!
 
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Sorry but I forget, have you tried SSRIs/SNRIs yet? I personally think they should really be considered in ex MDMA users, but mostly just Citalopram.

St. John's wort is another option that you could try OTC before SSRIs.

Don't feel like you have to exhaust yourself socially, I have a feeling depending on varying chemistry a person can be sometimes an introvert and sometimes an extrovert.

Therapies that increase neurogenesis can work for depression, SSRIs work in part by increasing neurogenesis. Depression is often times due to a cortisol mediated reduction in neurogenesis, although there are different causes of depression.
 
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Would SSRI's improve symptoms like derealisation and memory fog? I never seem to register any of the passing days properly and I struggle to remember what I've done in the last week.

Otherwise I'm pretty sure I'm improving. Still occasionally get a feeling of dread/slight panic coming up on me but it never lasts too long.
Almost at the 4 month mark now too.
 
I think SSRIs would be worth a try but for someone at the 4 month mark you might want to wait and see how you are doing 2 months from now - but Citalopram would be my recommendation. Serotonin does play a role in memory.

I am undecided as to whether or not natural recovery is superior to medicating a possible serotonin deficit early on with SSRIs. If I had to do things over personally I would've put myself on SSRIs.
 
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