Am I screwed or what? PLEASE HELP>>

[Mycallways]

So I posted here maybe 3 months ago...

About 17 years ago, at age 17, I developed what was assumed to be HPPD (34 years old now). It didn't onset immediately after drug use, but I had experienced a nasty flash-back after smoking from a gravity bong. The visual symptoms started maybe a month or 2 later. Prior to that, I had done psilocybin once, LSD 3 times, MDMA 4 times.
When it first onset, I saw a psychiatrist who put me on an SSRI and klonopin as needed. I have been on Paxil for the past 16 years!!
I have considered myself cured for maybe 8-10 years now. I stopped smoking pot 8 years ago. I never saw my old visuals such as trails, static, morphing. Perhaps I just learned to ignore them, or they faded, or they went into latency. I went to grad school, got a great job, and had been smooth sailing...

Anyways, fast forward to 8 months ago...I was super stressed about a long-distance relationship. I got very anxious and could;t sleep or eat (meanwhile, still on Paxil 15 mg daily). Smoked weed with some friends to try and cope (first time in 8 years). Did this 3 times. Sadly, after the 3rd time, the next morning, I had a migraine (I have a history of episodic migraines with aura - one every 4-5 months or so). I felt depersonalized for the next 2 weeks, but that faded. Maybe 2 months later, I developed a strange, migrating headache that has not let up since!! 8 months!!!!

On top of the headache/pressure, I have developed severe light sensitivity, illusory palinopsia (trails, light streaks, negative and positive afterimages), star bursting, halos, and mild static. This seems to be worsening.

I panicked and started a number of meds/supplements. Lion's Mane, Magnesium, B2, Fish Oil, CoQ10.

I saw many docs. Some doctors suggest I have a recurrence of HPPD (including Dr. Henry Abraham), some that I have a persistent migraine aura, some say I have BOTH!! I was placed on Lamictal which seemed to worsen my afterimages. I stopped after 2 months. I tried verapmil ER for 2 months. No help. I am now on nadolol 40 mg daily for 2 months with plans to increase until the headaches are controlled (hopefully). No help yet.

The latest headache specialist wants me to come off Paxil, and switch to fluoxetine because it is easier to use to come off SSRIs and it is also implicated in helping migraine.

I stopped all the supplements because they didn't seem to help after a few months.

Visuals are continuing to worsen. Same with the headaches. I have a weird pain/pressure in my palate and teeth that never stops. It's my understanding that HPPD shouldn't worsen if drugs are avoided.

I am looking for any help. I'm at the end of my rope. Should I come off the SSRI? Should I try to stay on supplements? Should I bite the bullet and try a small dose of klonopin daily? Oddly enough, I don't feel terribly anxious. Just in pain/discomfort. And I'm bitter.

Thanks so much!! I want to get better.

 

[Cotcha Yankinov]

I would be curious to see how you do on a medication called Sarpogrelate, also known as Anplag. It is formally for vascular migraines and arterial disease. Now I'm not trying to advise you on your medications because "I'm not a healthcare professional" blah blah blah but many times too much serotonin is implicated in migraines. There is a serotonin receptor called 5-HT2B that is in the vascular smooth muscle, when you activate the 5-HT2B receptor it causes the smooth muscle to contract and this is what can cause a migraine. This is from TOO MUCH serotonin activity at 2B (contribution from SSRI's increasing 2B activity??). Sarpogrelate antagonizes (shuts down) 5-HT2B. There is also 5-HT2A in smooth muscle. 5-HT2A is what psychedelics activate but these other medications (sarpogrelate, nuplazid) shut down.

Now the serotonin receptor that's involved with psychedelics is called 5-HT2A, one of the benefits of chronic SSRI medication is that its supposed to reduce your amount of 5-HT2A receptors but Sarpogrelate is not only a 5-HT2B antagonist but is a 5-HT2A antagonist as well, considering 5-HT2A antagonists block the effects of psychedelics I think this is a shot in the dark for helping your HPPD (If your HPPD doesn't get better from antagonizing 5-HT2B, which is intimately involved in regulating serotonin and the SERT). Seeing as the other 5-HT2A antagonists aren't very selective, the one that you might possibly be able to get your hands on is Nuplazid, a selective 5-HT2A inverse agonist that typically works wonderfully for sleep. Its on break through drug application for Parkinson's disease psychosis however, so I don't know if you could get your hands on this..

Sarpogrelate is where I think you could derive some benefit, most likely with the migraines but its a shot in the dark at the HPPD like symptoms as well. If too much serotonin is implicated in migraines then a serotonin increase from SSRI's make no sense, except in terms of chronic administration down-regulating the 5-HT2A receptors, but its hard to say what really happens, especially since SSRI's increase neurogenesis and could make you produce more 5-HT2A cells (That would offset 5-HT2A receptor downregulation). We've heard of monthly dosage of psychedelic mushrooms/LSD (a 5-HT2A agonist) curing cluster headaches for people, I believe this could be from down-regulating the 5-HT2A (like chronic SSRI administration is supposed to). I'm wondering if the SSRI's just aren't cutting it anymore and you should try to shut down some of the serotonin with antagonists. There is such a thing as too much serotonin, and there is such a thing as bad serotonin. 5-HT2A is the kind of serotonin that has found to be over expressed in suicide victims.

The closely related 5-HT2B is a very strange receptor but has found to be CRITICAL for the function of SSRI's and MDMA. Neither can work without 5-HT2B. 5-HT2B has some very strange effects (It is responsible for the function of the SERT) and I would be curious what would happen if it were to be combined with an SSRI but if things aren't getting better, me personally, I would think about slowly tapering off the SSRIs and playing it by ear. The definition of insanity is to keep on doing the same thing over and over while expecting a different result. The Sarpogrelate could be your best bet. There aren't really selective 5-HT2B antagonists/inverse agonists out there aside from Sarpogrelate. Serotonin is intimately tied into the vascular system, yes adrenaline does contribute to vasoconstriction but I believe people who are more into the migraine spectrum are often times having problems with excess serotonin.

Let me know if you have any questions or if I need to explain anything more clearly, sorry for all the nerd speak. Feel free to PM me anytime. Good luck!