Comedown after large dose - worried

[greenback]

SWIM would really appreciate some advice after an MDMA comedown that is not getting better after 6 days.

SWIM went out 6 days ago and had a few drinks followed by MDMA powder. SWIM is a novice and it didn't look like a lot, but after retracing steps was likely close to 1g - stupid, and SWIM is regretting it hugely. The trip was intense but SWIM drank water responsibly. SWIM has used MDMA (in smaller doses) a few times previously in the past few months - this the first time for about 6 weeks.

For the following four days, SWIM felt tired and moderately disorientated. SWIM went to work on days 3 and 4 and didn't feel too bad. Ate and slept normally.

On day 5, SWIM began experiencing head-rushes and a feeling of de-realisation, and anxiety. SWIM did not sleep at all that night. SWIM did some online research and stocked up on vitamins, omega 3, green tea, fruit, vegetables and seratonin-rich foods. The feeling of anxiety continued but reduced noticeably in the evening of day 5 after plently of food and a long walk that afternoon. At this point SWIM was feeling much better, almost back to normal.

On the night of day 5, SWIM slept well but woke up after 7 hours feeling anxious and with a bit of a cold sweat. After breakfast, SWIM began feeling a little better. In the afternoon, the anxious feelings returned and SWIM noitced the dizziness and feeling of detachment from surroundings had returned.

SWIM is becoming increasingly concerned about ongoing symptoms, and would like to know whether this is something that is normal, possible to just ride out (how long will it take?), or if something like ginkgo biloba, l-tyrosene or 5-htp are worth trying (SWIM has read contrasting opinions about 5-htp). It's getting to the point where SWIM is really worried.

The symptoms, which come in waves, are as follows:

- cold hands and feet
- occasional cold sweat
- feeling of disorientation
- anxiety
- moderate nausea
- moderate dizziness (almost always present, a bit like a slight tightness within the front of the head)
- slight tinnitus

SWIM hasn't felt depressed as such, just a bit down, but really wants the dizziness\disorientation to go.

SWIM would greatly appreciate some advice and reassurance.

Many thanks.

 

[neveroddoreven]

Firstly, no need for SWIM here. I had a pretty bad week long comedown off about 2g of good mdma consumed in 2 days (among other drugs...). I experienced brain zaps, mood swings, strange emotions, sleep paralysis and waking up pretty much every 30 mins each night for a week. Try and relax, dont be too anxious about it, maybe get your hands on some valium if you can. My symptoms went away after a while and so will yours, dont worry my man you'll be fine and dandy, you just overdid it and some people have worse comedowns than others, just learn from your mistake

 

[First Bad Comedown]

MDMA neurotoxicity is frequently discussed here on BL and a quick search will reveal many threads for reading.
A look into my post history is bound to offer you endless material for consideration, or concern.

First advice I normally offer is this - you are going to be OK.
No matter what, this happens eventually.

In my experience talking with MDMA victims, there is a trend to recover in the first few weeks/months especially among new users.
I am going to assume you are new, since you are using SWIM, which is a little annoying around here.
It is longer term users how typically experience more difficult recoveries, but I only consumed around 30 tabs lifetime.
I am 13 months into recovery and finally feeling pretty stable, but there is still ups and downs.

If you do not level out completely within 2-3 months, then you are probably looking at a 12 month process.
This is the trend seen with many anecdotal reports as well as several lines of research.
Self-reported depression/anxiety and fMRI scans detecting increases in regional blood flow tend to normalize after approx. one year.
18 months is considered the upper limit, with only the minority of users requiring 2 years or longer.

Some of these tests are subjective, and it is important to point out that many BL members have made statements like 'it never really goes away' which suggests lingering effects for years. Others claim to 'lose the magic' even after 4 years of abstinence.
Despite these troubling statements, the trend is to at least stabilize within the first 2 years. Only the most rare and unfortunate cases continue to suffer beyond this point, although some research suggests ongoing dopamine imbalance as of 3 years abstinence and a reduced response to future MDMA or serotonin agents.

Again - the trend for novice users is to recover within a few weeks.
'Brain zaps' are a great example of this, as those with early onset zaps tend to recover fast.
Some have described zaps for only a day or two!
For me it was 'head-pressure' for months with only a few 'zaps' from time to time.

The feelings you describe having are pretty typical, and I have continued to experience variations of them throughout most of the year.
Here are a few basics.

The intestines contain the vast majority of serotonin and serotonin receptors in the body (90%).
In the brain, the serotonin system comprises the most dense and intricate neurotransmitter system, reaching every brain region.
It is particularly intertwined with the dopamine neurotransmitter system, which it suppresses in 3 of the 4 dopamine pathways.
Serotonin has a profound influence on cerebral microvasculature, or small blood vessels in your brain.
Capillaries respond to increases in serotonin, or decreases.
Because the flow of serotonin around the brain influence blood distribution, it has wide-ranging effects across many brain circuits as it pulls blood and its constituents (glucose, hormones) into relevant regions of the brain.

MDMA releases a MASSIVE wave of serotonin that would not otherwise happen.
It suppresses dopamine as expected, until the peak.
Cortisol levels rise considerably during the comeup, also until the peak. This can be viewed as a defense mechanism against the serotonin increase, because cortisol increases the metabolism of brain serotonin.
Once the peak hits, both serotonin and cortisol drop off, and the pituitary releases powerful hormones known as oxytocin and prolactin.
These are associated with a desire to talk, social interaction, feelings of empathy/euphoria, and increased sensitivity to all the sense.
Prolactin activates neurons that are typically activated by orgasm or breastfeeding.

At the same time, the amphetamine effects of MDMA have increased dopamine supply and the serotonin suppression has targeted dopamine into the one pathway that all drugs target - the meso-limbic. When suppression is lifted, dopamine is allowed to flow around the brain, but the reward circuitry is uniquely activated. The farthest brain region from the brainstem, the prefrontal cortex, also contains a circuit very important to the meso-limbic reward pathway. The PFC is home to our highest evolved cognitive and emotional abilities - feelings like empathy/regret and your personality all come together here. And MDMA targets the PFC, which is right behind your forehead.

In several lines of animal research it has been demonstrated the the serotonin nerves in the cortex, esp. in the PFC, are thin and fiber-like.
They are much more vulnerable to damage than other areas of the brain, and serotonin nerves are much more vulnerable to damage than dopamine nerves. It is agreed upon by the research community that MDMA is a potent neurotoxin.

The most neutral and dispassionate statements are like this - "MDMA is a neurotoxin that selectively target higher cortical axons in the 5-HT network." or "MDMA causes a lasting re-organization of the serotonin network, leaving cortical regions with lower desnsity and sub-cortical regions with original innervation patterns, or even hyper-innervated."

The simple term is 're-wired'.
MDMA, esp. in large or repeated doses, causes the axons extending from the cell body to degenerate.
The network will then begin to re-establish connections over time, but will never achieve original patterns or density.

These are all accepted as truth.
The only debate that remains is the ultimate impact on life and health that this has.
It is surprising to some researchers that human MDMA users, even with long-term recoveries, can return to 'normal' function at all.
Anecdotal reports seem to indicate that minor changes remain, but slowly life returns to normal.

What dose causes a reliable form of 'brain damage' in humans?
This is another important question, since MDMA is one of the most popular drugs in the world.
And it has a rather stupid reputation for 'safety' - one that is NOT deserved.

The greatest principle that is illustrated in research is that REPEATED dosing is the most likely way to induce long-lasting 'damage' or 'alterations' to the 'brain-gut circuitry' that is the serotonin network.

1-2mg/kg is considered a likely 'safe' dose.
This is approximately one, but no more than two tabs in a session. Or 100-250 mg.
Anything above 5mg/kg is considered in the 'toxic' range.
I was certainly using at this level for most occasions.

One gram is considered a very foolish dose, even on BL.
Some users take this much and live to roll another day - but they are normally dick-sizing and ignoring the subtle consequences that inevitably exist.
They are eventually known as e-tards.

You should have known better than to take a known toxic dose of MDMA.
However, I cannot say with any certainty that you have done substantial damage to your cortical serotonin neurons.
Your initial symptoms do seem to indicate this, unfortunately.

The brain scans that can detect this are SPECT or PET scans.
An fMRI can show changes in blood flow, but not serotonin function.
The other scans are quite expensive and are not typically offered to a non-paying patient.
Most doctors and hospital staff are poorly informed on MDMA neurotoxicity anyways, and are usually of very little help unless there is an acute and life-threatening reaction.

The greatest way to determine the extent of damage you have done is to WAIT.
Again - most likely you are going to have 'brain zaps' or other symptoms and recover within a few weeks.
I have seen too many reports like your to believe otherwise.
Many researchers have documented that the greatest psychological deficits are seen in the heaviest cannabis users.
If you have been a regular user, then you are more likely to end up spending a year not feeling like yourself.

That is really an understatement.
It can be very bad, with many proclaiming that their soul is being destroyed slowly.
I cannot predict such gloom for you, but I typically use posts like these to educate other readers.
MDMA is not a 'safe' drug.
It must be used within a very NARROW set of parameters to avoid serious consequences.
The re-dosing principle should be WIDELY discussed and well understood in the global drug community.
All drugs become 'toxic' at high enough doses, but MDMA has a special talent for destroying the lives of its most arrogant users.

Suggestions...
Many will tell you not to read too much, or obsess about what is happening.
This is both valid and useless advice.
If enough damage is done to the serotonin network, then the brainstem is going to push serotonin into new brain circuits.
Not only does this move capillarries around, but it supresses normal neuron function - esp. dopamine.
A dopamine imbalance can grow over time to dangerous levels - as seen in psychotic disorders like schizophrenia.
A clinical diagnosis of such a disorder not made for at least one year of abstinence.
But the fact that this imbalance can occur, renders such advice laughable.

Yet there is still an impact if you can meditate and attempt to maintain control, as the brain is a powerful organ.
Healthy diet is very important, since most serotonin activity occurs through digestion.
High carbohydrate content is going to increase this serotonin activity, not what you want right now.
Lean protein with low glycemic carbs are best, and of course fruits/veggies and lots of fluids.
Sleep as best you can, but understand that insomnia is a very common early feature of recovery.

Fish oil should make its way into your GI on a daily basis.
Mylenation in the brain will benefit from this, and re-sprouting of axons is seen to happen along mylenated tracts.
Turmeric is a great anti-inflammatory and a mild SSRI.
Other than these two supplements, only vitamins and healthy diet are recommded.
Some swear by 5-HTP, although those with more substantial damage tend to dislike it very strongly.
I found it to increase anxiety a lot, and it is not good for the heart.
A high-tryptophan diet will supply all the serotonin you can handle.

SSRIs are often unsuccessful in MDMA users due to compromised serotonin transmission.
And they come with a heavy price, including an extension of the total recovery time needed and even an exacerbation of the negative aspects.
Anti-psychotics can control the mania, but do NOT improve depression. They come with many side-effects, including the possibility of movement disorders with long-term use. The medical community simply does not posses effective medication for the 're-wiring' process.

I found Piracetam to be extremely valuable, however.
A cheap and legal online supplement, it increases serotonin and dopamine in the PFC and may increase membrane permeability in the brain.
It certainly improves digestive function, and for me it cause the most pronounced and euphoric improvement of all negative symptoms.
It brought me out of the darkest and most frightening time of my life, but not permanently.
It is a 'pause' button, in my experienced opinion.
I cycled on and off of it 6 times over the last year - and each time I stopped taking it I degenerated over days/weeks.
The suffering and torment was waiting on me each time.

Piracetam is much safer than other medical options, but there is NO substitute for the 're-wiring' of the brain.
The network must be allowed to establish new connections and kill off (and reassign) neurons.
There is no way around this, you must go through it.

There is ONE coping method that does indeed make a difference, more so than supplements, diet, and meditation put together.
EXERCISE.

Working out releases nerve growth factor, BDNF, in the brain.
This is a serotonin growth factor that causes re-sprouting of axons and increases plasticity of existing axons!
It increases the number of capillaries in the brain, as well as the number of synapses.
With all brain injuries, from gunshots to stokes, physical exercise is the greatest tool at our disposal.
The body is designed to heal the mind.

No matter what level of 'damage' you have done, working out will provide meaningful relief.
It was the days that I felt the least capable of doing it, that delivered to me the greatest relief.
After several days of just moderate exercise, I would be spared the suffering in a complete way.
I cannot recommend it enough.

Whatever you are capable of doing, do it every day.
This will speed the 're-wiring process' more than you might believe.
And it will certainly offer you a vacation from the 'dopamine imbalance'.

I must repeat - I cannot know the extent of damage you have done and I suspect that you will recover within weeks.
If that is not the case, this post is designed to teach you many of the basics you will need.
And to teach those that read it.

Re-dosing should not occur with MDMA.
Spread the word.
FBC

 

[Renz Envy]

Combining alcohol with stimulants is known to cause mild panic disorder and anxiety problems. They can either go away in a couple of weeks or will continue until you seek psychiatric help/therapy.

I recommend putting your mind else where for a little while, chances are you've done a little damage to your receptors and your body just needs time to heal. You did not have a stroke, or pass out in an asphyxiated position, so it's safe to say you will probably recover.

Sorry you've had this happen.

 

[georgewc2001]

If you haven't tried it, get some 5-htp right away. You can get it at any supplement store. IME, it really does help with mood, anxiety, sleep, etc...all the problems from seratonin depletion. I'm coming off a huge month long binge and was really starting to get sick of the side effects so I picked up some 5-htp, which i had used after a binge couple years ago. The stuff works...really. I'm already feeling much better after only a couple days. Try it!

 

[georgewc2001]

"Some swear by 5-HTP, although those with more substantial damage tend to dislike it very strongly."

I'm sure i have substantial damage but i find that 5-htp works well...i don't take it for long periods but maybe 2-4 weeks after a binge. Your comments about it being not great for the heart are a bit concerning, but I can't imagine it being anywhere near as bad as taking massive amounts of mdma.

 

[First Bad Comedown]

5-HTP gave me massive anxiety in the early months of recovery.
Several others have agreed with me that it makes it worse.

Then there are those that swear it helps a lot.
I believe the difference is mediated by the amount of damage done to the network.
If the brain is trying to accommodate new axons and their influence upon existing neurons/circuits, then increasing the serotonin activity quickly could cause an increase in anxiety. The hypothalamus is the greatest suspect, because it is the command center of your endocrine system AND it is known to be hyper-innervated during the 'recovery' process. It is a relay station for the serotonin neurons extending to the frontal lobes!

The release of cortisol from the adrenals actually causes serotonin in the brain to metabolize more quickly, thereby lowering it.
So the cortisol response to 5-htp could be used to judge the amount of damage done.
If serotonin supply is simply too low, then augmenting it would improve symptoms and bring relaxation.
If serotonin capacity is compromised, then increasing it forcefully causes a cortisol response.

Former MDMA users are tested in a very similar manner - a number of different serotonin agents (tryptophan, fenfluramine, piperazine, or even MDMA) is administered. Cortisol is measured, and is pretty normal in former users or even elevated. But the prolactin response is used to judge the overall function of the serotonin network - and substantially lower prolactin has been seen in many former users. But not all.
These tests have been conducted after 2.5 years of abstinence! And anecdotal evidence suggests that even 3-4 years may not be enough to restore 'magic', which is directly attributed to prolactin release.

There is a division here, and as far as I can tell it has to do with the extent of damage.
And the amount of 're-wiring' that has been done.
At month 8 into recovery, I suddenly found tryptophan to be VERY relaxing, and it improved my REM sleep substantially.
Somedud reported a similar phenomena from taking more MDMA - he did not 'roll' but his anxiety switched off and he slept well for the first time in ages. It should be noted that the benefits faded and he had substantial difficulty within 2-3 months.

Tryptophan is supposed to be less risky for the cardiovascular system than 5-HTP.
Let the brain convert it for you. But you are right, amphetamines are likely more damaging.
It is the ongoing use of 5-htp that would be most concerning.

For a person in the early stages of recovery, I would recommend taking plain tryptophan not 5-HTP.
Also I would advise them to take a VERY small dose to begin.
This would require opening the capsule and emptying more than half its contents.
Too many people simply would take the whole pill and just see what happens.
Not a very smart idea in my opinion.

 

[georgewc2001]

^very informative...thx...for me, the most irritating side effect of excessive mdma use is how it effects sleep and i find that even after one day on 5-htp my sleep improves. after days in a row of not getting good sleep, it starts to wear on me. i can handle the depression and anxiety because its usually not a constant all the time thing, but 5-htp seems to help me with that too. anyway, there is no doubt that if mdma is damaging, i have a high level of it, but these days i only roll for basically the fall season and then break for the rest of the year so taking 5-htp for 2 or 3 weeks towards the end of the fall works for me. i'll look into tryptophan but i do eat turkey every day, so maybe i'm gettin a good dose of that already. plus don't wanna be tired all the time...isn't tryptophan known for that?

 

[twitchy_15]

so taking a pill, getting high starting to come down and taking more is really bad for you ?

 

[F1n1shed]

Yes twitchy, indeed. I have done that a good amount of times, wish i hadn't. In my early days i would dose SO far apart just to be on the safe side, well what do you know seems like i caused my self much more damage that way. Anyways FirstBadComedown pretty much nails it every time. I haven't read nearly as many research papers as he has, but the legit ones i have read have agreed with him time after time.

Best thing you can do is get active and exercise along with supplements, even though you have caused some damage those things mentioned will get you in a positive mind set. That will slowly make you happier and recover faster for sure, it will make the process of your serotonin axons resproute at a faster rate. Do not read any papers on mdma damage or anything, that will almost always make your situation worst or a slower recovery. Just look past it and move foward, your gonna be good in no time. Im typing this on a coke comedown, i probably articulated it weirdly

 

[greenback]

Thank you guys, I really appreciate the information and reassurance. This is scary stuff for me as I've only ever had a few pleasant experiences in the past but always with people who knew what they were doing (I acted alone this last time). I certainly won't be touching drugs again, I guess you live and learn. It's good to know there are others out there who know what this is like.

One minor positive is that looking back I don't think it could have been a gram, it was in a small clear 2x3cm bag and was a small amount at the bottom, and finished in 2 doses (a couple of dabs of the finger each time). Unscientific, but I've found images of a gram and they look more than I remember. So maybe it's not as bad as I thought - probably still a significant overdose though.

Hardly slept again last night (3 hours max.) - day 7 today, so I think I'll try Tryptophan as advised by First Bad Comedown (thanks v much for all the info) and see what it does for me. I've been feeling similar today as yesterday, so planning to go for a walk today, then cycling and maybe a workout tomorrow.

I've still got this sort of dreamy and dizzy feeling some of the time, with clammy hands, but it peaks and troughs and nearly completely goes away about 45mins to an hour after a good meal (an hour after breakfast this morning I was feeling almost myself again, but about an hour later the feeling of dizziness returned). The best way I've found to manage this is by eating small regular amounts of fruit and taking in regular liquids. I haven't had any brain flashes yet though, and I haven't felt depressed - just worried. Hopefully with exercise, a small amount of Tryptophan, sleep and a good diet this will gradually go away.

Thanks again.

 

[greenback]

Does this look ok? http://www.bodykind.com/product/174...utm_campaign=L-Tryptophan-30-x-220mg-Vegicaps

Thanks.

 

[Darksidesam]

^ I didnt know you could actually get L-Tryptophan as a supplement!

 

[First Bad Comedown]

Yes, you can buy plain ol' tryptophan, but lots of retailers do not carry it.
Years ago there was a bad batch of it and it fucked up a few people.
That is my scientific synopsis.

5-HTP usually comes in 50mg caps, while tryptophan is a much larger dose.
It definitely felt smoother to me when I was more sensitive, a slower process.
It still caused mild gastric events, such as the sudden gurgling of stomach fluids and the urgent need to evacuate!
But tryptophan converts into bile, not just serotonin.

Looks fine Greenback.
It already sounds like you are doing WAY better than I was in the first week.

I experienced no 'depression' until at least a few weeks in, either.
But the sense of anxiety, panic, and being unsettled was so constant I couldn't escape it.
And I was NOT able to eat solid food for a month, not without severe anxiety and physical pain.
Most stories of major damage that I have read, involve very fast and substantial changes in diet.
Not surprising since the serotonin system functions primarily to contract the intestines.

It has powerful influence over the endocrine system, and the constant sense of unease is evidence that your HPA is not doing well. Cortisol is most likely being released throughout the day, and this can lead to 'adrenal fatigue'. If your recovery takes more than a few weeks, it is important to familiarize yourself with this disorder. The odds of having it grow over time.

Sleeping problems are very common in the beginning.
This will pass fairly quickly, especially for you.
I'm glad you didn't take as much as you thought.

Let us know how your recovery progresses.
Just check back in intermittently.
Reports on recovery are extremely valuable to those that find themselves in your shoes!

 

[Darksidesam]

Sorry FBC but i reccomend against people using 5htp.
Ive had people who have used my E-diet over 5htp, saying it has better results.

 

[First Bad Comedown]

You are apologizing to someone that agrees with you.
Tryptophan supplementation is not necessary if healthy diet is followed.
And allowing the CNS to control its own synthesis is pretty important with most amino acids.

I typically recommend against tryptophan as well, and I warn about the risk of anxiety.
And combining 5-HTP with MDMA, esp. as a pre-load, is foolish in my opinion.
This is a risk factor for serotonin syndrome!

 

[bumblebee]

You will go back to normal mate it sometimes takes time, and at the time it feels like its never gonna go been there myself many times!!. A lot of it is aniexty. Last time i done pills i only done 2 and i had dizzyness and headaches lasting a whole week, thought it was never gonna end

 

[Heh?!]

Could you give a quick rundown of how the 5-HTP contributes to SS FBC? I had always thought this was the case, because I had heard 5-HTP with my Prozac was a bad idea, but I remember a short period of time here on BL when people were touting it's value as a pre-load supplement. It seemed strange to me.

 

[F1n1shed]

Skip the 5htp , it tends to make some people anxious and spacey during their recovery phase. As others have mentioned you should allow your body to synth serotonin on its own, get some nice healthy foods in you. Banana's are great for serotonin production, read up on serotonin foods and fruits.

 

[First Bad Comedown]

Run down?

How bout a link?
http://www.umm.edu/altmed/articles/5-hydroxytryptophan-000938.htm

Serotonin Syndrome, as i've said before, is a poorly defined condition.
This is typical with any disorder of the nervous system.
Serotonin is even more complicated, because it is the critical link between TWO nervous systems.

There is real value to the definition, because the symptoms seen in presentation are fairly reliable.
A slower onset disorder known as Neuroleptic Malignant Syndrome may overlap, but Serotonin Syndrome is known to be a VERY fast onset.

This is a critical fact for MDMA users to recognize.
If a friend taking MDMA should start to REALLY panic, you need to remove clothing and lower body temperature.
I have been IMed by an individual who credited me with saving their life for this reason!

This is really no joke.
It is rare, but thanks to MDMA it is NOT as rare as it should be.
Prior to SSRIs and esp. MAOIs, it was not a known disorder in medicine.
The body just doesn't create this disorder without pharmaceutical intervention.

MDMA is among the most potent serotonin releasing agents in the world, and certainly the most popular.
Combining ANY other serotonin agent with MDMA is a risk for Serotonin Syndrome.
And 5-HTP is a 'serotonin agent', because it is not just a precursor (amino acid) it is already bound to a hydrogen molecule, which skips a critical metabolic step. Plain tryptophan must be metabolized by the liver before it can cross the brain-blood barrier. But 5-HTP gets there more quickly.

It is very important to understand that no matter which serotonin agent is being used, the INTESTINES play a critical role.
Many of the MAOIs are known to fluctuate serotonin based on intestinal activity.
You can be FINE for many hours or even days.
But the contents of your intestinal tract can quite suddenly decide to increase serotonin activity in the brainstem!

Again - Serotonin Syndrome is a quick onset disorder.
People simply do NOT get a warning sign.

5-HTP is not nearly as risky as an MAOI, because the 'oxidase inhibition' of MAOIs literally disable the metabolism of serotonin.
Tryptophan supplementation only increases the precursor, but this DOES increase serotonin activity in the brain.

If a person needs to 'preload' with a precursor, this suggests a deficiency to begin with.
Why 'roll' in the first place?
Especially when DEPLETION of serotonin is linked to the leading neurotoxicity theory?

I firmly believe that more experienced MDMA users are at an INCREASED risk of SS as they continue to roll, especially if they are not properly spacing their rolls. So if you are using 5-HTP or tryptophan you need to ask yourself WHY.
As a post-load, the risk is greatly diminished, because the serotonin releasing properties of MDMA have already occurred.
If there is neurotoxic damage, then supplementation could induce real anxiety.

It is pre-loading that carries the greatest risk.
And this can be avoided entirely by stopping the tryptophan supplementation at LEAST 3-4 days prior to the roll.