Figuring Out What Went Wrong

[SpunkySkunk347]

Well, it could have been getting prescribed amphetamine... 60mg of Adderall XR a day.
Or maybe that wasn't entirely the culprit, perhaps it was the psychiatrist's insistence that I be on an anti-anxiety medication in addition to the adderall. 200mg of Sertraline a day ------ BUT WAIT A FUCKING MINUTE, Sertraline is an INHIBITOR of one of the main enzymes metabolizing amphetamine. WELL, that explains why the first 6 months out of the hospital with two fresh scripts (one adderall, one sertraline) were spent in psychosis. And yeah, I lost that "one girl who got away" during that time period - bet you can guess why: I was in a psychosis, I was paranoid -- and the psychosis got to the point where there wasn't even any rationality or logic behind the paranoia (I thought the lead singer from the band Tool had teamed up with my girlfriend to eat my soul; I also thought that AT&T and Google were frying my brain with brain-frying waves sent from cell phone towers.

Well, 2 years later, my brain was still recovering from that Mount Everest of a mistake in pharmacokinetics. And of course, going on weekly amphetamine binges wasn't helping my brain recover any faster.

But to give my brain some credit, I was asking a lot of it. I was reading Nietzsche, Schopenhauer, Descartes, Kant, Jung (the list goes on and on) -- and the pseudophilosophy was occupying all of my time. I thought I had some special insight into philosophical principles, and wrote over 200 pages of philosophical ramblings while never quite getting across the point I had intended - which was something like unifying the human race in love with irrefutable philosophical concepts proving the existence of love and its superiority to all other human behaviors.

Now that my brain had to repair itself from years of psychosis, I have about half the intelligence and intuitive problem solving skills that I used to -- or maybe I just like to think I was smarter when I was younger but really it was just testosterone?? I will never know, unless a doctor gives me the okay to play around with as many prescriptions I like to testosterone, opiates, stimulants, benzos. etc -- I will never truly figure out what the problem is in my brain on a psychiatric level.

Its a shame too - I had all the motivation and initiative to solve the rubix cube that is the human cognition; all I needed was a doctor who would prescribe me anything I ask for, and a girl who would love me unconditionally so she could serve as the anchor for my sanity.

But its all fucked now. I'm working minimum wage. My grandiose plans have fallen through. And all I needed was some cooperation.

What other culprits are there? Well, I sometimes think my obsession with the band Tool; its hard enough getting your soul eaten away by amphetamine and psychoses -- its even harder when it feels like Maynard James Keenan is there mocking me on my way down the spiral.

Luckily the very surrealistic psychoses never last for more than a few weeks to a month or two before I fuck up really bad, do something REALLY stupid, and have to give myself a reality check
But how can I keep telling myself that I'm some sort of prodigy when I've crashed and failed so hard so many times, and been broken back down to the weak, helpless child that I am on the inside? When you've had to start your ego over as many times as I have, you stop believing the lies you tell yourself.

 

[n3ophy7e]

Hey Spunky, man I am really sorry to hear about the massive prescription fuck-up from that psychiatrist. It is so shocking that there are some practising psychiatric specialists out there who don't recognise/remember about major contraindications like that. I don't know how old you are now, but chances are that you have a lot of time to turn things around. I can imagine you've been through hell with psychosis and related psychological symptoms, but please don't give up hope that you can achieve all the great things of which you are capable. The way you write indicates that you have retained so much of the intelligence and insight that you think you have lost. It's still there man, even if sometimes you feel like it's gone.

When was the last time you saw a psychiatrist or a psychologist? Are you on any meds now? Are you currently using any recreational substances?

 

[Cyc]

Hey Spunky, can you prove that this dr. prescribed you both of these drugs in tandem? Do you have two pill bottles with similar dates, or a copy of the actual script? Do you have a medical record to illustrate your psychotic state? Combine that with a bit of medical research online about these drugs contraindicating one another, print out a few pages from your state's legal website, and head down to your local courthouse and file a lawsuit.

 

[SpunkySkunk347]

I don't want to file a lawsuit. This doctor who put me on adderall and sertraline was a very nice guy and very understanding; he only prescribed me adderall because I suggested it, and he worked with my very closely for a month or two to find a dose that worked.. The only thing he did that I didn't approve of was putting me on sertraline (I had just gotten off of anti-depressants during my stay in that hospital, and I was hoping that I would be off them for good). But he insisted that I be on something for anxiety, so that the adderall didn't end up making my anxiety worse than it already was.
Overall, he did what I wanted him to do.

And I don't really know if the contraindication of mixing adderall XR with sertraline is that significant - since a large portion (about half of a given dose) of amphetamine is excreted unchanged in urine; and a smaller percentage (I'm not sure how much) is metabolized by CYP2D6 (which setraline is a moderate inhibitor of). I don't know how greatly sertraline affects amphetamine's metabolism and half-life, but in the past I remember a few sources that said that a CYP2D6 inhibitor will cause amphetamine to build up in your system with very uncomfortable results.
One might think that increasing amphetamine's duration in the blood stream would potentiate the positive effects, but this is not the case - since amphetamine's psychoactive effects are not directly related to the level of amphetamine in the blood:

Subjective effects are increased by larger doses, however, over the course of a given dose there is a noticeable divergence between such effects and drug concentration in the blood.[48] In particular, mental effects peak before maximal blood levels are reached, and decline as blood levels remain stable or even continue to increase.[49][50][51] This indicates a mechanism for development of acute tolerance, perhaps distinct from that seen in chronic use.[52]
http://en.wikipedia.org/wiki/Dextroamphetamine#Pharmacokinetics

So basically, more amphetamine in your system =/= stronger mental effects.
As regular amphetamine users will tell, there is a 'ceiling' dose of sorts where taking more amphetamine or a larger dose of amphetamine will not increase desirable effects, but instead only increase negative ones.
This is also true when attempting to potentiate amphetamine by making your body more alkaline with baking soda, which causes the elimination of amphetamine via urination to be greatly slowed down, and hence amphetamine levels in the blood last longer - however, this does not necessarily have a desirable outcome. I personally have had very negative experiences with trying to potentiate amphetamine with baking soda. First of all, the baking soda will very severely dehydrate an individual, increasing many negative effects of amphetamine. Also, the mental effects of amphetamine will wear off at about the same time that they usually do - but since the amphetamine is still in your system in high amounts, the negative peripheral nervous system effects (vascular constriction, etc) will keep going. The 'come-down' lasts much longer and is much harder.

So manipulating the half-life of amphetamine will increase its negative effects, not its positive ones. What I personally believe is that when I was on sertraline, its inhibition of CYP2D6 did cause amphetamine to stay in my system significantly longer, and ended up increasing negative effects that contributed to the development of psychosis - as well as causing physical damage to my body (probably due to vascular constriction, dehydration, over-heating, and perhaps just amphetamine's innate neural toxicity.

But I would never sue.. This doctor did listened to me and my suggestions; he wasn't arrogant like other doctors who would dismiss me as a kid who didn't know what I was talking about. He also helped me get off benzodiazepines via a taper with lorazepam, where as the hospital I was at previously had cut me off cold turkey as soon as I mentioned I thought I might be physically dependent to clonazepam, and then just put me on an anti-convulsant and an anti-psychotic (carbamazepine and something I can't remember). They also called up my mother and told her to flush the bottle of clonazepam I had at home down the toilet.

But anyways, back to the doctor who prescribed my sertraline and adderall: I knew amphetamine was capable of causing a psychosis, but I chose to be prescribed it anyways (since it had done amazing things for me in the past). I accept responsibility for what ended up happening. But in a casual non-legal sense, I wish the doctor didn't put me on sertraline - especially when I didn't want to be on it and just wanted to be done with anti-depressants for good before my serotonin levels became permanently compromised for the rest of my life. But I was under 18 then, and ultimately I could only influence his final decision, not refuse it.

Sometimes, bad things just happen, and no one is really at fault -- but this doctor for the most part worked with me, not against me.