Guidance About Psychosis

[RaiseHellPraiseDale]

Hi all, looking for some guidance about how to proceed after an experience with a (mild) drug induced psychosis.

A little background: Approximately 6 months ago, I had an odd experience that ultimately lead to me seeing a psychiatrist who diagnosed me with a DIP. I’m in my mid 20’s and an experienced drug user (daily cannabis, reasonably heavy drinker, occasional benzo use on hungover Sundays, weekend warrior with cocaine a couple of times a month, and sporadic use of psychedelics, ketamine, and MDMA at concerts throughout time in various doses and combinations). I also do have a limited history of mental illness in my family in that my great grandmother was LIKELY a paranoid schizophrenic or some sort of bipolar, based on details provided about her life, not confirmed but the antecdotes seem to suggest it.

The gist of it is, after a heavier than typical period of cocaine and nitrous use for a few months (large amounts of daily nitrous and cannabis, cocaine about 2-3 days a week every week with alcohol), I began hearing voices I believed were my neighbors “talking shit” about me in my apartment complex. The voices did not specifically talk to me, per se, but talked about me as if they were a couple arguing (one taking my side and backing me up, the other one doing the shit talking). Commenting on my lifestyle, things I was doing they couldn’t possibly know about, seemingly focused on insecurities I had and have, etc. I became thoroughly convinced that one of them was going to try to put spyware on my phone, “out” me on the internet for being a “racist” (which I am not), contact my employer to try to get me fired, etc. A large part of me understood that it couldn’t possibly be real and I couldn’t possibly be hearing them, but it still “felt” real enough it confused me. I did not hear them other places initially - this has changed some with time, but they’re nowhere near constant or anything, and typically only happen in quieter areas when with friends (I have a level of paranoia involved around how much noise we’re making and whether we’re possibly offending or annoying people because we do talk some shit joking around and can be pretty loud late into the night).

I did a 3 month stint back at my parents’ house, saw the aforementioned psychiatrist, and leveled out a bit. During this time my use of drinking has not change, but cannabis and cocaine use has been significantly curtailed (limited to small amounts on weekends). They do not appear to make the problem significantly worse, save from a little increased paranoia if I mix them in doses too high. Aside from a single use of ketamine, and a couple of mild mushroom trips, I have not touched “harder” stuff. Today, I still hear voices that sound like my neighbors talking or other people talking about me from time to time (get significantly worse in large social settings such as concerts), but aside from a couple of isolated incidents that caused me anxiety and prompted me to remove myself from the situation to return home, they’ve been more “annoying” than truly distressing, and I maintain a level of cognizance about the fact they are not real. The most distressing part is realizing they exist, rather than the content of what they’re saying (if that makes sense). I’ve never been violent or unhinged, or even really acted strangely in public or tipped anyone off about the internal turmoil I’m experiencing (save for being a little quieter than normal possibly), but they are occasionally an emotional disturbance on some level that prevents me from fully enjoying situations I used to thrive in.

I have a 3 night run of concerts coming up this weekend for Halloween, and I would love to be able to partake in MDMA. It would be a normal dose of 120 mg, tested and confirmed clean. Aside from some alcohol beforehand, I do not plan on consuming other drugs during the experience. I do, however, have some concerns about exacerbating my current issues or having a difficult time. I have access to about 3 mg of Xanax I plan to keep on me as a backup plan should things get insane, and can likely get the lurasidone prescription I have filled prior to the weekend if I need to (never cashed in after initial doc visit) for extra safety. Given all of this:

1. Is this just an objectively absolutely horrible idea? I understand there is some risk involved with ANY drug use in these circumstances, but wondering if there’s an increased MDMA-specific risk, given the experience laid out above.
2. Does anybody have experience taking MDMA following a similar set of circumstances, and how did it go for you?
3. Aside from having the aforementioned “trip-killers” on hand, are there any tools or tips you can give me to mitigate the risk of both short and long term negative consequences, should I make the decision to partake?

Thank you all in advance and apologies for the giant wall of text.

 

[RaiseHellPraiseDale]

Should note that I would only take the MDMA one of 3 nights and stick to the typical usage outlined above for the other two.

 

[Snafu in the Void]

Like you, I had a similar drug induced psychosis several years ago brought on by alcoholism, kratom/cannabis use, and several months of particularly heavy psychedelic use. My behavior never changed, I never experienced delusion or paranoia, but I also heard voices for about 8 months afterwards. They never spoke or even referred to me at all, it was like listening to a radio station. I always knew the voices were hallucinations, but they sure sounded real. Various other mild-ish symptoms but similar to what you describe.

In retrospect, I probably would have recovered much sooner had I quit all drugs. I continued using kratom, as well as alcohol and cannabis, although to a much lesser degree. This absolutely extended the duration of symptoms.

From what I've learned and through my own experience in recovering from drug induced psychosis, having a period of sobriety from ALL drugs is elemental in recovery and nominally important. This allows your brain to heal and reset to a more normal state.

Eventually after about 2 years, I was able to trip on LSD again and did so many times without any relapse or repercussions. Although I am retired from psychedelics now for other reasons.

Psychosis often creates permanent changes in the brain, which for the most part will always make you more susceptible to having another psychosis (even if you are symptom free when you use). I cannot stress this enough.

I have used many drugs since the psychosis and over time identified which, and to what degree, I can use in a safe manner without risking another psychosis. I have been borderline on having another episode from letting myself go and not watching it, although thankfully it has never happened.

I think it is very important you try to maintain sobriety, or at the very least only use one or two things at a time, until you reach a point where you no longer hear voices for several months. Certain drugs effect me differently now, and precipitate psychosis, more than others. I had to use them one at a time for awhile to learn which effect me negatively and risk psychosis.

So yes, it is a very bad idea and very risky. It's simply too soon. Like I mentioned, you should get to a point where you have not been hearing voices for quite some time before you even consider doing something like MDMA and going in to an environment like that. If you want to continue using drugs you need to give yourself the best chance at fully recovering from these symptoms. If you don't give your brain time to heal, there is a good chance you will worsen your symptoms and never be able to use drugs reasonably again.

Xanax will not save you from a relapse in psychosis. It will only control the symptoms, not prevent them from developing once the xanax wears off... although it's better than nothing, as is the antipsychotic (I am unfamiliar with lurasidone and not sure how it will interact with MDMA, might want to look that up to make sure it's safe).

I relate to your experience as well as your continued drug use, but take it from my own advice, you need to sober up for awhile until this passes. At the very least I highly suggest isolating the drugs you continue to use in order to identify which of them is exacerbating your symptoms most. There will always be time to party and drop some molly, but now is not the time.

 

[RaiseHellPraiseDale]

Hey snafu, thank you very much for the input. It’s reassuring on some level to know that I’m not alone in having the experiences I’ve had, and that recovery is possible.

I’m not sure I’m “capable” of going completely sober (well I certainly am capable, perhaps unwilling is a better word), but will continue to make efforts to regulate my usage and make better decisions for my brain. As much as I hate having to hear your answer, I recognize that it’s probably the best course of action and will more than likely refrain from using the MDMA.

I very much appreciate you taking the time to share your experience (and very articulately at that.) It gives me hope that there’s a path out from this situation I’ve found myself in, and one that doesn’t necessarily involve completely giving up a part of my life I’ve come to love (although I’m aware it might eventually come to that.) I wish there was a magic pill or silver bullet to solve everything, but like with many things in life, the only answer is time.

Peace and love buddy, thanks again for taking the time to bestow some wisdom and shared experience.

 

[RaiseHellPraiseDale]

As a follow up to the above (after further review) - which drugs specifically are more likely to precipitate psychosis in you? I understand this is highly subjective and variable among individuals (like anything pertaining to brain chemistry) but would appreciate another data point, given the overlap in our experiences in terms of symptoms presented and severity.

 

[Snafu in the Void]

I’m not sure I’m “capable” of going completely sober

I understand, I am the same way. I can modulate/control my usage to various degrees, but complete raw sobriety has always been almost impossible, even under the threat of psychosis, prison, homelessness, and death.

It's the curse we share, the burden we bear.

If you are slowly recovering even with your current drugs, this is good news at least. Just don't add anything new to the mix, especially things like MDMA which are well known to induce psychosis. MDMA particularly is a huge shock to your brain chemistry! I would also recommend cutting out the cocaine.

which drugs specifically are more likely to precipitate psychosis in you

Difficult to easily sum up, but I will try. This is also based on what I can use NOW, and not back when I was still having symptoms.

Tier 1 (the worst offenders)
kratom (daily dosing), heavy stims (cocaine, meth, MDMA), cannabis (high dose), dissociatives

Tier 2 (somewhat safe if used reasonably and not with many other drugs on top)
daily heavy alcohol intake, psychedelics (LSD and others), various other things I can't think of right now

Tier 3 (the safest)
occasional alcohol, opioids, benzos, cannabis (low dose), mild stims like adderall/ritalin


...back when I was still having symptoms, pretty much everything made it worse including alcohol. The only things that did not make it worse were benzos and opioids.

 

[RaiseHellPraiseDale]

You are the freaking man (or woman, not going to presume). I have searched far and wide but have not been able to find many others that have gone through something to a similar degree that were able to helpfully convey their experience. Many that were significantly worse, a few that were a little milder, but none right in this sweet spot. Last time I’ll reiterate it so I don’t overdo it, but cannot overstate my appreciation enough for the empathy and the helping hand from someone who actually seems to understand where I’m at as I navigate this.

Duly noted about the list you’ve outlined only being relevant post symptom cessation. I would say I’m somewhat in a holding pattern currently - things aren’t getting worse or better necessarily. Better than the initial episode (which I hypothesize was likely brought on by the combination of super heavy daily nitrous use, like 100+ balloons a day heavy, a 10 year daily cannabis routine, and a temporary 8-ball a weekend cocaine habit), but kind of trudging along at the same pace since the initial improvement period of a couple of months. Interestingly, neurofeedback was a tool i incorporated while I was home I found to be pretty helpful, but have since discontinued due to moving back out of state/it not qualifying for my insurance.

I would love for them to get outright better obviously but have on some level come to terms with living with them, what that means for me and my quality of life, and how to cope with them. I just don’t want to do anything to jeopardize the situation or that could really spin it out of control to a point I’m not able to effectively cope and suffer truly life altering consequences.

I will seriously consider complete sobriety. I’m not sure how attainable it is, but it might be the only way to get back to a comfortable place so I can piece together what exactly will work for me, and what won’t.

 

[foodcrisis]

i read the original post and it sounds mostly like you have your head on your shoulders, but you are experiencing unwanted voices... where you say "A large part of me understood that it couldn’t possibly be real and I couldn’t possibly be hearing them" seems like you are mostly in the right place and not experiencing dellusions which is pretty bad when it gets to that point where you think what is going on is real for whatever reason.

i have diagnosed schizophrenia and what's going on with you sounds pretty similar to what's gone on with me, esspecially how you say that the voices come when you think you and your friends are being loud while hanging out. i thought my neighbors started commenting on me because i used to play the drums and loud music all the time and i thought they had enough of it. i actually spent quit some time thinking it was real, so i think that you are able to tell that it's not actually happening is a good sign like i said.

i'm really not sure if you should try E or not. i use a lot of drugs with my schizophrenia and it always kind of stays the same even if i've been in the hospital and on meds for months, but that's not what everyone reports. i read a lot of reports of drugs making mental illness more intense, so that's a pretty loaded issue to recommend some one... but a common theory is that schizophrenia will come regardless of using drugs if a person really has it, not sure how true that is and i'd kind of tend to think other wise, but that's what i hear from a lot of people "it wasn't the drug causing the mental illness. it was underlying issues." i'd think drugs can definitely cause voices or make them more intense though., what people call drug induced schizophrenia or psychosis.

if you are going to continue to take drugs, maybe keep a journal and write about how you know you are experiencing auditory hallucinations or paranoia. it's not really fool proof, but could help keep a person grounded knowing that they were having some problems before.

 

[RaiseHellPraiseDale]

Thank you for sharing your experience foodcrisis - do you mind if I ask how disruptive to your life and well-being your experience with schizophrenia has been? Do you have any other symptoms aside from the auditory hallucinations taking on a persecutory bend? You alluded to months spent in a hospital and several medications - are you currently on any as you continue to use drugs? What kinds of drugs do you typically use?

This is not meant to be an interrogation. I’m trying to assess whether what I have is truly completely drug induced, or whether the alluded to genetic component in my original post might be the culprit (or some combination thereof). I’d also like to understand what your experience has been and what mine might possibly be should I end up dealing with something similar.

 

[foodcrisis]

yeah. i'm not sure how disruptive the voices actually are to my life. like it's not like they prevent me from working, but i have a herniated disk in my back and some pretty bad nerve damage symptoms, so that's the main thing that keeps me from working at this point. i also don't drive because i think i have a tendancy to space out easier, so it can be difficult to work relying on public transportation in certain areas. i also don't drive because i have HPPD. i'm convinced that's not necessarily because of my schizophrenia, but from years of psychedelic use. i never really got into mdma too much, but i was big into shrooms and acid anologues. i don't do those anymore, not really because my mental health, but because i have a tendency to want them all the time and they give me some stomach issues, so i decided it'd be best not to think about them. i used salvia recently and would still use that because it's so cheap and i don't really find it enjoyable enough to get addicted like shrooms and acid. i smoke a ton of weed still... the only psych meds i'm on at the moment is a low dose injection of haldol, not because i want to be on it or because doctors or authorities are making me, but because my parents feel better if i do, so i just take the lowest dose the doctor will give me and don't get too much side effects while i'm temproarily living with them. the injection does nothing to stop the auditory hallucinations for me even at high doses and combined with another drug like i've said before. i've had some meds that work to stop the audio, mainly risperdal pills. i'm torn whether or not i enjoy the risperdal pills. they can be relaxing and don't have too much side effecs for me other than erectile dysfunction which never sits well with me and i actually like my auditory hallucinations when they are not making me paranoid, which as time goes on becomes less and less... i thought i gathered that the OP was male, but also with erectile dysfunction mostly all psych meds will do that to everybody that's on them, so that's the thing, if you are really worried about the voices coming full time and don't like them, it can be a bad time when having to turn to psych meds. for females i also hear that they stop periods..... some of the medications feel awful too with restless leg syndrome and stuff. there is a big thread about invega a drug that a lot of bluelighters have been prescribed and the people are pretty much going through hell with the injections that they get.

 

[RaiseHellPraiseDale]

Foodcrisis - first of all, I’m legitimately very sorry to hear about the herniated disk. Any illness or malady that causes chronic physical pain is absolute torment. I wish you weren’t dealing with that.

Oddly enough, the voices themselves, while sometimes distressing, are not the worst part like you said. Especially as time passes and I get more “used” to them. The worst part is the downstream effects of my anxiety going “can I trust my own brain? Is shit permanently breaking?” that accompanies them.

“Breaking” is not the right word, as I don’t believe that anybody’s brain is “broken” just works differently than maybe most do, but it just concerns me - I consider my mind my biggest asset (behind the essence of my soul), and the prospect of permanently altering the way it functions and fundamentally undercutting my own trust in myself and my 5 senses in a way that will possibly impact my ability to function in life, relationships, the larger confines of society, etc is a scary thought. I refused psych meds initially when I saw the psychiatrist for the very reasons you’ve outlined - Insane side effect profiles and no guarantee they will actually work. Hedonistically, I refuse to let my dick stop working or kill my sex drive. It’s one of life’s most beautiful components and I honestly can’t stand the thought of taking that away from myself. But I also love drugs. Which might be causing or exacerbating my issues. It’s a precarious balance to strike and one I need to figure the fuck out here.

At any rate, thank you for answering my rather invasive and personal questions about you and your experience, as well as your thoughts about the initial question and situation I posed. I truly appreciate the honesty and your willingness to share with me.

It is very unlikely I will take the MDMA this weekend. Might just give it to a friend I know will enjoy it and spread the love and stick to the regiment that I know hasn’t been fucking me up worse. Peace and love.