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Protecting the brain and body while on amphetamines

FrogWarrior

Bluelighter
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Nov 10, 2013
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154
I wish I had known what I know now, when I first got prescribed ADHD meds. I'm starting this thread to inform others so they can take steps to protect themselves from the harmful effects of amphetamine.

Neurotoxicity:
The theory about why amphetamine causes neurotoxicity is that dopamine is supposedly a relatively reactive molecule. It gets auto-oxidised into a reactive metabolite which then causes oxidative damage to the pre synaptic terminals of dopaminergic neurons. Unlike Parkinsons disease, the dopamine cell bodies don't actually die, but without the terminals, they can no longer release dopamine.

Lots of studies have been done on methods of inhibiting the cytotoxic effects of 6-hydroxydopamine (6-OHDA), and this is directly relevent to amphetamine toxicity because the mechanism of 6-OHDAs neurotoxicity is the same as the one proposed for amphetamine. Actually there are two mechanisms behind 6-OHDAs neurotoxicity, heres an abstract:
The catecholaminergic neurotoxin 6-hydroxydopamine (6-OHDA) has recently been found to be formed endogenously in patients suffering from Parkinson's disease. In this article, we highlight the latest findings on the biochemical mechanism of 6-OHDA toxicity. 6-OHDA has two ways of action: it easily forms free radicals and it is a potent inhibitor of the mitochondrial respiratory chain complexes I and IV. The inhibition of respiratory enzymes by 6-OHDA is reversible and insensitive towards radical scavengers and iron chelators with the exception of desferrioxamine. We conclude that free radicals are not involved in the interaction between 6-OHDA and the respiratory chain and that the two mechanisms are biochemically independent, although they may act synergistically in vivo.
So one of the two reasons that 6-OHDA kills dopamine neurons is that it is easily converted into a free radical. I have posted studies on various substances which have been shown to prevent 6-OHDA neurotoxicity, so one can consider those studies to apply directly to amphetamine too.

Whether this is true or not, theres no harm in taking preventative measures. Here are some ways to protect against this type of neurotoxicity, as well as other forms of neurotoxicity and damage to other areas of the body such as the liver:

Antioxidants:

First and foremost, antioxidants will protect the brain cells against oxidative damage. Antioxidants also protect other organs such as the liver. This means that antioxidants that antioxidants prevent amphetamine induced neurotoxicity, assuming that the theory mentioned above is actually valid. This is the main part of this article since most of the damage caused by amphetamines boils down to free radical damage.

Firstly, a bit about antioxidants. Antioxidants protect cells in the body by neutralizing toxic free radicals. Its necessary to take a mixture of antioxidants because different types of antioxidants protect different parts of the body. Some anti-oxidants are water soluble, some fat soluble. Some anti-oxidants can penetrate membranes easily, some can't. Some anti-oxidants can readily cross the blood brain barrier, others can't.

Vitamin C is a water soluble antioxidant so it neutralises free radicals in the blood and aqueous areas surrounding the cells. Vitamin E on the other hand is a fat soluble antioxidant, so it protects fatty areas of the body such as the walls of the blood vessels. As a result, it prevents the hardening of arteries. Some antioxidants are soluble in both water and fat. Examples are alpha lipoic acid (ALA) and melotonin. Then there are antioxidants which are present inside the cells, and thus protect the cells from the inside. Glutathione is the bodies main endogenous antioxidant which protects the inside of cells. Unfortunately it doesn't get absorbed very well so ingesting glutathione doesn't work. Alpha lipoic acid is an analogue of glutathione which can penetrate cells and thus, protect the cell membrane and inner cell.

Co-enzyme Q10, also known as ubiquinone is a powerful fat soluble antioxidant, and because of its role in cellular respiration, it gets transported to the inner wall of the mitochondria, this gives it the unusual property of protecting the inner mitochondria (an area where protection is greatly needed) from free radical damage. Since the body uses energy from the mitochondria to produce its own endogenous antioxidants such as glutathione, protecting the mitochondria enables the body to produce adequate levels of these endogenous antioxidants. Another antioxidant which protects the inner mitochondria is beta-carotene. Co-enzyme Q10 also protects cholestrol against oxidation. Another powerful antioxidant used in the cellular respiration process is acetyl-L-carnitine (ALCAR). ALCAR protects the outer walls of the mitochondria.

In order to prevent amphetamine neurotoxicity, its essential to take anti-oxidants which can cross the blood brain barrier, and thus enter the brain where amphetamines act. Some powerful anti-oxidants which can readily cross the BBB are acetylcarnitine, alpha lipoic acid and melotonin.

The first antioxidant one should stock up on is vitamin C, because many other antioxidants rely on it in order to function properly. When many antioxidants such as vitamin E neutralise a toxic free radical, they themselves get converted into toxic free radicals, which if left unchecked, would go on to harm cells. Vitamin C on the other hand gets converted into a stable (non toxic) free radical so when an oxidized Vitamin E molecule comes into collides with a Vitamin C molecule, the oxidation chain comes to an end. Curcumin is a wonder substance when it comes to amphetamine use. Not only is it a powerful antioxidant which has been proven to protect against 6-OHDA damage, it also blocks CREB [12], which is one of the major pathways for tolerance to various drugs. CREB alters ones genes and is believed to play a role in long term changes caused by long term drug use[11]. PQQ is a powerful antioxidant which has been proven to protect against 6-hydroxydopa neurotoxicity.[1]

Melotonin like alpha lipoic acid, is a multipurpose antioxidant which is both water and fat soluble, penetrates cells, and readily crosses the blood brain barrier. Melotonin is a sleep inducing hormone, and can thus help counter amphetamine induced insomnia if taken at night time. Additionally, melotonin has been shown to protect the liver and even help repair liver damage. Melotonin is produced by the pineal gland in the absence of light hitting the retina, so its a good idea to use a blind fold for sleeping in order to maximize melotonin production in the brain.

Aspirin is a good antioxidant which has been shown to protect the brain against amphetamine related damage. It is also an anticoagulant so it helps counteract hypertension (a side effect of amphetamine) and prevents strokes and heart attacks etc. Thats why I always take aspirin along with dexedrine. Baby aspirin is all you need (higher doses are hard on the stomach).

Plant extracts such as grape seed extract and green tea extract are good because they contain a wide range of different anti-oxidants and classes essential nutrients such as flavonoids (nutrients with antioxidant and anti-inflammatory properties), isoflavones, carotenoids, essential fatty acids etc.

One should also know a bit about the bodies own endogenous anti-oxidants in order to know how to keep them at optimum levels. On top of protecting the mitochondria (explained above), another way to boost glutathione is by taking precursors such as acetylcysteine. The bodies antioxidant enzymes use zinc, copper, selenium and manganese so its a good idea to make sure one has enough of these trace elements in their body.


NMDA antagonists:

Another cause of brain damage is glutamate cytotoxicity. This happens when you have a surplus of glutamate in the brain, the glutamate overactivates the glutamate receptors and damages them. The 3 types of glutamate receptors are NMDA, AMPA and kainate.

NMDA antagonists protect the brain against this kind of damage and on top of that, they counteract tolerance to amphetamine. Magnesium is a partial NMDA antagonist so its a good idea to take a magnesium supplement every day. Full NMDA antagonist drugs like ketamine or DXM can of course be dangerous so shouldn't be combined with other drugs unless you know exactly what you are doing. Memantine is a safer option since it is a partial NMDA antagonist.

NMDA induced neurotoxicity seems to be caused, ultimately by the conversion of nitric oxide (a neurotransmitter released after the NMDA receptor is activated), therefore this kind of neurotoxicity can be prevented by blocking steps further down the cascade. For example, nitric oxide synthase (NOS) inhibitors such as methylene blue prevent NMDA excitotoxicity by inhibiting the cells ability to produce nitric oxide. NOS inhibitors also prevent tolerance to amphetamines. Note: methylene blue is also an MAOI, so it may not be safe to use in conjunction with amphetamines. The best way to block this damage, without interfering with the activity of glutamate receptors would be to block the action of superoxide itself. Co-Enzyme Q10 helps boost levels of superoxide dismutase, a class of enzymes which break down superoxide.


Other Ways to Inhibit Neurotoxicity:
Glial cell derived neurotrophic factor (GDNF) has been shown to prevent 6-OHDA neurotoxicity[14], therefore enhancing GDNF activity protects the brain. Calcitriol which is the hormonally active form of vitamin D upregulates GDNF expression[15], so taking vitamin D supplements may be a good idea. There are some claims that methylphenidate when used in conjuction with amphetamine, has a neuroprotective effect. I haven't found any clinical studies which back this claim up yet though. I also came across mention of modafinil having similar neuroprotective effects. There is evidence to suggest that modafinil does exhibit neuroprotective effects.[16] One of the mechanisms by which it does that is neutralisation of free radicals (its an antioxidant).


Protecting the Heart and Brain:
Amphetamine use causes some cardiovascular issues, and this can indirectly cause harm to the brain since its the cardiovascular system which carries the oxygen and other compounds needed to keep the brain cells alive and healthy. Thus, it is a good idea to take measures to prevent the risk of heart attack or stroke, and maintain a healthy cardiovascular system. Firstly, as mentioned in the anti-oxidant section, taking the right combination of anti-oxidants will protect the blood vessels. One factor which causes heart problems is oxidation of the arterial walls. Fat soluble antioxidants like vitamin E prevent this.

Oxidised LDL cholestrol also attacks artery walls so taking anti-oxidants like Co-Enzyme Q10 prevents this by shielding the cholestrol. Most people over 20 already have significant amounts of oxidized LDL cholestrol in the arteries, so another class of antioxidant called flavanoids can be used to reverse that. Flavonoids enter the blood vessel walls and dampen down the inflammation. A good flavonoid is quercetin.

Taking vasodilators may be a good idea in order to counteracting amphetamine induced vasoconstriction Gingko biloba is a decent vasodilator, which also contains powerful anti-oxidants. GABA activity induces vasodilation so boosting GABA levels is a good idea. GABA itself doesn't cross the blood brain barrier very well, but its picamilon can readily cross the BBB and boost GABA levels in the brain. Picamilon is basically a molecule of GABA binded to a molecule of niacin, which gets metabolised into GABA and niacin in the brain, so it can be considered a GABA and vitamin B3 supplement. It is an effective vasodilator. Boosting GABA levels will also help prevent glutamate excitotoxicity since GABA and glutamate balance each other out.

Anticoagulents such as aspirin help prevent blood clotting, and thus lower the risk of heart attack or stroke. One should be careful with stronger anticoagulents such as warfarin as they have a greater tendency to interact with drugs.

There are also substances which directly protect the brain against hypoxia induced damage. Racetams such as piracetam and related nootropics protect the brain by enhancing the bioavailability of oxygen to neurons in the brain. Piracetam has been shown to drastically reduce the brain damage incurred by stroke victims, if administered shortly after the stroke. There is also some anecdotal evidence that piracetam counteracts amphetamine tolerance.

I should also mention clonidine. Its prescribed as an antihypertensive, sleep aid and other things. The main theory is that it is an a2 receptor agonist, but another theory is that it binds to the imidazole. Whats interesting is that I2 receptors modulate neuroprotective mechanisms. Its I1 receptors that lower blood pressure, but clonidine (if it binds to these receptors) is probably not fully selective to the I1 receptor.

Protecting the Liver:
The majority of drug induced liver damage boils down to oxidative damage, therefore antioxidants are the most important factor for protecting the liver. The endogenous antioxidant responsible for protecting the liver against this damage is glutathione, liver damage occurs when the bodies natural glathione reserves are depleted faster than they can regenerate. Two powerful liver protecting supplements one should know about are milk thistle and acetylcystine. Milk thistle is the most powerful liver tonic known to man. It protects the liver against damage and even helps repair the liver. It works by increasing levels of glutathione which is a compound the liver uses to metabolise drugs.

Acetylcysteine is one of the bodies precursors for glutathione so it can used to boost glutathione levels. It is also a potent antioxidant in itself.

Replenishing Neurotrasmitters:

Amphetamine causes dopamine and norepinephrine to be released and as a result, it causes these neurotransmitters to get depleted at a relatively rapid rate. The obvious way to replenish them is to take neurotransmitter supplements. To make dopamine and norepinephrine, the body starts with phenylalanine, it goes:
Phenylalanine -> Tyrosine -> Dopa -> Dopamine -> Norepinephrine -> Epinephrine
I think I left out a metabolite or two but they're the ones you should know about. The most direct way to replenish your dopamine is by taking l-dopa. It gets converted to dopamine quicker than l-tyrosine does. However, amphetamine doesn't just deplete dopamine and norepinephrine, it depletes all the neurotransmitters in the metabolic pathway. It also depletes phenethylamine which is another neurotransmitter that the body synthesises from phenylalanine. With this in mind, its a good idea to take phenylalanine supplements so that you replenish the starting material.

Upregulation/Downregulation:
One of the problematic long term changes amphetamine use is the downregulation of various receptors such as dopamine and adrenaline (which are binded to by both epinephrine and norepinephrine), and transporters such as DAT and VMAT[4]. DAT which transports dopamine back into the cell and VMAT2 which is used to transport monoamines (such as dopamine) in the cells back into synaptic vesicles (the neurotransmitters have to be in these vesicles before they can be released). According to some studies[4] methamphetamine also downregulates the enzymes tyrosine hydroxylase (used by the body to produce dopamine) and tryptophan hydroxylase (used to produce serotonin). Therefore taking substances which are known to upregulate/resensitise these receptors, transporters and enzymes may be a good idea. Long term nicotine upregulates dopamine receptors[3], but of course long term nicotine use may be a bad idea since it is fairly addictive.

Uridine upregulates D2 receptors.[2] Uridine seems to be hard to obtain, an alternative is citocoline which is metabolised into uridine (and choline). Supposedly (I can only find anecdotal reports, if anyone knows of any studies, can you post them) lithium upregulates both VMAT2 and D2/D3 receptors. Lithium of course can cause its own neurotoxicity, so one has to research this in depth before deciding to take it. Lithium orotate is far safer than conventional lithium drugs because it has a very high bioavailability, meaning one can ingest lower quantities of it. Forskolin upregulates D2 receptors.[13]

Melotonin has been shown to prevent methamphetamine induced downregulation of tyrosine hydroxylase[8].

Substances which prevent 6-OHDA toxicity:
As I said, 6-OHDA neurotoxicity has the same mechanism of the supposed amphetamine induced neurotoxicity, so the studies done on it applies to amphetamines.

Anandamide has been shown to counteract 6-OHDA toxicity[7]. Anandamide is an endogenous cannabinoid so its possible that synthetic cannabinoids like THC have the same neuroprotective effect. As mentioned below, curcumin has been shown to protect against 6-OHDA damage.[5] Selegiline protects the brain against this kind of damage.[10]

Inhibiting Apoptosis:
Apoptosis is a built in self destruct mechanism for cells. Dopamine neurotoxins like 6-hydroxydopamine induce apoptosis, and according to some studies, amphetamines can do this too. So taking apoptosis inhibitors may be a good idea. According to some studies, curcumin protects the brain against 6-OHDA cytotoxicity.[5] Curcumin also protects the brain against ischemia induced apoptosis.[9] Resveratrol is an apoptosis inhibitor, as well as a powerful antioxidant. Red grapes and blueberries are two good sources of resveratrol.

Repairing the Brain
On top of protecting against damage occuring, its likely a good idea to take measures to reverse the damage that has already occured. Brain Derived Neurotrophic Factor (BDNF) and Nerve Growth Factor (NGF) are two substances involved in neuroplasticity, which help the brain recover from damage. Phosphatidylserine is good for boosting NGF activity. Acetylcarnitine and alpha-glycerophosphocholine (GPC) are two other substances that upregulate NGF receptors. It also enhances dopamine release, so it is a good substance to take during amphetamine withdrawal. I personally find that taking a combination of rhodiola rosea + phosphatidylserine counteracts some of my ADHD symptoms.

Centrophenoxine has been shown to remove lipofuscin deposits from cells, and help repair synapses. Centrophenoxine is metabolised into DMAE and parachlorophenoxyacetate. DMAE also clears lipofuscin from cells and boosts brain function. Lipofuscin is a fatty acid oxidation product which accumulates in cells with age, and excessive accumulation of it has been implicated in Parkinsons disease, Alzheimers and other neurodegenerative disorders, so removing it from brain cells aids the recovery process.

MAO-B Inhibitors:
Selegiline has been shown to protect against 6-OHDA toxicity.[10] If one is responsible and cautious enough, one should be able to figure out safe doses for combining amphetamines with selegiline.


References:
1.) http://www.ncbi.nlm.nih.gov/pubmed/17268846
2.) http://www.ncbi.nlm.nih.gov/pubmed/2906500
3.) http://www.ncbi.nlm.nih.gov/pubmed/20942582
4.) http://jpet.aspetjournals.org/content/early/2005/07/13/jpet.105.087916.full.pdf+html
5.) https://www.sciencedirect.com/science/article/pii/S0006899310022614?np=y
6.) http://www.ncbi.nlm.nih.gov/pubmed/9120425
7.) www.ncbi.nlm.nih.gov/pubmed/20182544
8.) http://www.ncbi.nlm.nih.gov/pubmed/19409439
9.) http://www.ncbi.nlm.nih.gov/pubmed/16075466
10.) http://www.ncbi.nlm.nih.gov/pubmed/11813232
11.) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796570/
12.) http://www.ncbi.nlm.nih.gov/pubmed/20513244
13.) http://www.ncbi.nlm.nih.gov/pubmed/9353595
14.) www.jneurosci.org/content/17/18/7111.full.pdf‎
15.) http://www.ncbi.nlm.nih.gov/pubmed/23626767
16.) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654794/
Thats just the start of the thread, I'll add more and clean it up when I have the time.

Some related threads:
http://www.bluelight.ru/vb/threads/...rotoxicity-and-Tolerance-Reduction-Prevention
http://www.bluelight.ru/vb/threads/...oxicity-and-Tolerance-Reduction-Prevention-II
http://www.longecity.org/forum/topic/47231-amphetamine-neurotoxicity-reductionprevention/
http://www.longecity.org/forum/topi...reverse-toxicity-caused-by-amphetamine-abuse/

Threads on upregulating/resensitizing dopamine receptors:
http://www.longecity.org/forum/topic/57414-substances-for-upregulating-dopamine-receptors/
http://www.drugs-forum.com/forum/showthread.php?t=194700

Some interesting articles on repairing the brain:
https://www.lef.org/magazine/mag2011/jan2011_Feed-Your-Brain_01.htm
http://www.encognitive.com/node/3743
 
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Absolutely excellent first post!

You should probably read through the three Amphetamine Neurotoxicity and Tolerance Reduction/Prevention threads for more information, as you're still missing a couple good ones like PQQ and Modafinil. Also worth mentioning selective MAOB-Is for the adventurous.
 
Full NMDA antagonist drugs like ketamine or memantine can of course be dangerous so shouldn't be combined with other drugs unless you know exactly what you are doing. One can take a prescription NMDA antagonist like memantine on days off the dexedrine to help prevent tolerance to the dexedrine.

NMDA induced neurotoxicity seems to be caused, ultimately by the conversion of nitric oxide (a neurotransmitter released after the NMDA receptor is activated), therefore this kind of neurotoxicity can be prevented by blocking steps further down the cascade. For example, nitric oxide synthase (NOS) inhibitors such as methylene blue prevent NMDA excitotoxicity by inhibiting the cells ability to produce nitric oxide. NOS inhibitors also prevent tolerance to amphetamines. The best way to block this damage, without interfering with the activity of glutamate receptors would be to block the action of superoxide itself. Co-Enzyme Q10 helps boost levels of superoxide dismutase, a class of enzymes which break down superoxide.

Memantine is not a full antagonist, and to reap the benefits should be co-administered with RX amphetamines.
 
Good post. The only thing I might take issue with is the anticoagulants. Watch your ass with those. I really don't think the risk-benefit ratio is <1 for Joe Schmo Adderall patient.

If in the future I have middle aged to older adult patients with ADHD on decades-long daily amphetamine use, who tell me they just don't get the same benefits anymore, I might consider putting some of them on memantine, or maybe even select ones, in excellent health and on few if any other meds, low daily doses of DXM (15mg bid, or 30 qd, or something like that).

In the years to come there'll probably be a raft of handy new NMDARAs similar to memantine, that don't have the quirky (and sometimes fun) side effects of a lot of the classic NMDARAs.
 
dude, I'm tired of linking my FAQ. ;)

ebola

LOL, maybe some day I'll manage to accidentally a hypertensive crisis and won't get my 20mg trandate push before popping a cerebral artery =D

Until then: wiki.bluelight.ru/index.php/Selegiline
 
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Absolutely excellent first post!

You should probably read through the three Amphetamine Neurotoxicity and Tolerance Reduction/Prevention threads for more information, as you're still missing a couple good ones like PQQ and Modafinil. Also worth mentioning selective MAOB-Is for the adventurous.

Thanks I'll give them a read. Does modafinil attenuate some of amphetamines negative effects? I read some good things about PQQ when it comes to repairing neurons and stuff like that. I'll add info on recovering from damage caused by amphetamines and other drugs too. I'm gonna start adding references too, so people don't have to take my word for it if I make a claim.

Good post. The only thing I might take issue with is the anticoagulants. Watch your ass with those. I really don't think the risk-benefit ratio is <1 for Joe Schmo Adderall patient.

If in the future I have middle aged to older adult patients with ADHD on decades-long daily amphetamine use, who tell me they just don't get the same benefits anymore, I might consider putting some of them on memantine, or maybe even select ones, in excellent health and on few if any other meds, low daily doses of DXM (15mg bid, or 30 qd, or something like that).

In the years to come there'll probably be a raft of handy new NMDARAs similar to memantine, that don't have the quirky (and sometimes fun) side effects of a lot of the classic NMDARAs.
Are you a doctor/psychiatrist? The world needs more open minded doctors IMO. Can you tell me more about the risks introduced by anticoagulents? I don't know a great deal about the subject, I've only looked into low dose aspirin (~60mg) so far. I personally use 60mg of aspirin daily, and the main issue I've gotten from it is some stomach pain.

I would love to know an open minded doctor who is knowledgeable in psychoptharmacology, the GPs tend to think only in terms of what is commonly prescribed for what. I suggested memantine to a doc once and he said "I'm not prescribing you an anti dementia medication". He reconsidered after I explained things to him, but he still said "I need to consult a psychiatrist first". It'd be nice to meet a doc that actually knows these things. I suppose psychiatrists are more knowledgeable about all this. I'm a chemist myself, but psychopharmacology is my real passion in life so I'm thinking of applying for med school to become a psychiatrist in the future.

As for new NMDA antagonists, I'd like to see AMPA and kainate antagonists become readily available. Well, I'm not sure about kainate, but from what I've read AMPA antagonists have similar anti tolerance effects. Would it not be better to block things a little further down the cascade though? For example, since NMDA receptors are involved in memory, would you not be better off counteracting tolerance by inhibiting nitric oxide synthase, to avoid interfering with ones ability to learn? Just an idea, I haven't researched this in depth. Not sure if nitric oxide release is involved in the memory process too or not. Worth looking into though. Methylene blue isn't a good candidate for this since its also an MAOI, it would be cool if there were more selective NOS inhibitors available.
 
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FrogWarrior, yeah, I'm a family physician in training, maybe a future geriatrician. I'm exactly halfway through my residency now.

The thing with anticoagulants is that they're only safe if you really don't do anything regularly that puts you at risk of bleeding. This eliminates a lot of sports, or any jobs or hobbies that carry a non-negligible risk of bodily injury. When I used to take ginkgo biloba as part of my cognitive enhancement stack, I used to bleed from minor cuts and scrapes for hours. I still have scars from the keratoses that formed in lieu of platelets for a proper scab. Anticoagulants are a terrible idea if you regularly consume any food or drugs that irritate the lining of the GI tract. This includes ibuprofen and other NSAIDs, recreational doses of alcohol, soda, and very hot beverages. For most young active people without a serious genetic risk for early coronary artery disease and high cholesterol, a the risks of a daily baby aspirin actually outweigh the benefits.

I think you're going to find that inhibiting the long term potentiation (LTP) cascade at any juncture, with any drug that has a strong binding affinity and high bioavailability, is going to give cognitive, learning, and memory problems as a common side effect. That's kind of what LTP is there for. Tolerance is essentially just a form of learning. This would make an interesting study that no one would fund, but I bet you could find a direct correlation between learning abilities / working memory and the rapidity and permanence with which people tend to become tolerant to drugs that act on the CNS.

Memantine and topiramate, due to their pharmacodynamics, only turn LTP down, not off. And still, cognitive and memory deficits are still commonly reported by users of both, including people who get real reported benefits from them.

I hope to be a GP who understands and uses his knowledge of psychopharmacology to heal. The problem is that you're often limited in what you can use by what insurance companies (or outside the US, what national health programs) will pay for. I can prescribe whatever I deem warranted to use to treat a patient. But if it's something used off-label in a highly unorthodox way, I can expected to get taken to task and have to fill out a lot of paperwork before someone's insurance carrier will even entertain the possibility of covering it -- and they often say no in the end, especially if it's not available cheaply as a generic. I would definitely want to collect as much support from studies on PubMed for any unorthodox therapy I prescribed. Because if something goes wrong and the patient suffers an unfortunate side effect, and either takes you to court or ends up in the hospital with a big bill, you're damn skippy I'll be taken to task for my use of the therapy I chose, and I'd better have good justification. All the more so if it's a scheduled substance, or one with known CNS action that has caused people problems.

If someone walks in willing to pay cash for the visit and the prescription, of course, then that takes a lot more scrutiny off me. I think you'll find a lot of the doctors (especially psychiatrists, IME) willing to make unorthodox moves when it comes to pharmacotherapy for their patients, are ones who are fee-for-service and cash only, serve a fairly exclusive clientele who value discretion in their medical care quite highly. On the other hand, you'll generally find that doctors who serve the masses and get paid by big powerful faceless institutions tend to toe the guidelines pretty closely.

Also, keep in mind that going out on a limb for a patient and doing something unusual is something most docs will only do once they know you, your body, and your medical history extremely well, and have a long-standing bond of trust with you that has never been sullied. This is, after all, people's bodies and lives at stake here. It's one thing to defend your own right to do with your body what you wish. It's another thing entirely to defend MY ability, as a paid consultant hired by you for knowledge you don't have that you trust I do, to do with your body what I wish. The regimen of drugs and supplements I take regularly and sporadically is not one that I would ever put any of my patients on.
 
Thanks I'll give them a read. Does modafinil attenuate some of amphetamines negative effects?
Definitely, subjectively co-administering modafinil results in a fairly reduced side effect profile from amps.

Methylene blue isn't a good candidate for this since its also an MAOI, it would be cool if there were more selective NOS inhibitors available.
Methylene blue is only an MAOI in stupidly high doses.

Edit: In fact, I'm on 5mg/day of selegiline and today took 200mcg Methylene Blue and 30mg 2-FMA. If it were acting significantly as an MAOA-I, I'd be dead from hypertensive crisis right now. Instead, 50mcg clonidine has me normotensive.
 
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Yeah. A decisively problematic issue for me has been that concurrent administration of stimulants and dissociatives severely attenuates a lot of what I look for in amps. In fact, amps seem to potentiate dissociatives a great deal for me.

ebola
 
I suppose this might be of some use to people who abuse amphetamine-like drugs, but if you're using amphetamine therapeutically (which many people on BL are), all of this damage prevention information is unnecessary. Of course I do not mean to insult your efforts to help users of amphetamine.
 
Taking vasodilators may be a good idea in order to counteracting amphetamine induced vasoconstriction Gingko biloba is a decent vasodilator, which also contains powerful anti-oxidants. GABA activity induces vasodilation so boosting GABA levels is a good idea. GABA itself doesn't cross the blood brain barrier very well, but its picamilon can readily cross the BBB and boost GABA levels in the brain. Picamilon is basically a molecule of GABA binded to a molecule of niacin, so it can be considered a GABA and vitamin B3 supplement. It is an effective vasodilator.


I was under the impression that vasodilators might not be necessarily good. Yes, it is true that they help counteract amphetamine vasoconstriction, but I thought that this also increases bloodflow to the brain, making it more exposed to the drug and increasing possible neurotoxicity. Could there be some truth behind this assumption?
 
I suppose this might be of some use to people who abuse amphetamine-like drugs, but if you're using amphetamine therapeutically (which many people on BL are), all of this damage prevention information is unnecessary. Of course I do not mean to insult your efforts to help users of amphetamine.

Therapeutic use is what I had in mind when I started the thread (although, it applies to all users), because prescribed amphetamines generally use them daily for a long period of time. A doctor prescribing a drug doesn't magically remove the negative effects of the drug. People prescribed opioids for pain still end up getting physically dependant unless they actively take steps to prevent that from happening. The same applies for people prescribed a daily dose of any psychopharmaceutical. Doctors are just people, you can't expect them to know all the potential negative effects of a drug they prescribe you, and how to protect against them. An example: Look up floxing. Its an adverse reaction to quinolone antibiotics which results in severe peripheral neuropathy. If the person prescribed the quinolone had researched it they would have known that taking a benzodiazepine during their antibiotic treatment would have been a good precautionary measure.

I was under the impression that vasodilators might not be necessarily good. Yes, it is true that they help counteract amphetamine vasoconstriction, but I thought that this also increases bloodflow to the brain, making it more exposed to the drug and increasing possible neurotoxicity. Could there be some truth behind this assumption?
Yeah, vasodilation will increase the bioavailability of the drug to the brain. The drug has to reach the brain for it to work in the first place, so its exposed to the drug either way. With adequate blood flow to the brain, you increase bioavailability of oxygen and nutrients too. I remember watching a documentary about African war lords and they showed them snorting gun powder with cocaine. I looked into that, and the reason they do that is because smokeless powder contains nitroglycerine which is a vasodilator, that increases the amount of cocaine that reaches the brain.
 
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Therapeutic use is what I had in mind when I started the thread (although, it applies to all users), because prescribed amphetamines generally use them daily for a long period of time. A doctor prescribing a drug doesn't magically remove the negative effects of the drug. People prescribed opioids for pain still end up getting physically dependant unless they actively take steps to prevent that from happening. The same applies for people prescribed a daily dose of any psychopharmaceutical. Doctors are just people, you can't expect them to know all the potential negative effects of a drug they prescribe you, and how to protect against them. An example: Look up floxing. Its an adverse reaction to quinolone antibiotics which results in severe peripheral neuropathy. If the person prescribed the quinolone had researched it they would have known that taking a benzodiazepine during their antibiotic treatment would have been a good precautionary measure.

Fair points you make, but all the studies that highlight the damage caused by amphetamine use doses that are seen in abusers and such. There is minimal (if any) evidence that therapeutic use of amphetamine causes any significant harm. If that were the case, surely the drug would have been taken off the market now... therapeutic psychostimulants have been on the market for decades.

Happily, one can take all the supplements you recommend in hopes of preventing any damage from amphetamine (imaginary or otherwise) without too much worry. At the worst, taking your advice will result in absolutely nothing happening.
 
frogwarrior, vasodilation doesn't increase brain perfusion per se. In fact if anything it tends to decrease it, since increasing the diameter of a pipe drops the fluid pressure. Systemic vasodilators come with some uncool side effects like orthostatic hypotension, mean headaches (note: migraine and tension headaches are treated with vasoconstrictors), and heart failure if any catecholamine stimulants are in the mix.

This is why cocaine or MDMA plus viagra is a losing combination too. It's like running your refrigerator with the door open or an electric pump with no water pumping -- you're demanding a high level of cardiac output by agonizing the shit out of those beta 1 receptors, but then making it harder to create a good pressure head for the heart to pump against by widening all the pipes! You'll literally burn your heart out in a matter of hours.

Can't say as I've ever seen "floxing" before. The quinolones are one of the better tolerated classes of antibiotics IME. But I'll grant you this -- on the rare occasions they're not well tolerated, it can be a real disaster.
 
Wow nice work, what are your ideas about adding an dri like methylphenidate (preferably the dex isomer which is not available here) to your dex-amfetamine.
In theory this would also have protective effects on the dopamine caused damage.
I was prescribed this combination for a while and it didn't seem to cause any extra discomfort like overstimulation and seems reasonably safe as it is prescribed.


Wonder about the motives behind methylphenidate being the first most used choice for AD(H)D over here is the neurotoxicity of amphetamine.
Although it does have more of a kick against AD(H)D for me, but oh the side effects
 
Wow nice work, what are your ideas about adding an dri like methylphenidate (preferably the dex isomer which is not available here) to your dex-amfetamine.
In theory this would also have protective effects on the dopamine caused damage.
I was prescribed this combination for a while and it didn't seem to cause any extra discomfort like overstimulation and seems reasonably safe as it is prescribed.


Wonder about the motives behind methylphenidate being the first most used choice for AD(H)D over here is the neurotoxicity of amphetamine.
Although it does have more of a kick against AD(H)D for me, but oh the side effects

Possible, although I can't seem to find any studies saying it is directly neuroprotective from amphetamines. I can for modafinil though, and have used this combo a lot.
 
frogwarrior, vasodilation doesn't increase brain perfusion per se. In fact if anything it tends to decrease it, since increasing the diameter of a pipe drops the fluid pressure. Systemic vasodilators come with some uncool side effects like orthostatic hypotension, mean headaches (note: migraine and tension headaches are treated with vasoconstrictors), and heart failure if any catecholamine stimulants are in the mix.
Good point. The kind of vasodilators I had in mind are gingko and vincopetine which are believed to produce their nootropic effects, in part by enhancing blood flow to the brain. I need to research this more.

Can't say as I've ever seen "floxing" before. The quinolones are one of the better tolerated classes of antibiotics IME. But I'll grant you this -- on the rare occasions they're not well tolerated, it can be a real disaster.
From what I read, its caused by the GABA_a antagonism induced by fluoroquinolones. All the reports of this I've heard, were with ciprofloxacin. I don't know whether its caused by glutamate excitotoxicity, or damage to the GABA neurons or what. BTW I meant to say taking a GABA_a direct agonist should help prevent this problem. Benzos on the other hand might make it worse, but I'm not sure. BZ agonists are positive allosteric modulators of the GABA_a receptor, so I wonder if that means they'd allow GABA_a antagonists to bind even more effectively to the GABA_a receptor.

Wow nice work, what are your ideas about adding an dri like methylphenidate (preferably the dex isomer which is not available here) to your dex-amfetamine.
In theory this would also have protective effects on the dopamine caused damage.
I was prescribed this combination for a while and it didn't seem to cause any extra discomfort like overstimulation and seems reasonably safe as it is prescribed.
I heard that too but don't know anything about it. I haven't looked into where these claims are coming from, have you found any studies on this? I wonder what the mechanism behind that would be.
 
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