To TheW0rm and Others w/ "comedown" issues

[Dawglaw]

TheW0rm - clear your inbox, I cant PM you back.

Mods - feel free to merge this with the comedown thread once TheW0rm sees it.

Here is my reply to your PM and I think it is generally applicable to all others dealing with post MDMA long term issues.

Hey man, I tried to pm you back a few days ago but your inbox was full. I am from SF.

I think you are completely over thinking it. Do not read shit online. Everything posted is anecdotal. MDMA is powerful but not powerful enough to completely re configure your neurochemestry. I went to doctors at Stanford and UCSF and while I didn't trust them at first, they were 100% right. It is all anxiety. Not ONE person has ever caused brain damage from a recreational dose of MDMA. Not one. Millions of people take MDMA, even ridiculous doses of it without brain damage. There is scientific evidence of MDMA triggering acute anxiety and stress disorders. We are just among the unlucky few that have triggered some sort of temporary mental imbalance.

The problem with MDMA and anxiety is that it is the perfect storm. Because it has such a profound effect on the brain and neurotransmitters, when people feel off after taking it they rush to google or bluelight and infect themselves with terrible ideas of brain damage.

The more you read about neurotransmitters or cortisol or whatever, the more you are going to convince yourself that there is some terrible problem with your brain. The reality is you are ok, your body is just very anxious about what you are experiencing. Googling shit is only freaking you out more.

I went to a psychologist after the doctors gave me an all clear with my physical health. I did NOT feel normal. As my past posts have documented, I was miserable. However, when I realized that constantly obsessing about it and searching online for answers was only making me feel worse, I went to a psychologist for help. I got CBT to help me deal with "moving on" and breaking the thought loops of brain damage or any of that other bullshit. Believe me man, I was convinced that I had HPA axis problems, chronic fatigue syndrome, MS, macular degeneration, a brain tumor, etc.

It was all cyber induced hypochondria stemming from obsessing about my comedown. My shrink made me stay off BL and avoid googling comedown related subjects for a month. By forcing myself to just accept the fact that I was going to feel fucked up for a while and doing my best to not let it bother me, I slowly got better.

I started working out every day to keep my mind focused. I played video games and I drank with my buddies and colleagues. I basically said I was just going to live my life as if my comedown never happened. I didn't fight my comedown, I just accepted it for what it is. The next thing I knew, it was gone.

Google mindfulness tips. By doing breathing exercises, I talked myself out of some VERY scary dereaslization early on. There has to be a ton of "mindfulness" stuff up in Arcata. Just get involved with something and keep yourself as busy as possible. So busy that you don't have time to worry about brain damage or a comedown. Life is too short to spend your time worrying about non-existant brain damage.

Don't obsess about it. Don't look for a magical diagnosis or a magic cure. There is none, your mind is playing a very nasty trick on you and you just have to let it unwind. It takes time and the symptoms are very real but they are not brain damage. I promise.

 

[Delfin]

Thank you so much Dawglaw for this post. I'm in the exact same situation as Worm.. I think your advice about staying off BL, google, etc, is the best fucking advice, and I intend to do it until I recover. Starting today.. Out of curiosity I would like to know how long it took you before you recovered from your depressive symtomps? Theese are my main issues..

 

[TheMedic]

This is the best advice someone can follow.

I did the exact same thing.

The mind is a powerful thing and if you are paranoid enough you can convince yourself into thinking you messed yourself up. To those experiencing this follow this advice to the letter

stay safe everyone

 

[Dawglaw]

Delfin - I hope you are not reading this because you should be staying off the internet and not poisoning your mind about your comedown. Anyways, post MDMA anxiety is not like a broken leg. Your recovery will depend on how you deal with it. If you stay positive and don't make it worse it will be over a lot sooner than if you try to fight it and use your internet PHD to try to diagnose yourself and then cure yourself.

Believe me, I did NOT think I was suffering from anxiety. I had so many "symptoms" that to me indicated real actual damage. It was only when I took some time to be logical about what I was doing when I realized that I was caught up in a crazy self inflicted mind game.

1) MDMA in recreational doses (even large recreational doses) does NOT cause brain damage
2) Even if it did cause brain damage, most brain damage is irreversible
3) If most brain damage is irreversible why the hell would taking some random concoction of herbs somehow rebuild my brain
4) Every medical professional I went to said it was impossible that one night caused brain damage
5) I am a smart guy but, am I with my computer and some wifi smarter than doctors who have spent their entire careers studying the effects of drugs on the brain?

The problem is, MDMA induced anxiety is very unsettling and extremely uncomfortable. People want a quick fix. There is no quick fix, you just have to make yourself as comfortable as possible and put yourself in the best situation to facilitate your recovery.

You have two choices - follow the advice of people who have been there before and recovered, and move on with your life or continue to spend your days agonizing about a bunch of self diagnosed imaginary bullshit and dig yourself into a deeper hole.

 

[THeW0rm]

Word man thanks for the feedback. I believe that I was especially suseptable to this due to my history with anxiety. I also understand that anxiety leads to irrational thinking which is why I am having such a hard time accepting that I am "okay". Also when I notice a physical manifestation, I sets me back to square one. I just need to get a grip.

 

[Dawglaw]

You are on the right track. Always try to think logically about what is going on. Physical symptoms can really throw you for a loop, but just keep moving forward. Try to figure out what really gets your anxiety going. For me, drinking coffee really fucked me up. Where as hanging out wiht my friends or having a few drinks would lower it almost to the point that temporarly I felt fine.

If you notice that your symptoms fluctuate depending on what you are doing or the time of day then you can link it to anxiety. Brain damage does not go away when you are distracted!

Also, you have something to pin this on: your pre-existing anxiety. Treat your anxiety and you will treat your comedown.

 

[swedger77]

excellent post DawGlaw.

I have been trying to get this point over for ages.

On a comedown, especially ones with brain zaps, or 4/5day of low mood, reading about brain damage from MDMA is quite simply the worst thing you can do.......it will trigger anxiety which will make everything worse.......complete viscous cycle. At least you (dawglaw) have had the balls to come back to report your now ok as with 99.9999% of folk who "think" they have impaire themselves

 

[badrobot114]

This post should be stickied. And i'm dead serious about this. Not only it is reassuring and honest, but it also provides some much needed sanity and -PROPORTIONS- to MED which is becoming increasingly riddled with "permanent brain damage" posts.

Somehow MED has made MDMA seem as nasty as MPTP and the level of overstatement about the potential side effects has frankly become beyond ridiculous.

 

[cosmosmariner]

Thanks for your post. I agree we should not obsess.

However, I don't want to leave people thinking such undefined statements as "recreational doses" of MDMA does not cause "brain damage."

I respect your opinion, but I don't think that's a scientific statement.

I would add to your solid caution about not freaking out, that people need to look for well-founded, scientific information on the internet, and take anecdotal reports and opinions with a high degree of skepticism.

I still believe prevention is the best method for safely enjoying substances without negative effects (regardless of whether or not we may call them "brain damage."). And I still think there is good information out there about prevention that can help people.

Consider this a friendly addition to your excellent advice.

 

[pmz]

I dont disagree with you. But what i finding frustrating is the rate of damn recovery. I keep my self so busy, entertained, work out, have 3 jobs. I practice endless amounts of mindfulness. I can socialize with no problem. It does not engulf me anymore. Yet the rate of recovery is so slow. That real feeling of joy and adrenaline and excitement does not exist in my body and its hard to play out a normal day without that. Shit, Ive avoided this site for a while. I dont look shit up anymore. The hard part is finding legitimate sources of joy and pleasure in my life. Thats what keeps bringing my mind back. Though, I can finally focus better, read better, think clearer, I just feel dead inside emotionally most of the times.


I dont think it psyching my self out. I cant imagine what else I gotta do, to get my self out of this funk

 

[pmz]

Just to add, you also had Derealization. Depersonilaztion is far different. did you have any experience with DP?

DR sounds farrrrrr easier to work with.

 

[zebrafish]

1) MDMA in recreational doses (even large recreational doses) does NOT cause brain damage [\QUOTE]

How do you know this? At what point does it cause brain damage then? If we say that the brain damage is due the cumulative effect of taking recreational doses many times, then we are assuming that the damage from MDMA is dose-dependant. Therefore, due to a dose-dependent relationship, a few very large doses can theoretically cause damage then. However, if we say that chronic users of MDMA have damage because the probability that they took a neurotoxic dose at one point in their MDMA career is high, then we can also conclude that one very large dose or dose taken in the right environment can cause neurotoxic damage. Therefore, I don't think we can say MDMA does not EVER cause damage after one dose.

2) Even if it did cause brain damage, most brain damage is irreversible [\QUOTE]

Depends on what you define as brain damage. The potential of an damaged axon to regenerate is poor compared to other tissues in the body. However, the brain has strong plasticity mechanisms, whereas other neural connections can be made to compensate for the functional deficit. The plasticity potential depends on the area of the brain damaged, the extent of injury, age of the patient, and the time course of the damage. This is seen all the time in patients with strokes or brain tumors. A slow growing brain tumor such as a low grade glioma in the premotor cortex or cerebellum in a young patient may not see any deficit at all due to ongoing plasticity mechanisms. On the other hand, an 80 year patient with an acute stroke in the internal capsule (where motor fibers converge before descending down into the brainstem) may see no recovery ever. Therefore, I think functional deficits due to axonal injury from MDMA toxicity can recover even if the axons themselves dont regenerate, if the extent of damage is low, the area of the brain involved has a higher plasticity potential, and the person is young.

4) Every medical professional I went to said it was impossible that one night caused brain damage[\QUOTE]

From which specialty were these medical professionals? Were they well versed on the effects of MDMA? Most physicians, even neurologists, are under the impression that drugs, including MDMA, take chronic abuse to produce long-term effects. This is the case with most drugs, including alcohol. They know all about the acute effects, but unless they specifically focus on MDMA, they probably dont know the data on MDMA long term effects. There is PROSPECTIVE data out there that shows even a few doses of MDMA produced statistically significant effects, although they may not have been clinically significant. See the NeXT study from the Netherlands.

5) I am a smart guy but, am I with my computer and some wifi smarter than doctors who have spent their entire careers studying the effects of drugs on the brain?[\QUOTE]

How do you think these doctors know their stuff? They are reading the same papers and journal articles we are. They are dissecting and interpreting the results and methodologies the same we are. They may have more biological background compared to the lay person, but human clinical outcome studies dont require too much knowledge of human biology/physiology anyway. There are people on this website who know much more about MDMA damage than most doctors.

The problem is, MDMA induced anxiety is very unsettling and extremely uncomfortable. People want a quick fix. There is no quick fix, you just have to make yourself as comfortable as possible and put yourself in the best situation to facilitate your recovery. [\QUOTE]

I think your theory that it is all anxiety induced problems, which they go away once the anxiety is resolved is only applicable to some people. Anxiety produces a cluster of symptoms each with their own probability of occurring. For example, shortness of breath, chest pain, neck pain, dizziness are all somewhat common in the anxiety syndrome. However, things like brain zaps, visual snow, HPPD are quite uncommon among anxiety sufferers. However, these symptoms seem common amongst people here with long term MDMA problems. The chance that all these people have these rare symptoms due to anxiety alone is quite unlikely. Therefore, there is probably something other than anxiety accounting for these problems in these people.

 

[pmz]

1) MDMA in recreational doses (even large recreational doses) does NOT cause brain damage [\QUOTE]

How do you know this? At what point does it cause brain damage then? If we say that the brain damage is due the cumulative effect of taking recreational doses many times, then we are assuming that the damage from MDMA is dose-dependant. Therefore, due to a dose-dependent relationship, a few very large doses can theoretically cause damage then. However, if we say that chronic users of MDMA have damage because the probability that they took a neurotoxic dose at one point in their MDMA career is high, then we can also conclude that one very large dose or dose taken in the right environment can cause neurotoxic damage. Therefore, I don't think we can say MDMA does not EVER cause damage after one dose.

2) Even if it did cause brain damage, most brain damage is irreversible [\QUOTE]

Depends on what you define as brain damage. The potential of an damaged axon to regenerate is poor compared to other tissues in the body. However, the brain has strong plasticity mechanisms, whereas other neural connections can be made to compensate for the functional deficit. The plasticity potential depends on the area of the brain damaged, the extent of injury, age of the patient, and the time course of the damage. This is seen all the time in patients with strokes or brain tumors. A slow growing brain tumor such as a low grade glioma in the premotor cortex or cerebellum in a young patient may not see any deficit at all due to ongoing plasticity mechanisms. On the other hand, an 80 year patient with an acute stroke in the internal capsule (where motor fibers converge before descending down into the brainstem) may see no recovery ever. Therefore, I think functional deficits due to axonal injury from MDMA toxicity can recover even if the axons themselves dont regenerate, if the extent of damage is low, the area of the brain involved has a higher plasticity potential, and the person is young.

4) Every medical professional I went to said it was impossible that one night caused brain damage[\QUOTE]

From which specialty were these medical professionals? Were they well versed on the effects of MDMA? Most physicians, even neurologists, are under the impression that drugs, including MDMA, take chronic abuse to produce long-term effects. This is the case with most drugs, including alcohol. They know all about the acute effects, but unless they specifically focus on MDMA, they probably dont know the data on MDMA long term effects. There is PROSPECTIVE data out there that shows even a few doses of MDMA produced statistically significant effects, although they may not have been clinically significant. See the NeXT study from the Netherlands.

5) I am a smart guy but, am I with my computer and some wifi smarter than doctors who have spent their entire careers studying the effects of drugs on the brain?[\QUOTE]

How do you think these doctors know their stuff? They are reading the same papers and journal articles we are. They are dissecting and interpreting the results and methodologies the same we are. They may have more biological background compared to the lay person, but human clinical outcome studies dont require too much knowledge of human biology/physiology anyway. There are people on this website who know much more about MDMA damage than most doctors.

The problem is, MDMA induced anxiety is very unsettling and extremely uncomfortable. People want a quick fix. There is no quick fix, you just have to make yourself as comfortable as possible and put yourself in the best situation to facilitate your recovery. [\QUOTE]

I think your theory that it is all anxiety induced problems, which they go away once the anxiety is resolved is only applicable to some people. Anxiety produces a cluster of symptoms each with their own probability of occurring. For example, shortness of breath, chest pain, neck pain, dizziness are all somewhat common in the anxiety syndrome. However, things like brain zaps, visual snow, HPPD are quite uncommon among anxiety sufferers. However, these symptoms seem common amongst people here with long term MDMA problems. The chance that all these people have these rare symptoms due to anxiety alone is quite unlikely. Therefore, there is probably something other than anxiety accounting for these problems in these people.

you said it way better than I could have.

I still do not think its anxiety based. Maybe at one point it was. But there has to be more to it than just anxiety.

 

[ScaredFirstTimer]

[Putting everything in a negative light]

It doesn't matter whether each specific statement Dawglaw brings up is right. The general idea he is bringing across is more important if it can help people to stop obsessing over their current symptoms, which I've found myself to be very helpful. Don't evolve into Bben dude. I agree that it can be interesting and important to discuss actual research on the matter, but not in every thread. Not every time someone tries to be positive about this hell that many of us find ourselves in right now.

 

[Dawglaw]

My advice is worth what you paid for it.

There was a poster on BL who had a comedown and his self diagnosis and obsessive research made things much worse for him. He diagnosed himself with strokes, performed insane medical procedures on himself and basically scared the living shit out of me with his nonsense. Based off of his information which he treated as gospel, he really convinced me that I had serious neurological problems.

I only offer my anecdotes and my advice as someone who has been there before. Been suicidal after my life had been turned upside down, been stuck in a state of dissociation for 8 fucking months. I know how terrible it is.

I am not trying to discredit anyone rather I am trying to offer my experience and opinions to help other people who are going through it.

 

[zebrafish]

My advice is worth what you paid for it.

There was a poster on BL who had a comedown and his self diagnosis and obsessive research made things much worse for him. He diagnosed himself with strokes, performed insane medical procedures on himself and basically scared the living shit out of me with his nonsense. Based off of his information which he treated as gospel, he really convinced me that I had serious neurological problems.

I only offer my anecdotes and my advice as someone who has been there before. Been suicidal after my life had been turned upside down, been stuck in a state of dissociation for 8 fucking months. I know how terrible it is.

I am not trying to discredit anyone rather I am trying to offer my experience and opinions to help other people who are going through it.

You are probably referring to First Bad Comedown. It is impressive and commendable how much research he did on the subject and the massive amount of knowledge he attained in the neurosciences, especially since he did not have a medical background. However, I think to some degree he took that knowledge and, fueled by his obsessiveness and paranoia, extrapolated on them to develop theories about his condition that cannot be supported by evidence, nor were they always consistent with basic neurophysiologic principles. That said, I believe his basic message, that MDMA can be neurotoxic in the right doses and enviroment, is correct.

 

[ScaredFirstTimer]

Dear ScaredFirstTimer,

I completely understand you. When this all started for me, all I wanted was for people to tell me that I will be back to my old self in just a matter of time, and that everything will be ok. I scoured these forums to find stories of people who had claimed they recovered, because it was the only thing that made me feel better. When you brought up Bben, I remembered how his posts used to make me feel: as if someone was stabbing me in the chest. He would cold-heartedly tell everyone they were fucked for life, and would take my hope and crush it like a bug and throw it out the window.

Today is exactly 8 months ago to the day that this all began for me. I miss the old me incredibly. However, I am not exactly like Bben. I HAVE made significant improvements over these last 8 months. My speech fluency has gone COMPLETELY back to normal: no more difficulty finding words or stumbling over my speech. That is a significant neurologic recovery that attests to the plasticity of the brain. My concentration has dramatically improved, as has my energy levels. I can work 15+ hours straight now if I wanted to without blinking an eye. My sleep has dramatically improved. I have now been falling asleep everynight and staying asleep. This is a HUGE improvement. My anxiety is GONE. I have not had a panic attack in months. What I do have left is dizziness/lightheadedness and tinnitus, as well as some mild memory problems when it comes to people's names. I can live with the tinnitus, but if you take away my dizziness, I will be unstoppable.

ScaredFirstTimer, I'm here to tell you that the brain DOES have the capacity to improve after damage. Even if one has had a neurotoxic event, and their axons dont regenerate, the plasticity mechanisms the brain possess can cause a significant improvement in functional deficits over time. You claim you have made significant improvements over just a 3 month period and are continuing to improve. This is a very good sign. As with everything in medicine, there is no guarantee that you will recover 100% of everything you lost. No one on here and no doctor can guarantee you that. However, because of your improvements, your prognosis is quite good.

I feel it is my duty, given everything that I have gone through, to sift through all the BS I have found on this site about MDMA damage and recovery. I have found many posts stating that everyone with long-term effects from MDMA will surely recover 100% with time , diet, and exercise. There are posts that assert that SSRI's impede or hurt your recovery, or that supplement X is better than supplement Y. There is no data to support any of this, and for people desperately needing hope to read a lot of these kinds of things on this forum I feel is misleading. I believe in evidence-based medicine. There is a lot of good data that shows MDMA is neurotoxic with the right doses and conditions in mammalian brains. However, there is little to none of good data on how to treat long-term MDMA damage (class IV evidence at best which consists of mainly case reports). Given this paucity of evidence, these forums are very useful, because some treatments that have been effective for one person, sparks ideas for another suffering with similar symptoms.

I still stand by the fact that not everyone's symptoms after MDMA damage is due to anxiety, although this may be the case for SOME people. If this is neurotoxic damage, not everyone will recover 100%, but most will improve given that most MDMA users are young and otherwise healthy. I post what I post because I want the public to know MDMA damage is real, and that this drug is dangerous if not used correctly. I want to see more objective discussion of the data that is available about this drug, and not subjective opinions. When I used MDMA I was oblivious to the potential long-term damage caused by MDMA, and if I knew what I know now, I would have never touched the stuff. That is entirely my fault and my mistake, but I can make the public aware of what the evidence says about this drug, so that others will not make the stupid mistake I did.

As month after month of this hell rolls by, I find myself looking less and less for recovery stories in order to feed my hope of my own recovery. Instead, after 8 months, I find myself trying to work towards acceptance that these are my symptoms. The big question is can I still have a productive and successful life with these symptoms. I hope the answer will be yes. Any improvement after that is just icing on the cake.

You, like PMZ, and myself are continuing to see improvement. I think thats the best prognostic sign we have that we may see light at the end of the tunnel. Good luck, my friend.

Zebrafish

Good post! What you say about your improvement is amazing man. I am truly very happy for you.

At this point I can accept that what I'm experiencing is indeed brain damage. I don't have a problem with that at all. Coincidentally, before I read this thread I was actually thinking that my brain might be able to compensate fully for the potential damage that has been done. I do not believe that the regrowth of axons is the kind of recovery to rely on, but neuroplasticity indeed is amazing, and I believe that my brain can compensate fully if I really have sustained neuronal damage. The reason I've been having trouble accepting that it is damage, is as I've said before, because of the fluctuating nature of my symptoms. Now I've realized that I might have damaged serotonin neurons in a regulatory part of the brain.

I can also accept that I won't get back to 100%. I will not accept this though, until at least 3-6 more months have passed. I know for a fact that I won't be entirely the same person, as this has been the single hardest challenge in my life. I still believe that I might get through this as a better person when it ends.

I agree that it is important to enlighten the world, and the scene especially, about the potential damage of MDMA. The factors that is involved might be especially important, because I have a group of friends that exclusively does MDMA in the most potentially neurotoxic way possible. Almost exclusively as poly-drug abuse, and always coupled with a huge intake of alcohol. They try to stay away from redosing, but 3-4 redoses throughout the night is not uncommon at all. None of them have ever experienced any long term negative effects, and some of them does work/studies at a very high intellectual level, without any problems. Compared to them I've exposed myself to maybe 1% of the neurotoxic potential of the drug. It then comes down to a biological susceptibility to EITHER damage, or an acute anxiety response. Which is more likely do you think?

 

[zebrafish]

Good post! What you say about your improvement is amazing man. I am truly very happy for you.

At this point I can accept that what I'm experiencing is indeed brain damage. I don't have a problem with that at all. Coincidentally, before I read this thread I was actually thinking that my brain might be able to compensate fully for the potential damage that has been done. I do not believe that the regrowth of axons is the kind of recovery to rely on, but neuroplasticity indeed is amazing, and I believe that my brain can compensate fully if I really have sustained neuronal damage. The reason I've been having trouble accepting that it is damage, is as I've said before, because of the fluctuating nature of my symptoms. Now I've realized that I might have damaged serotonin neurons in a regulatory part of the brain.

I can also accept that I won't get back to 100%. I will not accept this though, until at least 3-6 more months have passed. I know for a fact that I won't be entirely the same person, as this has been the single hardest challenge in my life. I still believe that I might get through this as a better person when it ends.

I agree that it is important to enlighten the world, and the scene especially, about the potential damage of MDMA. The factors that is involved might be especially important, because I have a group of friends that exclusively does MDMA in the most potentially neurotoxic way possible. Almost exclusively as poly-drug abuse, and always coupled with a huge intake of alcohol. They try to stay away from redosing, but 3-4 redoses throughout the night is not uncommon at all. None of them have ever experienced any long term negative effects, and some of them does work/studies at a very high intellectual level, without any problems. Compared to them I've exposed myself to maybe 1% of the neurotoxic potential of the drug. It then comes down to a biological susceptibility to EITHER damage, or an acute anxiety response. Which is more likely do you think?

Even if this all due to anxiety, one needs to ask why this anxiety ocurred. If you did not have a history of anxiety, and did not experience a traumatic event while you were rolling on MDMA, and you experienced anxiety before you went online to visit sites like Bluelight, which could induce a fear response, then where did this anxiety come from?

That suggests that the MDMA caused some changes at the cellular and molecular levels, and in the case of anxiety, most likely in the limbic system, especially the amygdala. The limbic system is involved in the regulation of mood and emotions in response to the environment. Alternatively, the changes could have ocurred in the thalamus/hypothalamus, where the hypothalamus controls sympathetic outflow, which creates the features of the anxiety response: tachycardia, increased blood pressure, sweating, etc.

Whether you want to call these changes at the cellular level "damage" or not is just a matter of semantics. Now, one could say that the biological damage that occurred has been reversed, but the brain has now been trained to respond to the enviroment and internal thoughts with anxiety, therefore the symptoms you experience continue to manisfest despite repair of the cellular structural damage. This is in line with what Dawglaw proposes, and I cannot disagree that this is the case with some people.

Alternatively, one could say that there is sustained damage to the limbic system/hypothalamus which is causing the anxiety which then causes all the other symptoms. What kind of "damage" is it? If you are experiencing symptoms for months, then I think its less likely "downregulation" of receptors or enzyme inhibition, as these processes do not fit this time course after just a acute and transient MDMA event. The neurotoxicity model based on axonal damage via oxidative injury seems to fit this timecourse better.

Finally, the symptoms you experience may not be related to anxiety at all. Cognitive disturbances may reflect injury to the prefrontal and parietal cortices. Insomnia may be related to hypothalamic injury, especially in the suprachiasmatic nucleus. Fatigue may be an endocrinological dysfunction due to hypothalamic dysregulation or pituitary insufficiency.

Which model of damage is causing your symptoms can be hard to tell, and it may even be a combination of the above. I therefore think properly treating all models may the best approach. If you have residual anxiety despite cellular repair of the damage, then therapy such as cognitive behavioral therapy can help, with or without the aid of antidepressants. Even if there is sustained damage at the cellular level, then I still think therapy will help because it in effect induces "plasticity" in the limbic structures. Moreover, if all your symptoms are anxiety based due to cellular damage, then your prognosis may be better than if your damage is more in neocortical structures such as the prefrontal cortex or basal ganglia. Reinnervation by serotonin axons as measured by local SERT density was more pronounced in the structures such as the hypothalamus and amygdala compared to neocortical structures. In fact, some studies showed hyperinnervation of some of these areas.

If your damage is in the neocortical structures then time and neuroplasticity mechanisms will lead to improvement. Adaptation of the brain is just like adaptation of any other organ: it is fueled by demand. So keep a high demand on your cognitive abilities. Read a lot on a variety of subjects. Keep working or stay in school if possible. Play challenging video games. Engage in activity that require a lot of attention/concentration as well as in activity that require abstract reasoning.

Finally, if your symptoms are due to endocrinological disturbance then this is easily diagnosed, which is why I recommend everyone with these symptoms obtain an endocrinological workup. Cortisol, testosterone, and thyroid disturbances can all cause fatigue, poor energy, decreased cognition, and depression. All these hormones are ultimately regulated by the hypothalamus, and under at least some serotonergic control.

 

[ScaredFirstTimer]

Is there research to back up the claims that MDMA can cause damage specifically to the parts you are mentioning? Is there actually consensus about whether damage can be sustained in exactly the way you are describing here? And is there any way of diagnosing/finding out what kind of damage/which part of your brain is damaged?

If not, then why is it necessary to bring up here? After reading your post, I now have a whole new paradigm to make the "brain damage" model fit every symptom I have. People who read that post might conclude that they have extensive neuronal damage all over their brain. And that is on the basis of how you interpret vastly different scientific papers that's published on the matter.


What do you think about the accounts I gave about my friends' MDMA usage? Why isn't the extent of neuronal damage proportional to the amount of neurotoxic exponation to MDMA? By neurotoxic exponation I mean exclusively using MDMA in many times the recommended dosage while being black out drunk, some times blacking out from the MDMA itself too, on a semi-regular basis.

I notice that I'm coming off confrontational here, I'm only trying to provoke some more thoughts on the matter. I think you are one of the greatest assets to this site right now, but I also think that you are trained to look for diagnoses, and to make things fit within a medical/treatable paradigm, which isn't necessarily the best thing.

Edit: Why does one need to experience a traumatic event during rolling for it to be acute anxiety btw? Because that's the only scenario that fits with the list of symptoms required for the diagnosis? Couldn't big changes in the serotonin system (reversible in the short term for the sake of argument) mimic or give a similar effect? I think we already know that it can considering the thousands and thousands of people that experience a "normal" comedown from MDMA.

 

[zebrafish]

Is there research to back up the claims that MDMA can cause damage specifically to the parts you are mentioning? Is there actually consensus about whether damage can be sustained in exactly the way you are describing here?

MDMA binds to SERT receptors on serotonin neurons. SERT receptors are transmembrane proteins located exclusively on serotonin neurons. So to understand which parts of the brain MDMA has a higher affinity for, and could potentially damage, one needs to know the differential distribution of serotonin axon terminals in the white matter of different parts of the brain. There is a lot of literature about this distribution of serotonin terminals throughout the brain. One good paper I can think of of the top of my head is by Barnes, et al in the journal Neuropharmacology from 1999 (I think). It is a good review article describing the distribution of serotonin terminals in the brain, as well as the different types, functions, and distribution of post-synaptic serotonin receptors.

For example, serotonin terminals are rich in the hippocampus, structure located in the deep medial aspect of your temporal lobe, and is responsible for a lot of learning and memory functions. There have been several studies that have demonstrated damage to this structure, and some imaging studies even demonstrating volume loss to this structure, after MDMA use. I can't remember the exact papers anymore, so you will have to search for them. Another serotonin rich area are the striate (visual) cortex and the visual association cortex. This may explain why many people have visual systems or HPPD after MDMA damage.

And is there any way of diagnosing/finding out what kind of damage/which part of your brain is damaged?

Most of the ways researchers have found serotonin neuronal damage from MDMA use has been through imaging studies, as part of a large clinical research study. A lot of studies have use PET (positron emission tomography) or SPECT (single photon emission computed tomography) scans in conjuction with radiolabeled tracers that bind to SERT proteins, in order to determine regional SERT densities in various parts of the brain. Areas with lower SERT densities than normal are thought to reflect decreased serotonin neuronal density. There are a lot of these types of studies, and you can easily search for them.

Newer imaging studies further provide evidence of MDMA induced changes include functional MRI (fMRI) studies and diffusion tensor imaging (DTI) studies. Some of the fMRI studies have shown increased activition of different cortical areas when MDMA users are performing a specific task compared to drug naive patients, indicating increased utilization of blood flow and oxygen consumption to these areas, which reflects decreased efficiency in these cortical areas in MDMA users. I think the DTI studies most clearly demonstrate axonal destruction in MDMA users. DTI imaging uses the diffusion of water molecules down long white matter tracts in the brain. Axonal damage significant disrupts these normal diffusion patters, which can be picked up by this imaging paradigm, and has been demonstrated in some studies among patients with MDMA abuse. The big question is if you went and performed these tests, and they demonstrated neuronal damage or structural/functional changes, would would you do differently after having that knowledge?? This is why I think after ruling out readily treatable problems, such as endocrinological disturbances, MDMA damage is really just a clinical diagnosis, since there is no drug or surgery currently with sufficient evidence to reverse the damage. You would continue healthy living, enviromental modifications to enhance neuroplasticity, and neuropsychiatric drugs to target specific symptoms, regardless of what the imaging studies showed.

What do you think about the accounts I gave about my friends' MDMA usage? Why isn't the extent of neuronal damage proportional to the amount of neurotoxic exponation to MDMA? By neurotoxic exponation I mean exclusively using MDMA in many times the recommended dosage while being black out drunk, some times blacking out from the MDMA itself too, on a semi-regular basis.

Like I mentioned in a previous post, it takes the proper environmental and biologic/genetic factors in addition to dosage to produce significant neurotoxicity. Given that millions of people around the world use MDMA, and only a very small proportion of people develop these problems after only a few uses of the drug, I think all these factors are not present in most people using the drug. For most people, it takes chronic abuse using "normal" dosages to see clinical differences. You and I and other people on this site may just be unlucky in that all the factors were present when we took MDMA.

I notice that I'm coming off confrontational here, I'm only trying to provoke some more thoughts on the matter. I think you are one of the greatest assets to this site right now, but I also think that you are trained to look for diagnoses, and to make things fit within a medical/treatable paradigm, which isn't necessarily the best thing.

You are not confrontational at all. I think this type of discussion as well as more objective review of the literature is what this forum needs, if we are to call this site a harm reduction site. Regardless of being trained or not, looking for diagnosis and trying to make it fit a pathophysiological model is the most logical way I can think of to approach a problem involving human health. If someone presents with a cluster of symptoms, you then come up with a differential diagnosis based on your knowledge of pathophysiological processes that can lead to those symptoms. You then perform further testing to narrow down your differential diagnosis, in order to come up with one diagnosis that best fits all the symptoms/data available.

Edit: Why does one need to experience a traumatic event during rolling for it to be acute anxiety btw? Because that's the only scenario that fits with the list of symptoms required for the diagnosis? Couldn't big changes in the serotonin system (reversible in the short term for the sake of argument) mimic or give a similar effect? I think we already know that it can considering the thousands and thousands of people that experience a "normal" comedown from MDMA.

I'm just trying to show that new onset anxiety in a person that didnt have anxiety problems before have to come from somewhere. Perhaps you have anxiety now because you witnessed someone getting murdered while on MDMA. Perhaps you have anxiety now because you came on Bluelight after rolling and read about all the horror comedown stories. If neither of these is the case, then where did the anxiety come from after doing MDMA? It must have been caused by some changes affecting the 5-HT system. For most people, anxiety is experienced during the "normal" comedown due to serotonin depletion and tryptophan hydroxylase inhibition. For those experiencing anxiety on a longer term basis, one needs to wonder if long term changes in the limbic system aka "damage" has occurred.

There is a LOT of studies about MDMA damage and long term effects, ranging from clinical outcome studies, imaging studies, and animal studies looking at molecular and cellular changes. You have to be careful looking at these studies, because the cohorts being studied may not apply to your situation. Also, with any study, there are ALWAYS some methodological flaw, such as it being a retrospective study or the sample size in the cohort is too small. You have to understand these flaws, before you can confidently believe that the result of the study is the truth. One good review article that kind of summarizes a lot of the imaging and clinical outcome studies over the last decade or so is an article by Gouzoulis-Mayfrank. I will try to find it if I can.