healing wrote: ↑Sun Jan 28, 2024 2:21 pm
Hello all, it’s been a while since I’ve given an update on my situation and I figured I would check back in. In the past few years I’ve been through some very low lows after a crash from memantine. After my crash, I believed that there was truly no hope left for me and that I was better off dead. After a couple of years of intense suffering, I found a few interventions that have worked wonders and I now live a mostly normal life again. I’ll try my very best to recount my trials and experiences in the most accurate way possible in hopes of helping anybody that may be in a similar position now or in the future.
Here’s a bit about my pre-crash baseline condition for context:
https://pssdforum.org/viewtopic.php?p=24315#p24315
Memantine Crash
Back in 2020, I was advised by a member of this community to try incorporating memantine into my regimen to slow my tolerance to d-amphetamine (dexedrine), which at that point had been the most effective intervention that I had come across (
https://pssdforum.org/viewtopic.php?p=35723#p35723). In truth, I don’t exactly remember when memantine crashed me, whether it was during treatment or during withdrawal is anybody’s guess. When I did crash, though, my condition became systemically worse and I developed new overstimulation and neurological problems. As mentioned in my history (pre-crash), I originally had emotional apathy, low libido, brain fog (including some exercise-induced brain fog, which especially worsened after the crash), anhedonia and depression. Essentially, all of these symptoms worsened on top of the new overstimulation and neurological symptoms that I will describe below:
Overstimulation symptoms
DP/DR, sensitivity to bright lights and sounds, extreme fatigue, exercise-induced HPPD (this was mild and seemed to go away from either time, the incorporation of lithium, or both).
Neurological symptoms
Difficulty with fine motor skills (like typing on a phone and writing on paper), slurred speech, brain fog and some balance/coordination issues.
After the crash, both the overstimulation and neurological symptoms are all-present (to varying degrees), but I noticed that they worsen with anything that increases my blood sugar. That is: eating (in a glucose-dependent way, where carbs give me the most problems, then proteins, and then fats), intense exercise, beta agonists (acutely, but actually improves me once my blood sugar dips back down) and right after waking up (likely the dawn phenomenon, where a spike in cortisol raises blood sugar).
I completely stopped responding to drugs after the crash. Pre-crash, I would get regular euphoria from stimulants as mild as coffee, and as mentioned profound relief from low doses of d-amphetamine. After the crash, I didn't react to 30mg of d-amphetamine with no tolerance.
Needless to say, after my crash I was totally destroyed and I withdrew from the world completely. I stopped attending university, stopped seeing friends, stopped going to family events, stopped dating, and essentially did not leave my house for an entire year. I couldn’t even carry a conversation in those days. I felt an overwhelming sense of impending doom in every moment, I was considering suicide and it felt like hell on earth.
Recovery
In a somewhat expected way, I noticed that the very worst of my problems (overstimulation and neurological) got better when I took measures to keep my blood sugar controlled and as low as possible via a low carb diet (which eventually became a ketogenic diet) along with intermittent fasting. I implemented these practices and they helped a good deal; I was able to live a more normal life but I was still incredibly disabled and mostly homebound.
Lithium carbonate was a godsend for me. I experimented with doses ranging from 50-600mg/day, and it was the single most effective intervention that I have found post-crash. After first taking it I noticed an immediate systemic improvement in all of my symptoms. Specifically, it dampened much of the post-crash overstimulation and neurological symptoms, and even restored part of my drug response. With lithium, I was able to reenter the world, go back to university, workout regularly, and even begin dating again. Dosing is interesting, I noticed that it is most effective at 50mg, and anything beyond that is very emotionally and cognitively blunting. All in all, I would say low-dose lithium has given me most of my life back.
My current regimen
Putting everything together, I currently follow this regimen to this day:
Lifestyle
-Intermittent and prolonged fasting-IF 20:4 and sometimes OMAD (one meal a day), prolonged fasts (usually around 3 days) every few months
-Ketogenic diet with supplemental MCTs (usually about 2-3 tablespoons a day taken with meals)
-Lifting 4 days/week along with aerobic exercise
-No fap
-Focus on sleep hygiene and quality
Drugs
-Daily coffee (~2 cups a day)
-Lithium carbonate (50 mg a day before bed)
-d-amphetamine as needed (2.5-5mg)
On my best days, where every variable is maximized, I feel near my 100% pre-crash self. My drug response is almost completely restored and I am able to live a mostly normal life.
Theories
Blood sugar
The most obvious conclusion that I came to is that rises in blood sugar negatively affect me, and that I feel best when I keep it as low as possible. To this end, it makes sense that keeping steady-low blood sugars through a low-carb diet and intermittent fasting would improve me, and it did. A ketogenic diet was the logical next step for me, as there are a multitude of benefits in using ketones instead of glucose to fuel our cells, especially in neurological conditions:
https://www.mdpi.com/2072-6643/14/9/1952
Indeed, after starting a ketogenic diet I saw a systemic improvement in my condition beyond the benefits of low-carb. Apart from maintaining a steady blood sugar, I don’t exactly know why I function so much better on ketones. It could be anything from shifting the overall GABA/glutamate balance, lowered oxidative stress/anti-inflammatory/neuroprotective action, BDNF upregulation or maybe even its epigenetic effects (BHB acts as a histone deacetylase inhibitor on multiple classes). If I had to guess, I would say it’s probably a combination of all of them along with some unknown mechanisms.
Intermittent and prolonged fasting also help to maintain tight blood sugar control and aids in ketosis production, but I think it has unique benefits beyond being a vehicle for ketosis itself. That is, I am systemically better while being in a state of ketosis AND fasting than being in a deep state of ketosis via MCTs alone. I never feel more alive and vibrant than I do on multiple day fasts, especially with the combination of coffee. If I had to guess, I would say it’s probably due to its anti-inflammatory action, BDNF upregulation, and autophagy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836141/
Lithium
Like ketosis, I don’t know exactly WHY lithium improves me as much as it does, just that it does. Lithium has many mechanisms of actions and it is impossible to say which ones I benefit from. If I had to guess, I think there is something that is causing neuronal hyperexcitability (maybe in a similar way that epilepsy or autism does) and that’s why it helps so much. But like I said, the addition of low-dose lithium gave me immediate improvements.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627470/
My Advice
The dangers of self experimentation
As we have seen time and time again, this condition is random and crashes can happen to anyone with any supplement or drug. It’s safe to say that we have some kind of genetic variation that predisposes us to persistent post-drug syndromes like PSS. I have seen multiple cases where people have severely crashed on the most innocuous of substances, like betaine or methylfolate, and some have even sadly ended their lives after those crashes. So, my first word of advice would be one of CAUTION. Self experimentation is a double edged sword. Using my case as an example, for every “life-saving” improvement like lithium there is a “life-altering” crash like memantine. If you can stand it, I would greatly encourage you to avoid self experimentation.
Before self experimentation
Before any self experimentation, check objective biomarkers like thyroid hormone levels, sex hormone levels, vitamin D levels, etc. Deficiencies in these can cause PSS-like symptoms and can easily be corrected by your endocrinologist. Also, remember that some PSS cases resolve themselves with time.
If you can, I would wait at least 6 months before trying anything.
If you must self experiment
I understand all too well how the advice of “avoid self experimentation” feels when you’re suffering. You feel that you NEED to do something and you’re willing to roll the dice and do whatever it takes to get some functioning back. I understand it because I was the same way. Although I recommend against it, if you must self-experiment, I would greatly encourage you to start with lifestyle interventions first and foremost. Lifestyle changes are the bedrock of any serious regimen and are by far the least risky. These lifestyle changes would include a special focus on sleep hygiene, diet (low carb, ketogenic, MCT supplementation ?), fasting, exercise, nofap, etc. Don’t fall into the idea that only pharmaceuticals can improve you because you’re “too damaged” or whatever, this is a logical fallacy fueled by desperation. Beyond lifestyle interventions, I don’t feel comfortable personally recommending any further treatment as there is simply no way to know how a substance will affect you, it will be for you to discern. The way I see it, the order of least risky to most risky goes something like lifestyle changes -> hormonal interventions (when deficient) -> psychiatric drugs (obviously stay away other drugs that are associated with post-drug syndromes).
A word of encouragement, personal thoughts
I know how easy it is to lose hope when you’re stricken with this condition. Believe me, if I can crawl my way back out of this then there is hope for all of you as well. Try to keep your head high and keep looking to the future. Assume that your situation will get better, pray to God sincerely and have faith that He will answer your prayers. It is possible to go from being unreactive to 30mg of amphetamine to recovering a response to caffeine.
The saying that “cured/mostly cured people don’t come back to the forum” is absolutely true. Coming back on here fills me with dread but I feel I have a duty to all those suffering to at least document my experiences. I wouldn't say I'm "cured," but I would say I'm mostly recovered from the most hellish experience of my life. Life is all about perspective
If you have any further questions or would like to get in contact with me, my email is
healingpssd1@gmail.com