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Dr. Bob is Robert Hsiung, MD,
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Posted by sweetmarie on July 6, 2001, at 15:28:06
This is a question on behalf of my friend.
She became ill about a year after she had stopped using Ecstasy, which she had been regularly using for a couple of years. She went into hospital, was given Nardil (Phenelzine), became much better and was discharged. She discontinued the Nardil, and her symptoms came back. She went back onto it, and it worked again. However, she stopped it again and became unwell. The third time she went back onto it, it totally failed to work. She`s (obviously) very cross with herself for stopping the Nardil, but `hindsight` etc, etc.
Basically, her problems are severe anxiety, `racing` thoughts, bad head pains, an inability to concentrate or focus, and dissociation. She`s very often suicidal, and has no life to speak of. In total, she`s been incapacitated for about 5 years.
She has long suspected that her illness is the result of her heavy use of `E`. Her psychiatrists have not known what is wrong with her at all, and she`s been tried on many different drugs since the Nardil.
She recently saw a specialist (the bloke that is currently treating me), who said that he was more-or-less certain that the illness is Ecstasy-linked. He told her that there are 2 medications that can be used for this - Nardil and Lofepremine. As she`s tried the Nardil, she really only has the option of Lofepremine.
Does anyone have any info on possible treatments of this type of condition?
I`d be grateful for anything that anyone can tell me.
Ta,
Anna.
Posted by Elizabeth on July 6, 2001, at 23:23:55
In reply to Long-term effects of Ecstasy, posted by sweetmarie on July 6, 2001, at 15:28:06
What evidence is there to support the idea that your friend's depression is related to her ecstasy use? The time course -- onset of depression a year after she last used ecstasy -- just isn't consistent with a drug-induced mood disorder.
Anyway, if Nardil worked for her, she should probably go with another monoamine oxidase inhibitor, such as Parnate or Marplan. She might try augmenting with lithium. (She should *not* take ecstasy with MAOIs!)
-elizabeth
Posted by sweetmarie on July 7, 2001, at 6:15:28
In reply to Re: Long-term effects of Ecstasy » sweetmarie, posted by Elizabeth on July 6, 2001, at 23:23:55
> What evidence is there to support the idea that your friend's depression is related to her ecstasy use? The time course -- onset of depression a year after she last used ecstasy -- just isn't consistent with a drug-induced mood disorder.
She has no actual evidence. She`s seen 3 psychiatrists prior to this specialist, and none of them have had a clue as to what is wrong with her. And she doesn`t have depression as such - just bizarre head stuff (whirling thoughts, strange head pains, acute anxiety, `unreal` feelings etc). She`s had brain scans, and various other physical examinations which have showed that there`s nothing wrong physically. She`s also had phsychotherapy, which has been unhelpful.
The Ecstasy use was very heavy e.g. 6 days a week for a long period of time, during which time she wrote two cars off and lost two jobs.
I guess that 5 years of being unwell with seemingly no cause, and no `typical` symptoms (she`s been variously diagnosed as having `atypical depression`, `borderline personality disorder`, and just severe anxiety), it seems likely that the illness is drug-related. >
> Anyway, if Nardil worked for her, she should probably go with another monoamine oxidase inhibitor, such as Parnate or Marplan. She might try augmenting with lithium. (She should *not* take ecstasy with MAOIs!)
I`ll certainly suggest other MAOIs to her. She`s been on Lithium for about 6 months now, firstly as an augmentation of the Nardil, and currently as an augmentation of Venlafaxine. She started a course of ECT, but was summarily discharged from hospital after 3 sessions as a result of `inappropriate behaviour` (she was very distressed and quite aggressive, which I personally think should have been dealt with during her stay, but ...).
Anyway, thanks for your reply and suggestions. I`ll pass them on to her.
Anna.
p.s. she has absolutely no intention of ever touching a non-prescription drug again!
Posted by MM on July 7, 2001, at 7:06:23
In reply to Re: Long-term effects of Ecstasy » Elizabeth, posted by sweetmarie on July 7, 2001, at 6:15:28
She might have had problems before her ecstacy use, which is why it was an attractive drug for her, and why she used it so heavily. It's supposed to make you feel like everything's ok with the world (although when I used it, at least half of the times I had SEVERE anxiety attacks), so of course it would be attractive to people who aren't very happy. But you also have to remember that it's VERY unlikely she used PURE, clinical grade MDMA, and the pills (unless she tested every single one) were probably cut with all kinds of things, many of which could possibly cause some problems; PCP, coke etc. (tho I don't know if those are usually used to cut X). I hope she finds some meds that help her out.
Posted by sweetmarie on July 7, 2001, at 9:53:00
In reply to Re: Long-term effects of Ecstasy, posted by MM on July 7, 2001, at 7:06:23
> She might have had problems before her ecstacy use, which is why it was an attractive drug for her, and why she used it so heavily.
I think you`re right there. She was also drinking fairly heavily at the time.
It's supposed to make you feel like everything's ok with the world (although when I used it, at least half of the times I had SEVERE anxiety attacks), so of course it would be attractive to people who aren't very happy.
I`ve never dared to try it because I`m frightened of possible anxiety effects. I had to stop smoking cannabis because it caused severe anxiety and paranoia.
But you also have to remember that it's VERY unlikely she used PURE, clinical grade MDMA, and the pills (unless she tested every single one) were probably cut with all kinds of things, many of which could possibly cause some problems; PCP, coke etc. (tho I don't know if those are usually used to cut X). I hope she finds some meds that help her out.
Anyway, thanks for that feedback (appreciated).
Anna.
Posted by kid_A on July 7, 2001, at 12:26:57
In reply to Re: Long-term effects of Ecstasy, posted by sweetmarie on July 7, 2001, at 9:53:00
As far as I know, MDMA gradulaly saps your seratonin as an after effect of producing an over abundance of it... Apparently your body gets used to the overabundance of seratoninn and stops producing it.... This is just from recolection...I used escstacy lightly between a period of 1989-1992 and then very heavily between 1994-1996 or so... Afterwards, many people I knew of complained of emotional problems that they had not previously had.
However... Its all a guess really, I took ecstacy because I wanted to escape the dread of reality, and it seemed to work for that... So I definitely had problems long before my ecstacy use. Has it caused damage to me in some way? Surely, but to what extent I dont know... Every drug perscribed or not has its side effects some of which are long standing... Lets all consider the chemicals we injest every day just to feel 'normal'.
In my experience most people who exhibit a need to take street drugs on a constant basis in order to have 'fun' have some deep rooted underlying problems that they may not be willing to recognise... just my 2 cents...
ps. most modern day ecstacy sold is not pure ecstacy, pure ecstacy use really went out around 1994 or so, and they started cutting it with ketamine or heroin or whatever else that might produce some intense feeling... they commonly use vitamin b12 as just a plain 'filler'....
> > She might have had problems before her ecstacy use, which is why it was an attractive drug for her, and why she used it so heavily.
>
> I think you`re right there. She was also drinking fairly heavily at the time.
>
> It's supposed to make you feel like everything's ok with the world (although when I used it, at least half of the times I had SEVERE anxiety attacks), so of course it would be attractive to people who aren't very happy.
>
Posted by MM on July 7, 2001, at 13:22:23
In reply to Re: Long-term effects of Ecstasy » sweetmarie, posted by kid_A on July 7, 2001, at 12:26:57
I got the anxiety/paranoia with pot too. I used it often for like 3 years, (not what I would say is heavy) and now I don't touch it. I'm not even sure I liked it all that much before anyway tho.
The one difference between prescription and street drugs is that you usually know what grade your getting with prescription, or what's in it. Not that prescription drugs are little miracles sent from heaven, (and I'm actually not on any at the moment) but I do know that there's less of a risk I will ingest something like ketamine (the times I had "panic attacks" on a pill, there was probably a lot of K in them and I was having a dissociative thing) or whatever crap they decide to cut with. I actually think it would make more sense to legalize most street drugs so that we could take more precautions (because people could admit they are on something) and people would know what they are getting. People are going to "self medicate" anyway.
Posted by geekUK on July 7, 2001, at 19:43:35
In reply to Re: Long-term effects of Ecstasy, posted by MM on July 7, 2001, at 7:06:23
E wont have been cut with coke (to expensive as far as I know_) ketamine and pcp are common. glucose, paracetamol,chalk, asprin ect. rule of thumb -if its cheap and white it maybe in there!
that it's VERY unlikely she used PURE, clinical grade MDMA, and the pills (unless she tested every single one) were probably cut with all kinds of things, many of which could possibly cause some problems; PCP, coke etc. (tho I don't know if those are usually used to cut X). I hope she finds some meds that help her out.
Posted by jimmygold70 on July 7, 2001, at 20:23:05
In reply to Long-term effects of Ecstasy, posted by sweetmarie on July 6, 2001, at 15:28:06
Ecstasy causes overstimulation of the serotonin pathways in the brain. This has been shown (as expected) to cause death of neurons in the brain of mice.
I suppose your friend might have already had a dysregulated serotnin system before starting the use of E, and it just made things much worse. Your friend's best bet would be to use drugs that enhance the transmittion of serotonin.
Nardil is a good example. Try to figure out what doses she has taken. It should be tried at doses of up to 90mg/day. Maybe she missed doses, who knows ?
However, an interesting apporach would be to use techniques targeted at Obsessive-Compulsive disorder (OCD) treatment. Some of your friends' symptoms resemble that of OCD. As she as already tried SSRIs (i.e. Prozac), those should be raised to the highest dose (i.e. Prozac 80mg or even higher) and augmented with Risperdal. The Risperdal augmentation strategy might prove extremely helpful for your friend, from my experience.
Also, taking Prozac makes E useless (you feel very little effect when using it, except for the stimulation), so it might discourage her use of it.
Here in Israel, we had much success using Depakene in emotionally unstable patients such as your friend. It can be added to any cocktail suggested above. Also, it will make alcohol useless for her, since, to my experience, it does terrible hangovers when used with alcohol...
My 2 cents,
Jimmy
Posted by Elizabeth on July 7, 2001, at 21:28:47
In reply to Re: Long-term effects of Ecstasy » Elizabeth, posted by sweetmarie on July 7, 2001, at 6:15:28
> I guess that 5 years of being unwell with seemingly no cause, and no `typical` symptoms (she`s been variously diagnosed as having `atypical depression`, `borderline personality disorder`, and just severe anxiety), it seems likely that the illness is drug-related. >
"Atypical depression" means something specific (it doesn't just mean that she has depression with an atypical presentation). It isn't generally drug-induced. I think (based on what you've said) that, although it's possible that the ecstasy had something to do with her illness, it's unlikely.
> I`ll certainly suggest other MAOIs to her. She`s been on Lithium for about 6 months now, firstly as an augmentation of the Nardil, and currently as an augmentation of Venlafaxine. She started a course of ECT, but was summarily discharged from hospital after 3 sessions as a result of `inappropriate behaviour` (she was very distressed and quite aggressive, which I personally think should have been dealt with during her stay, but ...).
Sometimes aggression can result from antidepressant withdrawal. Just a thought.
ECT isn't generally indicated for atypical depression or borderline personality, BTW.
-elizabeth
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