So where to start. This is going to be a somewhat long story/report in an attempt to give some value back to the community and maybe help those in similar situations.
FYI - this will be long and do not have a TLDR but hope this conglomerate of information can help someone else.
To start, I'm an 26 year old male at 6'1 and 220lbs lean with a fitness background. Ex pharmacy student that is starting med school this summer but, first, lets back up about two years. It may be relevant that I have ADHD (predominantly inattentive) and am in my mid-20's. Been prescribed adderall for about 5 years and its been a life changer in a good ways - nothing negative to say directly but, as you will see, we need to be nice to our dopamine systems which I was not. This past year has culminated in some severe anxiety, depression, instability, break downs, mood swings, and anhedonia.
January 2018 - Two years ago I went back to school (after working a year post undergrad) for pharmacy school. Also just under two years ago I was diagnosed with the autoimmune condition Ulcerative Colitis. This has been a difficult thing for me to navigate as it has caused and exacerbated some issues that I was mis-attributing to other factors.
I have always responded very well to dopamine based drugs - anything from caffeine to adderall with little to no side effects, always a positive mood lift, and always a positive effect on sex drive. Over the past two years I have used varying amounts of adderall ranging from nothing, many days, to 100mg ER per day when I had an extremely heavy organic/biochem accelerated course load. That said, I have always had a very high sex drive as well and have borderline sex addict tendencies at times which I have tried well to control.
Within that time, I also began picking up nicotine use in the form of dip which provided a significant up-kick in mental function, drive, focus, and recall combined with adderall and other nootropics (it was a lot but keep in mind I was doing 100 hours of school work a week at some points and pulling straight A's). Marijuana use has also been daily for sleep for probably 5-6 years.
March 2019 - Now a year ago I had my second ulcerative colitis flare that led to my 2nd or 3rd related hospitalization. The fallout from that flare was a massive cortisol response, approximately 8 weeks with no more than 3 hours of sleep per night MAX, anxiety, severe panic attacks, emotional instability. You name it. I was working diligently with multiple doctors to work through the symptoms all while attempting to study full time (poorly) for the MCAT - somehow ended up with a 511 after only about 5 weeks of effective study with massive relationship instability and crippling anxiety attacks and regular, daily mood swings. Worst 3 month period of my entire life.
June - August -- I began slowly, slowly feeling better and having 1 good day in 5 and then 2 in 5 and slowly life began getting somewhat back to normal. In August I started Wellbbutrin/Bupropion XL at 150mg per day in order to help with the residual mood and anxiety issues which were barely lingering.
September - October --The next 6 weeks proceeded to slowly turn into hell with worsening depression after a period of feeling better. Anxiety went up, sex drive went down, and all motivation for life left. Every since quitting on October 10th its been an every day struggle and obsession to get back to normal with mental and mood stability similar to during the flare. This culminated in 100% zero sex drive, complete erectile dysfunction, and no interest in normal things that I used to love.
Recovery -- I've spent months now searching through medical literature to try and find some answers about what is wrong and where. Why I have little motivation, nothing feels good, very little sex drive, and low life enjoyment because I have always been a happy, positive, go-lucky person.
November 8th -- My first success was BPC-157 in a desperate attempt to stop mood swings and mental instability that bordered on suicide a few times. Here, I have no evidence but I believe that this was due to some serotogenic imbalances that likely developed partly due to the ulcerative colitis chronic inflammatory markers, inflammation, and potentially linked to dopamine dysfunction. My first 4 day course of BPC (500mcg BID for one day, then 500mcg QD for 2 days, and 100mcg QD for one day) completely abolished all the anxiety and severe instability/mood swings that I suffered and brought me a period of about 10 days where I felt entirely back to normal. Life felt amazing, loved living, felt motivated and happy to just wake up a breathe every single day. That's how life should feel.
Then, I dropped back into the gray angry haze that I had been used to but without the severe instability and manic phases - just more of a stable depression which was still a relief. I attribute this to a few doses of adderall that knocked me back while my receptors were starting to return to normal.
So - now to today. Last night I went to Bassnectar NYE which was probably the most elaborate amazing show of the century. Hesitantly, I candyflipped and went a little easier than normal since I have been trying to figure out my brain issues lately. Doses were 300ug LSD followed by 120mg very pure crystal MDMA that I have tested in our organic lab.
[Side Note on BPC - ever since using BPC my stimulant tolerance has been significantly reduced and I rolled harder on 120mg last night than I ever have in my entire life by 2-fold even compared to much higher doses. I have never had a roll that was "too hard for me" but I was entirely overwhelmed at the peak and almost blacked out and puked. Beyond more magical and amazing than any time I've taken MDMA and above and beyond even my first roll. I really attribute this to the effects of BPC resetting that serotonin system. From here on out, I'll never be dropping more than 100-110mg 3-4 times per year.]
November - December/Current - Other Therapies -- during this time I was constantly reading, manipulation, and trying to feel normal. Here are a few I've narrowed down to positive benefits over the past 6 weeks.
Ketamine - this has definitely been beneficial and have been administering approximately 100mg intranasally ~2x per week for about a month and will continue for probably 4-8 more weeks. Coupled with writing and meditation this can be very helpful. However, I have used the S and R-isomers as well as racemic and, in my experience, only the R-isomer or racemic mixture was helpful to me while the S isomer was not.
Psyilocibin Mushrooms - so far I have only used micro doses of about 0.3g with varying results - sometimes great and sometimes causing some more edginess/anxiety.
Estrogen - I have been a competitive NPC bodybuilder in the past so I have been using steroids for years after being diagnosed with some endocrine dysfunction late in high school (approx 2012). Now I use approximately 300-400mg of testosterone per week and that's typically it. However, I discovered that while I used to not do well with Dianabol and estrogen conversion, it helped with mood uplift and mental clarity that I attribute to the neurogenesis/neuroprotective properties of estrogen. I have used approximately 10-15mg QD.
Lions Mane - this has seemed to restore a small amount of drive, motivation, interest in life, and sex drive.
Holy Basil - this is one of the few adaptogens I have had a good response to and has seemed to help with cortisol levels, and my always problematic sleep. Its also improved the effects of melatonin and decreased marijuana tolerance which I try to keep low anyways.
Summary -- all of this in hindsight seems somewhat stupid and intuitive but during the past year I have been in such a hole at times and trying desperately to figure out what part of my brain or body was the problem. Many of us can probably relate with the unhealthy habits and cycles we can fall into over time without noticing the broad impact at first. The obsession with getting back to normal - especially since anyone with severe depression or anhedonia can likely relate - can also pigeon hole us into a mindset at times.
Now, looking back at the big picture which the LSD trip last night helped me with, I got this giant epiphany that I had been looking too micro and symptoms/progression over the past several years led to a down regulation of dopamine D2 receptors and dysfunction of the Dopamine Reward System due to too much sex, adderall, nicotine, marijuana - and all of this coupled with the autoimmune responses made it more difficult to discern what was causing what. I did recently find and have saved some medical literature to support this view of what has happened and that its an impact specifically and primarily at the D2 receptors.
NOW, to Full Recovery -- So all of this has led me to realize how much backtracking needs to be done and I am going to reshape my life for the next few months to facilitate restoration of the dopamine system and receptors. I am going to retail a rough outline of this below but ANY INPUT on compounds to help restore dopamine receptor sensitivity is always appreciated! Keep in mind this is a lot but I am slowly trying to reverse several years worth of beating on my dopamine system with some of the more natural methods available.
No Sex/Masturbating - the first week is going to consist of minimal or no sex or masturbating. Maybe once or twice for the girlfriend but no 3-5x a day fapping like usual.
Coffee - no more than 2 cups per day and green or matcha tea the rest of the time for approximately the next month.
EXERCISE - every day for at least 20 minutes (if cardio only) but intense cardio/weights for at least an hour a day is the goal. Lots of sweat and pushing myself to do something even if I want to or would rather lay in bed and do nothing.
Meditation - minimum 10 minutes every single day.
No Adderall or dopamine stimulants - going to start with 2 months but will likely go 3-4 at least. I have approx. 6 months until med school starts so plenty of time to take a break.
Psilocybin Mushrooms - very comfortable with psychedelics and feel they are very healing so I am going to start this life shift with one trip approximately a week from now on at least 3.5g with meditation, music, and mindfulness being the focus.
Ketamine - will continue with 100mg 2x per week.
BPC-157 - going to start with a 10 day course at 500mcg QD.
Inositol - high dose for a month to help restore D2 receptor density.
Dianabol - 15mg QD to help with estrogen mediated neuroprotection and plasticity.
Lion's Mane - will continue with 1-2 grams per day.
Fish Oil/Uridine/Choline - I already use a lot of fish oil but am going to be taking approximately 5g EPA/DHA a day on top of other omega-3 sources such as flax, olive oil, and chia seeds. Combined with uridine and CPD choline.
Agmatine - to help with dopamine modulation and some of the same NMDA antagonistic action as ketamine (taken on days not taking ketamine approx 5 days per week).
Supplements and Antioxidants - I will also be focusing on a VERY clean diet (already is from having the Ulcerative Colitis) with lots of fruits, fiber, micronutrients, fresh food, and other antioxidant supplements like pine bark and green tea along with NAC and glycine. ALCAR, alpha lipoic acid, and curcumin are also staples for me.
Also Considering -- Also considering using some emoxypine succinate (Mexidol), and huperzine. Others that I need to research more are
NSI-189/Bromantane are two others that I have but have not used before and need to research more. Going to try to stay away from the less researched drugs I think until I feel that I've recovered though as I want my brain to do this through more natural mechanisms as much as possible.
9-Me-BC seems very interesting but needs more research. Probably more of a later last resort in a few months if needed.
Ibogaine - finally this is one I don't think I will need at all but sort of a last resort fix-all and am going to go through the health screening with my doc in the next month in case I do want to use it. Microdosing is likely what I would opt for.
Obviously this is a little bit of a cocktail but I am mostly concerned with restoring things back to normal before medical school starts this summer so I think a lifestyle approach with exercise, nutrition, and meditation at the core with some things proven to help further restore dopamine function will be very beneficial.
Overall this has been a pretty interesting journey and have scoured thousands of pages of medical literature over the past few months. I will post a few relevant/interesting links at some point as well. This is not over and it will still be a long and sometimes painful road to recovery but the learning has been invaluable and I hope will one day make me a better, more understanding, and empathetic doctor. Hope this may help someone in the future!
