Severe PSSD Remission/Management with Ketogenic Diet and Low-Dose Lithium

[healing]

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

[Tree]

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

Everything you say makes sense and my experiences are almost identical. I crashed from ginger but every cognitive/emotional/sexual symptom got worse over night and has stayed that way. My pssd has been exteme the past few years. Nothing I've tried has worked and extremely sensitive to everything. Even magnesium or zinc rich foods make my symptoms worse. I hardly eat. My hunger sensation is non existent. I'm in a bad place. Chicken greek yogurt rice and beans is all I can tolerate eating. I microdose bcaas daily as it seems to help reduce the overstimulation feeling. Recently I've been microdosing gabapentin with some success. It seems to help with my tinnitus and insomnia a little. I've tried lithium orotate but it made symptoms worse after a couple of small doses. I've no idea what to do at this point.

[Determined-Mind]

Thank you for your feedbacks.

Has the lithium improved your sexual functioning? If so, how did you feel before/after?

Here, I've compiled 5 positive stories with lithium orodate: some people described worsening of their symptoms in the first few days and improvements later on : https://coda.io/d/Treatment-options-for ... SFe#_lufra

Several people have combined it with panax ginseng (from 300 mg to 1g). But, the people didn't seem to have neurological disorders like yours.

Here, stories about sexual functioning with prescription lithium : https://coda.io/d/Treatment-options-for ... PEX#_luQ9G

Your neurological symptoms remind me of those of people suffering from head trauma. In Norman Doidge's book on neuroplasticity, I remember him mentioning a tongue stimulation technique : PoNS stands for Portable Neuromodulation Stimulator device.

[Extremaduro]

Any diet cannot be a cure, but your drug regimen may be helping you.

[healing]

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

Everything you say makes sense and my experiences are almost identical. I crashed from ginger but every cognitive/emotional/sexual symptom got worse over night and has stayed that way. My pssd has been exteme the past few years. Nothing I've tried has worked and extremely sensitive to everything. Even magnesium or zinc rich foods make my symptoms worse. I hardly eat. My hunger sensation is non existent. I'm in a bad place. Chicken greek yogurt rice and beans is all I can tolerate eating. I microdose bcaas daily as it seems to help reduce the overstimulation feeling. Recently I've been microdosing gabapentin with some success. It seems to help with my tinnitus and insomnia a little. I've tried lithium orotate but it made symptoms worse after a couple of small doses. I've no idea what to do at this point.

I'm sorry to hear about that. Could the crash be from ginger acting as a 5-AR inhibitor? https://www.e-jkfn.org/journal/view.htm ... 9&vmd=Full . I also had a complete loss of appetite when I was at my worst, I have no clue what it's from but I'm sure it's somehow related to overall dopaminergic tone. What dose of bcaas do you take everyday and why do you think it helps the overstimulation? I remember looking into them a few years ago and i think I remember that they lower aromatic amino acid uptake across the BBB like tryptophan and phenylalanine, which theoretically would lower both serotonin and the catecholamines. If gabapentin helps then maybe altering your gaba/glutamate balance through a ketogenic diet would also help https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722878/ . You could try supplementing MCT oil to probe your response to ketones without fully committing to the diet. The diet also massively improves my sleep quality and I dream much more intensely

[healing]

Thank you for your feedbacks.

Has the lithium improved your sexual functioning? If so, how did you feel before/after?

Here, I've compiled 5 positive stories with lithium orodate: some people described worsening of their symptoms in the first few days and improvements later on : https://coda.io/d/Treatment-options-for ... SFe#_lufra

Several people have combined it with panax ginseng (from 300 mg to 1g). But, the people didn't seem to have neurological disorders like yours.

Here, stories about sexual functioning with prescription lithium : https://coda.io/d/Treatment-options-for ... PEX#_luQ9G

Your neurological symptoms remind me of those of people suffering from head trauma. In Norman Doidge's book on neuroplasticity, I remember him mentioning a tongue stimulation technique : PoNS stands for Portable Neuromodulation Stimulator device.

I don't think the lithium had a significant impact on my sexual functioning either way besides delayed ejaculation and better orgasms in the adaptation phase. For me it's mostly helped the non-sexual aspects of my PSS. For what it's worth I don't have ED and I get morning erections, I don't think my androgen receptor function is compromised. I sometimes feel like I've been hit in the head what's interesting is that the neurological problems get better and even reach full remission with phasic dopaminergics like d-amphetamine and caffeine. They are parkinsons-like and the eating problems vaguely resemble cholinergic crisis, they are also triggered by nicotine. I've tried high doses of Mucuna pruriens with little success so I think it's probably a function of low phasic dopamine and high acetylcholine

[healing]

Any diet cannot be a cure, but your drug regimen may be helping you.

I didn't mean to come off as saying I'm cured, maybe my wording was confusing. I would say I manage the condition with the lifestyle interventions and drug regimen. A cure and remission/management have similar outcomes. If I stopped following my regimen (which I have tried a few times) I relapse. It's kind of like how Terry Wahls reached remission with her RRMS with lifestyle interventions and now lives a mostly normal life.

[Extremaduro]

Good news. Keep it going.

[Semogomes]

Congrats. It gives me hope as I'm 3.5y in and severe as well.

I have some questions if you don't mind.

Did you have physical symptoms such as muscle loss/weakness/pain, fatigue, shrunken testes and penis, cold penis, flaccid glans, also any gastrointestinal ones?

What's the timeline of your interventions since the meantime crash?

why do you think low dose lithium works better than high dose?

[healing]

Congrats. It gives me hope as I'm 3.5y in and severe as well.

I have some questions if you don't mind.

Did you have physical symptoms such as muscle loss/weakness/pain, fatigue, shrunken testes and penis, cold penis, flaccid glans, also any gastrointestinal ones?

What's the timeline of your interventions since the meantime crash?

why do you think low dose lithium works better than high dose?

Hi there, I'm glad I could inspire some hope.

Of the symptoms you listed I had/have chronic fatigue, especially post-crash.

Spring 2020
-Memantine experimentation and crash

Summer-Fall 2020
-Intermittent fasting, low-carb and later keto

Summer 2021-Spring 2023
-Lithium and dose experimentation

When I was experimenting with lithium dosing I went through on and off phases of following the diet and intermittent fasting because lithium was very effective on its own and I was able to regain a social life. After a breakup in 2023 I decided to double down on the diet and intermittent fasting, and during that time I also started incorporated MCTs and lowered my lithium dose from 100mg to 50mg.

I think low doses of lithium is probably more effective than high doses because lithium generally has a blunting effect on dopamine release. From what I've read, lithium exerts its effects on neuronal excitability/dopamine release by inhibiting glycogen synthase kinase 3 (GSK3) ( https://www.pnas.org/doi/10.1073/pnas.0307921101 ). In my case, I think finding the right dose was a matter of inhibiting GSK3 enough to lower neuronal excitability without crushing it entirely. I noticed that there was a very real difference between 100mg and 50mg. Of course there are other possible explanations as well, it's possible that its effects on neuroinflammation/neuroprotection and gene regulation via HDAC inhibition is non-linear and effective at very low doses. To support this point, naturally occurring trace amounts of lithium in drinking water has been correlated with a reduction in suicide ( https://pubmed.ncbi.nlm.nih.gov/32056756/ ).