Akathisia III - (my) Practical Application

[brightside]

********NOTE********​

FOR THE SAKE OF READABILITY, DOWNLOAD THE ATTACHED PDF.​

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This is post 3 of 3. Post 1 is Akathisia I - My Story, and Post 2 is Akathisia II - Deep Dive​

Akathisia III - (my) Practical Application​

This post only focuses on my personal experiences. However, the most practical application of information from my post that I could offer would not be from my post at all. Instead, I really recommend writing things down. Tracking symptoms, supplements, and ideas is probably the most important thing you could be doing for your akathisia aside from actual treatments.

I do not recommend anything in this post. I state things that work for me, and things that have a potential to help according to their specific mechanisms.

Guidelines that I follow​

Drugs are SECONDARY to nutrition. While there exist some “safe” dopaminergic that seem to have only benefits (for example Bromantane), it is never a good idea to take a dopaminergic drugs before nutrition is addressed. Upregulating TH (in the case of bromantane) should be accompanied by some sort of beneficial effect that reduces oxidative stress or resolves cell dysfunction (which bromantane might do, I just don’t know enough about it to say it is a good idea) as is the case with aspirin.

Other drugs including bromocriptine and cabergoline have been shown to reduce oxidative stress exactly through their dopamine agonist properties (through D2) and upregulate GSH. But even in these cases, there can be side effects and receptor downregulation is almost always an issue.

In general, the benefits of dopaminergic are outweighed by the negatives. This is especially true considering the nature of akathisia and the associated metabolic dysfunction. Dopaminergic push the system that is already exhausted. Why push your body before giving it the basic nutrients?

Just because you ate nutrient dense food or took a supplement does NOT mean you are “nutritionally replete.” I occasionally see people quickly writing off various vitamins or minerals when trying to narrow down the list of things that are possibly missing. Taking a single dose of 200mg of Thiamine does not constitute “High Dose Thiamine Therapy,” and a bad reaction does not imply that this therapy should be avoided. This applies mostly to thiamine and the HDTT, however it can be true in other situations and substances as well.

I have had many experiences when I required abnormally large amounts of various nutrients in order to escape the state, I was in. When considering age, weight, general health, lifestyle, stress, and other factors, nutrient requirements differ wildly. That is obvious, but people often forget to adjust their intake when life circumstances change. Especially in cases of SIBO, I believe higher doses are necessary to push through and achieve some absorption.

As an example, I required up to 3 grams of potassium on many occasions to finally escape the deficient state that I was in. I kept drinking OJ and it wasn’t until I drank my 6th cup that a massive cloud was lifted, and I was able to function normally. This situation specifically was from B1 deficiency/lactic acidosis, combined with SIBO irritation that causes potassium loss.

Nothing is deterministic. Mainstream medicine is slowly starting to realize this, but they are not there yet. Genetics are not deterministic, at least for the majority of people and the majority of cases. Everyone has a some kind of genetic mutation, MTHFR for example, but good health is not unattainable. Even if you are predisposed to some condition, or epigenetics are working against you, it does not mean that you will live a miserable life and that there is no way out. There is, and you just have to find it.

Experiment, experiment, and after that, experiment. Experimenting is really the only way to find out what works and what does not. That is an obvious statement, but I think people really fail to experiment effectively. They might stick to a particular therapy for too long, or switch things up too quickly. Adding too many variables at once is a great way to learn nothing. I am often tempted to throw everything but the kitchen sink at my current state, whatever it may be, but in the end, I learn nothing. A better version of this guideline is written at the top of this forum, “Perceive, think, act.”

Specific Substances​

• Folate. Folic acid is a poor supplement to increase folate. Methylfolate is a popular supplement, and generally works well, however, it is also associated with occasional negative reactions in some people. Because of this reason, Folinic acid is probably the best folate supplement. Not only will it not trigger negative reactions, but it also doesn’t require a transporter to be escorted into the brain.
• Thiamine/B1. Thiamine HCL, Benfotiamine, Sulbutamine, fursultiamine(TTFD), and allithiamine are all forms of b1. Some are more effective than others, but in general, they can all be used for HDTT. Despite what people say, sometimes, a certain form can simply not work. In my case, both thiamine HCL, and Benfotiamine were ineffective, while TTFD was and still is a daily staple for me. Thiamine HCL is “safer” and less extreme on your body, however, it can also mean it is not as effective.
• Potassium – While not directly effective on my akathisia, potassium was and still is a fundamental nutrient in my diet. I heavily rely on it to feel well and recommend ensuring adequate intake as per the RDV.
• Iron. Most iron supplements are highly toxic. I would not recommend them, unless in extreme circumstances. The supplement I take, and the one I think is the highest iron quality you can take is “heme polypeptide”. Essentially, it’s iron that is bound to protein in a very similar way to regular heme that is found in meat. I have found iron supplements that are from beef spleens, but I have yet to try or research them. I used to take iron gluconate, which hurt my stomach, and made me feel ill. The current iron I take gives me no symptoms besides colored stool.
• Lactoferrin. Lactoferrin is an excellent supplement to use with or without iron. Lactoferrin is a protein found in all body fluids of the human body and is part of the innate immune system. Anything that contacts the human body will potentially run into lactoferrin. Lactoferrin grabs free iron and prevents bacteria from using it. This mechanism reduces the growth of bacteria and has also been shown to reduce the growth of fungi such as candida and viruses. Individuals supplementing lactoferrin have seen increases in hemoglobin, decreases of stored iron, all while not increasing dietary iron. This shows then, that lactoferrin works directly to increase usable iron, fighting the “anemia of chronic disease” that I mentioned in the previous post.
  
  When researching akathisia and its connection to the gut, I decided to run an experiment. At that point I had taken amoxicillin several times to reduce SIBO symptoms, but unfortunately it wasn’t very effective at reducing the akathisia. This time around, however, I used a combination of amoxicillin and lactoferrin. To my surprise, my akathisia symptoms were reduced up to 90%! While this surprised me at first, I now know that iron chelation increases the effectiveness of antibiotics. Lactoferrin might be a safe option to do this. IP6 might be interesting too, however, unlike lactoferrin, IP6 would be harmful to iron deficient individuals.
• Vitamin A is probably the next most potent tool in my stack. When I feel I am deficient, it provides a consistent dopaminergic boost in energy. It also reduces my lactic acidosis, working to improve sugar metabolism. I don’t supplement often, but once I feel the need, I use 50,000 IU for a week or two to prevent toxicity.
• Selenium – Besides my diet, I eat an additional 6-10 brazil nuts per day. Some sources state that a single brazil nut contains up to 90 mcg of selenium. If that would be the case I would be having major selenium toxcicity symptoms, however the opposite is actually the case. If I don’t eat brazil nuts twice a day I will feel miserable within 18 hours of my last consumption. I am probably an edge case in this regard; however, it could be the result of my TTFD mega dosing.
• MSM – I started taking MSM recently, and after a long time of eating large amounts of Brazil nuts, I find that I often forget to eat them. I think the sulfur might be buffering GSH production, but I do not know for sure. Either way, MSM is now a part of my stack. I left the older info about selenium because I feel it still might be relevant, however I do not eat that much Brazil nuts anymore.
• BComplex. All of the B vitamins are very fundamental to my health. I alternate a B complex, and a high dose of B2,B3,B6, and B9. The dosages are 400mg of riboflavin, 500mg of niacinamide, 25mg of p5p, and 1-3mg of methylfolate. A b complex is usually not enough to buffer the high dose thiamine, so I resort to high dose of these vitamins.
• Copper. Copper seems to be a potent metabolic booster in dosages at and above 4-6 mg. While it does not directly improve akathisia, it a cornerstone of my stack and reduces my lactic acidosis, and provides the mental energy I need.
• Zinc – I use zinc semi-frequently as its quite helpful to my digestion and mind. I have not noticed any direct effects on akathisia, however it remains a very useful tool nonetheless.
• ABX – I really like using Amoxicillin, although now I have built a slight tolerance to it. I reserve it for very extreme occasions. Recently, I tried Azithromycin with mediocre results. I have also experimented with Doxycycline and penicillin; however, I find that amoxicillin is the most effect at removing my akathisia swiftly. This effect does not work unless I take my normal stack and it is only an occasional helper in times of great distress.
• Cyproheptadine – While on paper, cyproheptadine seems like a great treatment option for akathisia, in practice it provided mild relief at best. When I used it frequently, I noticed the drowsiness, the relief in digestive discomfort, and the profound ability to shake away my learned helplessness.
• Hormones – Often hit and miss, various hormones have been only somewhat helpful. Progesterone was quite pleasant at first, but now I can take 30 mg and feel no different. Pregnenolone has the longest and best track record with me, and it served me well for many months. It reduced my lactic acidosis, brain fog, and subsequently akathisia. 11KDHT and Androsterone have also been interesting to experiment with, however they both are also somewhat hit or miss and do not help the akathisia directly.
• Other – There are probably plenty of things I am forgetting, but for now this is the end of this list. I will update this thread if I will have anything noteworthy. Some honorable mentions: Pyrucet, which worked fantastically a handful of times, and thyroid/bile, which also worked very infrequently.

My current stack looks like this:​

After Waking Up/Breakfast:

• TTFD 200mg
• B complex Thorne Stress B
• OJ 1 cup
• Coffee 1 cup

Afternoon/Lunch:

• Copper/Zinc 4mg/30mg, every day, alternated
• OJ 2 cups
• Coffee 1 cup
• Vitamin A/D 50K IU/30K IU, when dosing for a short period (with bile)
• Iron 10mg with copper 1-2 times per week

Night/Dinner:

• TTFD 200mg
• OJ 2 cups
• Selenium 200mcg 2-3 times per week
• MSM 3 g 2-3 times per week
• Calcium 400 mg
• Methyl B9/B12 lozenge 400mcg/5mg, 2-3 times per week

With this exact stack I am able to feel quite decent. I have been changing it for the better part of 3 years, and it has remained more or less the same. Every part is critical, even the coffee.

Additionally, eating a decent amount of protein also makes me feel quite well, however due to my digestive issues, I am only able to tolerate so much. The more I can digest, the better I feel.

There are plenty more substances to investigate; however, I decided to keep this post short. That’s partially because I don’t want to give recommendations, and partially because doing deep research on each potential substance would take too much time.

However, I made a small chart of my opinions on various substances that I bumped into. This list is not exhaustive, both, of the possible substances and their individual effects and side effects. I DO NOT RECOMMEND FOLLOWING IT. Even “safe” substances can cause reactions, the reactions which must be kept to a minimum especially in vulnerable states like akathisia.

 

[Runenight201]

Does this protocol allow you to eat anything, or are you mindful about what you consume? Do you believe that your diet affected your Akathisia at all?

 

[brightside]

Does this protocol allow you to eat anything, or are you mindful about what you consume? Do you believe that your diet affected your Akathisia at all?

Not completely. I eat easier to digest food, and keep vegetables to a minimum. I do eat some gluten, and the high dose B1 does allowed me to eat it with no issue.

However, I am mindful about not eating too much, and usually eat to like 60% fill and then drink coffee to kill the rest of my appetite. If I eat too much fat, or too much protein, or too much food in general it will be difficult to digest, which will result in slow digestion, and then inflammation, and then akathisia. But there isn't a particular food that can set me off, so I think that B1 does help me to digest everything equally.. bad lol.

The point is, this protocol keeps me from wanting to KMS and keeps my akathisia to a minimum, but it doesn't cure me of everything. Even though it seems like the high dose b1 really should according to my symptoms..

My diet consist of mostly, eggs, milk and other dairy products, OJ, a serving of meat, bread, rice, coffee + sugar, and just random stuff. These foods I digest the best, and these foods are the "cleanest" and most nutrient dense food that I can reasonably manage to eat.

 

[Runenight201]

Not completely. I eat easier to digest food, and keep vegetables to a minimum. I do eat some gluten, and the high dose B1 does allowed me to eat it with no issue.

However, I am mindful about not eating too much, and usually eat to like 60% fill and then drink coffee to kill the rest of my appetite. If I eat too much fat, or too much protein, or too much food in general it will be difficult to digest, which will result in slow digestion, and then inflammation, and then akathisia. But there isn't a particular food that can set me off, so I think that B1 does help me to digest everything equally.. bad lol.

The point is, this protocol keeps me from wanting to KMS and keeps my akathisia to a minimum, but it doesn't cure me of everything. Even though it seems like the high dose b1 really should according to my symptoms..

My diet consist of mostly, eggs, milk and other dairy products, OJ, a serving of meat, bread, rice, coffee + sugar, and just random stuff. These foods I digest the best, and these foods are the "cleanest" and most nutrient dense food that I can reasonably manage to eat.

I just started supplemented with B1 (thiamine HCL 300mg) and aspirin combined and I definitely notice an improved mood and sense of well-being after doing so. Anything to watch out for with that combo? I was thinking of adding Niacinamide 500mg daily as well to that stack.

I also may try that lactoferrin you mentioned. I got bloodwork done and while my RBCs aren’t critically low, they are on the lower side for optimal functioning, so in theory that lactoferrin should raise it and make me feel better.

Kinda unfortunate you can’t eat to full satiety, but I understand that preventing Akathisia and resulting suicidal ideations is definitely worth never hitting that full satiety. Do you think it would be a productive angle to address that? There was another user here a while ago, I believe her name was kelji or something like that who advocated that it was caloric surpluses that fixed all metabolic issues and corresponding disease states. I definitely feel best when I can get sufficient calories, but it seems like it’s a battle between eating excess calories for robust energy vs having those calories pathologically break the body down because they aren’t being digested!

 

[brightside]

I just started supplemented with B1 (thiamine HCL 300mg) and aspirin combined and I definitely notice an improved mood and sense of well-being after doing so. Anything to watch out for with that combo? I was thinking of adding Niacinamide 500mg daily as well to that stack.

I also may try that lactoferrin you mentioned. I got bloodwork done and while my RBCs aren’t critically low, they are on the lower side for optimal functioning, so in theory that lactoferrin should raise it and make me feel better.

Kinda unfortunate you can’t eat to full satiety, but I understand that preventing Akathisia and resulting suicidal ideations is definitely worth never hitting that full satiety. Do you think it would be a productive angle to address that? There was another user here a while ago, I believe her name was kelji or something like that who advocated that it was caloric surpluses that fixed all metabolic issues and corresponding disease states. I definitely feel best when I can get sufficient calories, but it seems like it’s a battle between eating excess calories for robust energy vs having those calories pathologically break the body down because they aren’t being digested!

Yeah, I tried that when I originally started "peating" and gained 70 pounds Lol. To be fair, 50 of those are from high cortisol, as I have some cushing's syndrome symptoms.

I basically under-ate my entire life, and could never gain weight even with a large caloric surplus. I realize now that, that food wasn't being digested and that I was hypo. Anyways, once I started "peating" I tried gaining weight again, and used Cypro, and various peaty foods. I slowly gained around 15-20 pounds, going from 150 to 165-170. I am 6' so that is not that bad. However, after a few months my weight started climbing, but my caloric intake remained the same, and rather low, around 2000-2500. That is not a lot of calories, especially for my age and activity levels.

I see it like this, whatever the metabolic dysfunction that I had before, never resolved, which caused my original health problems, my permanent over-reaction to metronidazole, and my current hormonal problems. Whatever it is, I know its down at the mitochondria, but having tried all possible(that I know of) co-factors and treatments, I don't know what else to explore. It's about energy, always was, and always will be.

No, you should not have any issues with that dose. Once you start hitting 1500mg or so, you should really take a look at all of the necessary co-factors, or just message me. You can also try TTFD, but that is substantially harder to "maintain", at least in my experience.

That's a good idea, but only if you have the money for all that. Lactoferrin isn't prohibitively expensive, but it does add up.

I definitely feel best when I can get sufficient calories, but it seems like it’s a battle between eating excess calories for robust energy vs having those calories pathologically break the body down because they aren’t being digested!

Yep! You definitely hit the nail on the head. This also applies to a bunch of random therapies I see around here. Let's take cypro, for example. On the one hand, stopping the inflammation and stress reactions is very good for gut function, but on the other, not letting serotonin flush out the contents of the gut will just promote bacterial growth. Of course, if you have decent bio-energetics, then suppressing the stress response is all that you need, but it doesn't seem to be the answer in all cases. (except for "natural" ways of supressing inflammation such as hormones, vitamins, and carrots)

 

[David PS]

I had not remembered hearing of akathisia. Peat mentioned it and it appears here.

Ray Peat The Comedian

Opening up the thread posted on Peatarian many years ago, showcasing the more light hearted and comedy quotes of Ray Peat. Feel free to post any others you've found. Ray Peat The Comedian - Ray Peat Q&A ". . . Rather than showing that salt causes stomach cancer, the experiments showed that a...

raypeatforum.com

Please read the quote in the spirit that it was intended.

Incidently, I have a strong reaction to nightshades. Even mustard that contains 'natural spices' will cause a reaction reaction. Total elimination of all nightshades is my only remedy.

 

[brightside]

I had not remembered hearing of akathisia. Peat mentioned it and it appears here.

Ray Peat The Comedian

Opening up the thread posted on Peatarian many years ago, showcasing the more light hearted and comedy quotes of Ray Peat. Feel free to post any others you've found. Ray Peat The Comedian - Ray Peat Q&A ". . . Rather than showing that salt causes stomach cancer, the experiments showed that a...

raypeatforum.com

Please read the quote in the spirit that it was intended.

Incidently, I have a strong reaction to nightshades. Even mustard that contains 'natural spices' will cause a reaction reaction. Total elimination of all nightshades is my only remedy.

I have ran into that quote a few times in the past but never noticed his little joke haha.

I do agree, and I did go over serotonin quickly in my post, but honestly both cypro and 10-met-harmalan have both been quite useless in relieving akathisia. It’s definitely an avenue that I still want to explore though, along with estrogen’s role, and other signaling molecules.

As far as nightshades, what kind of symptoms do you experience? In the past I have made sure to stay gluten, and vegetable free, eating only meat, milk, and eggs, but the results were underwhelming. I do eat a lot of tomatoes during the summer, and occasional potatoes throught the year, and haven’t noticed a difference between the two seasons. How long till I would notice a difference from not eating any nightshades?

I remember reading a reddit post, where a guy cured his chronic hyperhidrosis by quitting nightshades. Its a very interesting topic

 

[David PS]

I have ran into that quote a few times in the past but never noticed his little joke haha.

I do agree, and I did go over serotonin quickly in my post, but honestly both cypro and 10-met-harmalan have both been quite useless in relieving akathisia. It’s definitely an avenue that I still want to explore though, along with estrogen’s role, and other signaling molecules.

Ray's jokes are dry and not always easy to notice. His writings and this forum are a treasure trove of information on serotonin, estrogen and SSRIs. The general rule is that you have to dig for his gems. Oftentimes, others will mine his gems and post them. There is memorable line about commerical bananas in this deep link.

Ray Peat Humor

This made me laugh out loud. Not sure if it is a dog owner thing though. "Some dogs alertly look at the thing a person is pointing at, other dogs just sniff the pointing finger. " Ray Peat

raypeatforum.com

As far as nightshades, what kind of symptoms do you experience? In the past I have made sure to stay gluten, and vegetable free, eating only meat, milk, and eggs, but the results were underwhelming. I do eat a lot of tomatoes during the summer, and occasional potatoes throught the year, and haven’t noticed a difference between the two seasons. How long till I would notice a difference from not eating any nightshades?

More then a decade ago, I had trouble sleeping through the night. After a few hours of sleeping peacefully my hands would begin to ache and they would wake me from my sleep. As the months rolled by, the amount of time that I could sleep continuously gradually decreased until I was waking up 3 or more times during the night. I noticed the benefit of avoiding nightshade after about month. I was not until another 3 months after I started interpreting 'natural spices' in the ingredient list on food labels as truly meaning 'probably contains nightshades' that my issues fully resolved.

 

[JCastro]

I have experience with intense akathisia that I was able to get under control with careful pharmacological and dietary intervention, but was very close to the brink for a while, as you allude to being common. I don't have time at the moment to deeply assess your project but based on a cursory read of the 3 threads I commend you for your work. This is life-saving material and only a small number of people will ever be in the position to create such a guide. Inspiring and impressive.

PS: For now I will only add that I agree with your hypothesis on the pathophysiology/perfect storm of akathisia emergence.

 

[brightside]

I have experience with intense akathisia that I was able to get under control with careful pharmacological and dietary intervention, but was very close to the brink for a while, as you allude to being common. I don't have time at the moment to deeply assess your project but based on a cursory read of the 3 threads I commend you for your work. This is life-saving material and only a small number of people will ever be in the position to create such a guide. Inspiring and impressive.

PS: For now I will only add that I agree with your hypothesis on the pathophysiology/perfect storm of akathisia emergence.

Good for you! I am glad you managed to figure it out.

What do your interventions consist of?
And how did it start for you?

Thank you, I appreciate it. I am in a quite lucky position, being able to control my symptoms enough to write, and learning of Ray Peat and his ideas, and having just enough neuroticism to rewrite it 5 times haha.

 

[gunther]

@brightside

Brightside, thank you for your post and research.

After reading it I realized that I recently went through much the same thing as you described with akathisia after quitting Effexor. I can't imagine anything that could be worse. Days, weeks and months of feeling pure terror. Everything was frightening and it was like the universe was collapsing and going to leave me in a state of eternal suffering. The only descriptors that even come close are terror, fear, horror, worry and anxiety.

I was able to pull out of it when I discovered that Benadryl calmed me down. It was like a miracle that stopped my mind from spinning, allowed me to relax and most of all allowed me to think. At the same time I had been slowly increasing my Effexor dose until I was able to function.

From there I started down the familiar path of elimination diets, supplements, vitamins, minerals and eventually stumbling onto Ray Reat. I still struggle from time to time, but am doing much better than I was. Currently, my regimen looks close to yours, mostly discovered by slow trial and error. I work to avoid serotonin and boost dopamine. Looking forward to your posts.

 

[brightside]

After reading it I realized that I recently went through much the same thing as you described with akathisia after quitting Effexor. I can't imagine anything that could be worse. Days, weeks and months of feeling pure terror. Everything was frightening and it was like the universe was collapsing and going to leave me in a state of eternal suffering. The only descriptors that even come close are terror, fear, horror, worry and anxiety.

I was able to pull out of it when I discovered that Benadryl calmed me down. It was like a miracle that stopped my mind from spinning, allowed me to relax and most of all allowed me to think. At the same time I had been slowly increasing my Effexor dose until I was able to function.

From there I started down the familiar path of elimination diets, supplements, vitamins, minerals and eventually stumbling onto Ray Reat. I still struggle from time to time, but am doing much better than I was. Currently, my regimen looks close to yours, mostly discovered by slow trial and error. I work to avoid serotonin and boost dopamine. Looking forward to your posts.

Sorry about your experience, man, it really is the worst possible discomfort. Its great that you managed to find a solution and wean off eventually.

You do have an interesting presentation. You mention terror more than the fidgeting, and you were on an SNRI, which I would say is pretty uncommon. I wonder about the mechanisms.

Im glad that my posts helped you put a name to what you were experiencing, my effort was worth it.

What would you say is the top 3 beneficial substances?

 

[gunther]

Sorry about your experience, man, it really is the worst possible discomfort. Its great that you managed to find a solution and wean off eventually.

You do have an interesting presentation. You mention terror more than the fidgeting, and you were on an SNRI, which I would say is pretty uncommon. I wonder about the mechanisms.

Im glad that my posts helped you put a name to what you were experiencing, my effort was worth it.

What would you say is the top 3 beneficial substances?

Thanks. It was a flippin horror show. I'm still hooked on Effexor, 2.4mg. That may seem a tiny amount, but if I miss it, I'll get anxiety attacks. I was on .6mg for a year and my plan was to hold there and work on my mood. Once I got better I was going to quit, but I kept getting worse over that year, so I increased the dose. Right now I take four tinee tiny little beads.

At the height of the symptoms, I fidgeted a lot. I couldn't even sit down to eat as I had to keep pacing. During this time I went on long walks to burn energy. But by far the worst symptom for me was terror, fear. The only guess I have for mech of action is the 5HT2A receptor. AND IM GUESSING. I remember reading that SSRIs are 5HT2A antagonists, which would blunt SE tone, which would cause SE to become abundant as it is upregulated. During withdrawal the 5HT2A is back open for business, causing SE to flood the system. This would also cause DA tone to plummet. I've read a ton of stuff about this, understood some of it, but remember even less. I'm pretty sure that diphenhydramine is also a quick acting 5HT2A antagonist. So, boom. That sort of explained things for me. However, I've since read and learned more and my take away is that things are most likely way more complicated than I've been able to understand.

Over the few years I noticed that things that in general seem to boost DA were making me feel better, such as tyrosine, phenylalanine, coffee, chocolate, salt. I think our own bodies tell us important information by what we enjoy or crave. Usually it tells us in a very quiet voice, so it's hard to listen.

The most beneficial things that helped alleviate my symptoms are:
1. Effexor. I know this is the exact thing I'm trying to quit, but if I know I can rescue a severe downward spiral with a little bit of Effexor, it goes a long way helping just knowing its there.
2. Benadryl - This is a gift from god. Truly I depend on it weekly. I still can spiral out of control with anxiety and 25mg of it will stop it in its tracks.
3. Tyrosine - (DLPA and Mucuna Pruriens) These are kinda hit and miss. Sometimes I get a huge boost from them, sometimes they do nothing. It doesn't seem to be a tolerance type of thing, as the response seems random.
4. Gluten - I quit gluten and my harsh doom and depression went away. If they come back I can pin point it to something I ate with gluten in it. EVERY SINGLE TIME.
5. Other - Bs, C, E, D, etc. Honestly, I have no idea how well any of this stuff works. I THINK that I get more energy if I take my Activated Bs, but it's so hard to say.

In SSRI withdrawal circles, they talk about windows and waves, which are the seemingly random nature of the appearance of withdrawal symptoms. I'll get two or three days of great energy, positive outlook and happiness followed by a complete day of anxiety and worry. It all seems so random, which maybe it is and maybe it isn't. Point being is that it makes it hard to track and evaluate anything that isn't a short acting substance.

 

[redsun]

I remember reading a reddit post, where a guy cured his chronic hyperhidrosis by quitting nightshades. Its a very interesting topic

The build up of solanine from excessive consumption of nightshades would increase stimulation of adrenergic and cholinergic fibers that innervate sweat glands. Increased nicotinic receptor activation would also promote release of catecholamines which further stimulates sweat glands.

 

[brightside]

@gunther

Thanks. It was a flippin horror show. I'm still hooked on Effexor, 2.4mg. That may seem a tiny amount, but if I miss it, I'll get anxiety attacks. I was on .6mg for a year and my plan was to hold there and work on my mood. Once I got better I was going to quit, but I kept getting worse over that year, so I increased the dose. Right now I take four tinee tiny little beads.

That must be quite annoying to do, since if you miss taking those tiny little beads, your world basically ends for the time-being.

---

At the height of the symptoms, I fidgeted a lot. I couldn't even sit down to eat as I had to keep pacing. During this time I went on long walks to burn energy. But by far the worst symptom for me was terror, fear. The only guess I have for mech of action is the 5HT2A receptor. AND IM GUESSING. I remember reading that SSRIs are 5HT2A antagonists, which would blunt SE tone, which would cause SE to become abundant as it is upregulated. During withdrawal the 5HT2A is back open for business, causing SE to flood the system. This would also cause DA tone to plummet. I've read a ton of stuff about this, understood some of it, but remember even less. I'm pretty sure that diphenhydramine is also a quick acting 5HT2A antagonist. So, boom. That sort of explained things for me. However, I've since read and learned more and my take away is that things are most likely way more complicated than I've been able to understand.

Have you read on my second post the "Proposed Theory" section? Essentially the idea is that the LC, a adrenergic cluster of neurons, is overactive during akathisia, partially responsible for the terror feeling.

While the 5HT2A connection definitely makes sense, from what I have seen it would not be able to cause such severe symptoms. The atypical anti-psychotics are 5HT2A antagonists, and increase dopamine function by only a little bit. Of course the inverse could be different, excess SE would lower DA much more than antagonism would raise it, that's fully plausible. But either way, I have a feeling the LC and some kind of response by noradrenaline is also a big player.

It's interesting, since for me fear only appeared with intense akathisia, and the most distressing symptoms were the physical sensation along with the emotional distress. I presume the difference being in dopamine and noradrenaline differences in whatever brain areas, since I know that D2 is vital for emotional regulation, and fear is a response to noradrenaline.

Also, the 5HT2Ar are kind of weird, in that with antagonism, they downregulate. Wikipedia puts it this way: "Nevertheless, upregulation is the exception rather than the rule." Since effexor is an antagonist you can expect decreased SE activity at the 5HT2A, assuming the withdrawal period is over, which I suppose is where you are stuck. But it is partially good news, as you can (hopefully?) expect downregulated 5HT2A, which is known to be upregulated in depression.

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The most beneficial things that helped alleviate my symptoms are:
1. Effexor. I know this is the exact thing I'm trying to quit, but if I know I can rescue a severe downward spiral with a little bit of Effexor, it goes a long way helping just knowing its there.
2. Benadryl - This is a gift from god. Truly I depend on it weekly. I still can spiral out of control with anxiety and 25mg of it will stop it in its tracks.
3. Tyrosine - (DLPA and Mucuna Pruriens) These are kinda hit and miss. Sometimes I get a huge boost from them, sometimes they do nothing. It doesn't seem to be a tolerance type of thing, as the response seems random.
4. Gluten - I quit gluten and my harsh doom and depression went away. If they come back I can pin point it to something I ate with gluten in it. EVERY SINGLE TIME.
5. Other - Bs, C, E, D, etc. Honestly, I have no idea how well any of this stuff works. I THINK that I get more energy if I take my Activated Bs, but it's so hard to say.

Good list, thank you for writing it out. I am sure other readers will find it very helpful.

Have you tried Cypro? Cypro is also a 5ht2a antagonist, but for whatever reason that I don't care enough to investigate, Cypro is used much more often than Benadryl. Although, it IS a D2 blocker at higher doses. Now that I write this, I remember distinct relief by Benadryl aswell, but it was from general mental symptoms and not akathisia at the time. Cypro never did that for me, rather it uncoupled my learned helplessness reactions from me, more longterm.

I have the same response to dopaminergics. Always random and inconsistent. I think that it is SE and inflammation originating from my gut. Have you been able to track gut function and also bile release with episodes and effectiveness of dopaminergics?

High dose B1 might be helpful in quitting. If you look through @mostlylurking 's profile, she often brings up B1's ability to prevent excess SE. (In addition to its massive effects on cellular energy production)

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Over the few years I noticed that things that in general seem to boost DA were making me feel better, such as tyrosine, phenylalanine, coffee, chocolate, salt. I think our own bodies tell us important information by what we enjoy or crave. Usually it tells us in a very quiet voice, so it's hard to listen.

Agreed.

 

[brightside]

The build up of solanine from excessive consumption of nightshades would increase stimulation of adrenergic and cholinergic fibers that innervate sweat glands. Increased nicotinic receptor activation would also promote release of catecholamines which further stimulates sweat glands.

Thanks for the clarification. AChE inhibitors are popular and present in many herbs too, which is why I don't like using them.

 

[brightside]

Ray Peat Humor

This made me laugh out loud. Not sure if it is a dog owner thing though. "Some dogs alertly look at the thing a person is pointing at, other dogs just sniff the pointing finger. " Ray Peat

raypeatforum.com

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More then a decade ago, I had trouble sleeping through the night. After a few hours of sleeping peacefully my hands would begin to ache and they would wake me from my sleep. As the months rolled by, the amount of time that I could sleep continuously gradually decreased until I was waking up 3 or more times during the night. I noticed the benefit of avoiding nightshade after about month. I was not until another 3 months after I started interpreting 'natural spices' in the ingredient list on food labels as truly meaning 'probably contains nightshades' that my issues fully resolved.

Interesting.. My experiments have clearly not been long enough. I will keep this in mind the next time I do such an experiment.

 

[gunther]

Have you read on my second post the "Proposed Theory" section? Essentially the idea is that the LC, a adrenergic cluster of neurons, is overactive during akathisia, partially responsible for the terror feeling.

I've read through your three part series and I'm on the third pass. I was planning on reaching out to you with questions as soon as I feel I fully understand your posts.

Have you tried Cypro? Cypro is also a 5ht2a antagonist, but for whatever reason that I don't care enough to investigate, Cypro is used much more often than Benadryl. Although, it IS a D2 blocker at higher doses. Now that I write this, I remember distinct relief by Benadryl aswell, but it was from general mental symptoms and not akathisia at the time. Cypro never did that for me, rather it uncoupled my learned helplessness reactions from me, more longterm.

Yes. I failed to mention it. I'm still tinkering with it and don't have a good handle on it yet. I think it kinda dopes me out but does provide relief.

I have the same response to dopaminergics. Always random and inconsistent. I think that it is SE and inflammation originating from my gut. Have you been able to track gut function and also bile release with episodes and effectiveness of dopaminergics?

How would I track that? Like, stool appearance? I've noticed that shortly after I start feeling good, my stool end up looking like a pinup model. I have no idea how to track bile release, or what that would entail.

I've gone through many gut dysbiosis type diets complete with anti-microbials like oregano oil, garlic and such.

 

[brightside]

I've read through your three part series and I'm on the third pass. I was planning on reaching out to you with questions as soon as I feel I fully understand your posts.

Oh, okay. Don't try to infer something what I didn't write, though. It was hard to effectively mash these two ideas together, but most of my post talks about the causes of "low dopamine" as opposed to the actual mechanisms of akathisia. Like I mentioned, they do overlap, and quite a bit at that, but because of that disconnect the post is still not fully completed. I am attempting to figure out the connections, but its quite tough, given that there is little information on akathisia in general and I have to dive straight into neurochemistry. I will update this thread with findings or theories, but for now, its incomplete and the majority of the post isn't necessarily 100% applicable to akathisia.

Regardless, I tried to find causes of actual "low dopamine" and they seem to be made up of pathways that I think are applicable to pretty much any health condition. You could replace the word "Akathisia" with "low motivation" or "fatigue". I suppose its just rebranded Ray Peat advice haha. But I figure that the topics I dove into are broad enough that they can and will have an impact on akathisia, I don't doubt that. Exposure to LPS is highly destructive, regardless if you are focusing on brain tissue or the cardiovascular system. There are just a few pathways that remain hidden to me that result specifically in akathisia, and I'm definitely looking at serotonin for that, although I was really curious about a larger list of causes such as calcium homeostasis, estrogen and hormonal impacts, blood flow of tissues, and the general communication between different involved brain regions (VTA, LC, NAcS/NAcc, Basolateral Amygdala, etc).

I hope my point was clear, "low dopamine" does not necessarily = "akathisia", and there is more at play than I mentioned.

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Yes. I failed to mention it. I'm still tinkering with it and don't have a good handle on it yet. I think it kinda dopes me out but does provide relief.

Gotcha, well, let me know if you figure out something!

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How would I track that? Like, stool appearance? I've noticed that shortly after I start feeling good, my stool end up looking like a pinup model. I have no idea how to track bile release, or what that would entail.

I've gone through many gut dysbiosis type diets complete with anti-microbials like oregano oil, garlic and such

Yes, although I suppose if you have healthy bile release then there is nothing to track. I'm not sure what a pinup model is..
Inadequate bile release results in pale, fatty stool. I have chronic issues with that, and am unable to "achieve" the correct color. Nothing seems help it besides additional bile, which then largely resolves my dysbiosis. I don't know how other people's digestive systems work, but I have read the same on here. For example.

I probably haven't tried as much, but I did try a decent amount and nothing works as well as Ox Bile or Amoxicillin. However, I realized that until fundamental problems like energy production and proper secretion of digestive juices is addressed, I won't benefit from largely insignificant changes in diet. (What difference does milk vs meat make when you don't digest either? haha). What I do know, is that avoiding irritating foods is key, meaning large amounts of fiber and processed foods.

I hope my post made a clear enough impression of just how much proper digestion and energy production is interrelated. I think the map/chart image is a good visual representation of how everything is interconnected.