I have an amphetamine SUD: Dexedrine and Vyvanse. My personality has been lost, my ability to socialize is gone, my affect is permanently blunted, I have rapid speech that can be hard to follow, my thinking is severely distorted, my sense of time is gone, et cetera. I have also been diagnosed with delusional disorder and take 60mg of Lurasidone.

I’ve been taking 60-90mg of Vyvanse, 40-60mg of Dexedrine, and at times 20-60mg of expired Adderall along with this, for the past three weeks. Before this, I had a five-day hospitalization because of the SUD where l was stabilized on 60mg of Vyvanse.

I felt fine from the dosage increase and experienced no negative effects. However, I also took up chain smoking when I got out of the hospital, and it made me really sick.

I was getting worse and worse side effects from the smoking. I developed extreme lethargy, headaches that wouldn’t stop, inability to fall asleep at night or feel sleepy, muscle weakness, sense of fear, overheating and sweating, severe neck and shoulder pain on my right side, fear of socialization, worse personality changes on top of what I already experience, paranoid thinking, obsessive thinking, borderline delusional thinking, et cetera.

Then three days ago, everything hit me all at once. I had just chain smoked and was overcome by a horrible state. All of a sudden, I felt like I hadn’t slept in days. I was overcome by irritability to an extent I didn’t know was possible; it was like my brain was short circuiting at any stimuli. I would startle and jump at any sudden noise, like my phone dinging, and become very angry and want to start crying. Light and noise hurt my head and upset me. I would become enraged and frightened by stimuli. I checked my BP and it was high, and it’s never been high before in my life. I was also shaky and my muscles were twitching in my legs. I got tinnitus as well.

No amount of painkillers stopped the headache or neck and shoulder pain. The right side of my face felt numb, as did the top of my head. The underside of my wrists and forearms throbbed for no apparent reason. It felt like I took the LD50 of rat poison. I was so nauseous and dizzy it was hard to lie down, but standing up was worse. I would also get extremely overheated to the point where I was sweating through my clothes. My neck was so tense that the right side of my jaw cracked when I opened my mouth, and this hasn’t gone away.

The next morning I felt really unwell and lethargic, but not extremely bad. I thought taking more amphetamines would make me feel better. Then later that morning, I tried to smoke a cigarette and the state hit me again. It was basically the same thing as before. Only this time instead of overwhelming irritability and rage or fear at any stimuli, I developed paranoia and extreme rumination that caused despair.

I again had a crippling headache like I’ve never experienced before, severe nausea, throbbing pain at the bottom of my head, and excruciating upper back and neck tension and pain on my right side. My sense of reality and self was gone again. It lasted all day. I looked like I had been hit by a truck. I didn’t look familiar. I spent the entire day on paranoid rumination, in which I was overcome by guilt and apologized out loud repeatedly.

Today it happened again. But this time, I took a high dose of pregabalin when it hit me, so I stayed calm. However, I don’t understand why it happened again, because I didn’t smoke a cigarette. The state hit me around four hours after taking 70mg of Vyvanse and 40mg of Dexedrine. I might have taken 20mg of Adderall on top of that.

I have spent the last six hours in excruciating pain from the headache and muscle tension that painkillers don’t help. I again had extreme nausea, and I became dizzy when turning my head. Pressure would change in my head when I stretched my neck even slightly. It felt like my head was being hit by an iron bar constantly, and my right eye hurt. I had physical symptoms of fear and panic that I still have now.

Before the state hit me, I was sweating excessively, was a bit disoriented, and out of touch. I still looked like I had been hit by a truck when I woke up, and I felt unwell and really tired. But once the amphetamines kicked in shortly after taking them, I began to feel better. I thought I was on an upswing.

So, I don’t know what’s going on or what could potentially happen. Does this sound like amphetamine toxicity, or was it possibly the cigarettes in combination with them? I want to know if the symptoms that come all at once are characteristic of amphetamine toxicity, and what could hypothetically happen in the worst case scenario based on known data. At what point would the symptoms call for urgent medical treatment? I’m not getting chest pain.