Can a Comedown Kill You?

My worst comedown hit me after three long days of drinking and ecstasy use at a festival in 2015. Upon returning to reality, my sleep became a grisly vortex of sweating, brain zaps and night terrors, which reached its apex when I was floating in an orange dreamscape and having a conversation with my conscience, who told me I was a terrible person. I bolted awake, soaked in sweat, and looked at my bedside radio; I'd only been asleep for 30 minutes, meaning I still had a whole night of this horror left to endure. It was a low moment.

That was the third night back from the festival and, more than once during this period, I wondered whether I'd nudged the pleasure boat too far from the shore: whether I would, in fact, get comedown-ed to death. Since then, I've wondered whether death-by-comedown is actually possible, so I called some experts to find out.

"First, you have to break down the difference between a comedown and withdrawal," says Rick Bradley, Operations Manager of Addaction, a leading drug, alcohol and mental health charity. "People still get confused about that. The withdrawal from drugs like alcohol and benzodiazepines can be really problematic and dangerous if not managed properly."

To alight at the point where you're at danger of withdrawal from either of these substances, you need to have an extended period of daily, heavy use: a bottle of spirits a day, two big bags of cans. It wouldn't be your Big Friday drinker, but someone with a profound dependance.

Alcohol and benzo withdrawal are both acutely unpleasant. In the 24 to 36 hours after beginning withdrawal from the former, depending on the severity of addiction, the physical ailments could include tremors, sweating, agitation, insomnia and – in the worst cases – lead to delirium tremens, a terrifying psychosis with vomiting, diarrhoea, electrolyte disturbance, seizures and possible death.

"It's definitely not safe to completely stop drinking [for extremely heavy drinkers]. The comedown/withdrawal could be fatal," says Dr Ben Sessa, addiction psychiatrist and MDMA psychotherapist. "You have to do a medical detox and give the person high dose benzos to protect their brain, or do a controlled detox and slowly cut down over weeks and months."

Benzodiazepine withdrawal is, for a nation in thrall to its anxiety-hoovering power, probably more of a concern for England's youth. Like alcohol, spontaneous withdrawal could be deadly.
"You risk a seizure because your brain is used to being swamped in this drug and will become hyper-aroused," says Sessa. "You have to taper off really slowly."

Withdrawing from opiates like heroin is similarly agonising, with the body's pain receptors merrily firing rounds into the person's bones and joints. Thankfully, it isn't actually dangerous in a physical sense. So what of the existential comedowns that bedevil the lives of the weekend caners?

"I actually think comedowns are an artefact of ravers and the way in which they take MDMA and other drugs," says Sessa, who leads clinical trials into using MDMA to treat mental disorders. "If you spend your weekend taking drugs, drinking, barely sleeping and eating poorly, those terrible feelings you're experiencing at work aren't due to serotonin depletion: they're a hangover."

He points out that participants in his trials – who take around 120mg of MDMA (half a strong pill, effectively) in a controlled, holistic setting which definitely doesn't involve them calling in a final bag at 5AM – wake up feeling refreshed and often bathed in that elusive "afterglow" that is the holy grail for MDMA users.

The afterglow can last anything up to five days, and there are hopes that MDMA treatment for people with PTSD may soon become an accepted avenue of modern psychiatry. But for people with mental health issues who are taking MDMA and other comedown-influencing drugs outside of a clinical setting, there may be some cause for concern.

"If someone is prone to feelings of depression or low moods and you are increasing those emotions, it would likely make that comedown more profound. That could be a concern," says Bradley, speaking with 13 years' experience of working with people with substance issues.

In 2015, delayed comedown effects were cited as a likely cause in the death of Ben Stollery, 18, who killed himself the Monday after taking MDMA the Friday before. Stollery had a history of mental health issues and, in her report, coroner Julie Knight said, "On the balance of probabilities, I do believe his state of mind was influenced by MDMA and the comedown part of this drug."

Although it's important to acknowledge the fact that Ben Stollery's tragic case is the exception rather than the rule, and that approximately 439,000 people take ecstasy every year in the UK, a prospective low mood is worth considering for those experiencing mental health issues. You could help counteract comedown anxiety by following some common sense procedures: book the Monday off work when you’ve got a big weekend coming up; go out on the Friday rather than the Saturday; try to get some decent sleep, as both Bradley and Sessa acknowledge poor sleep as possibly the key contributing factor to any comedown.

In a pragmatic sense, tiredness could also be a danger if you're driving, using machinery or perhaps not being 100 percent present crossing the road while listening to Elliott Smith deep cuts and pondering the vagaries of your existence.

So, in a nutshell, a comedown won't kill you by itself. But look after yourself, accept your actions and listen to your conscience when you’re thinking about a carry-on instead of going to bed. Or you’ll end up like this poor, sweaty sucker.

@dhillierwrites