“Adrenaline Rush” phenomenon— What helps?

A significant subset (NIH CPET study estimated at 25%) of people with ME experience a phenomenon colloquially described as an “adrenaline rush” during and after overexertion, but before PEM begins. This is characterised by a rush of “fake energy” giving symptoms such as tatycardia, muscle tremors, feeling of overheating etc.

This is definitely not a fun phenomenon, as it significantly worsens the crash and is impossible to “turn off”.

I’m starting this thread to discuss how people manage these events, and what they’ve found helps.

For me:
Helps a lot: Continuing to pace rest (despite insticts) ie. stop feeding the adrenaline rush
Helps a decent amount: Benzodiazepines (althogh tolerance is a big risk here)
Helps a tiny bit: Melatonin, Beta blockers, CBD, Mast-cell stabilisers
Doesn’t help: Breathing exercises, compression garnments

Medications I’m curious if would help (has anyone tried?): Clonidine, Alpha Blockers, Calcium channel blockers, Dessmopresin, Gabapentin etc.

I’d be very grateful it anyone has tips or insight, I think this is the main factor in why I am continually declining in physical functioning.

 

I've been on gabapentin twice for different things, and it didn't make any difference to my difficulty with this. No idea about any of the others.

The only thing that's ever helped is your item 1: working against it by continuing to pace. It doesn't make me feel any better at all, but it might limit the length of the episode / help break the cycle.

 

Thank you for starting this thread

I often get adrenaline surges, usually from trying to do my basic ADLs and/or basic household activities.

This is true for me as well. I haven't tried any medications, though.

The only other thing I've found that helps limit the length of the episode/help break the cycle is to quickly get rid of the fake energy, so you can wind down and start resting properly as soon as possible.

Spoiler: NSFW

Masturbation to the point of climax can be a very effective way.

 

I heard this talk by Dr. Rebecca Ryan organized by Renegade Research last week, in which she discussed something similar to this phenomenon in conjunction with digestive issues and problems of the Gut-Brain-Axis:

https://www.youtube.com/watch?v=RXPSfAnw5fE

I found it very useful to hear that she connects adrenaline rushes as well as nightmares to digestive problems and insulin resistance.

(if you give me a few days I can link you to a more specific time code and summarize her talk. Energy currently very limited)

 

Agree. And I think of it as being there to get me out of danger eg when I’ve had to get to a medical appointment by train or something and it is engaging that to get me home to safety before I crash or just to allow me to even try it

others try and hold this against us ‘as if we could’ but it’s weird it is like the whole superhuman mum when child in danger thing. But it has huge payback and isn’t for anything else. Yet there’s the problem of course your noisy neighbours, non understanding friends and family etc not seeing ‘can’t’ and not acknowledging that with that it’s even worse than PEM because fir that bit if pushing through the wall it’s days or more of being in pain overdxerting just waiting for your body to rest enough to even get to PEM .

And because you are awake and I’ve realised so many others are callous unfeeling and self-focused they claim ‘well you can speak’ or whatever.

but Kitty and you are right. Live in this zone and you are beyond your means and will deteriorate fast and get stuck in upregulation which is so scary if it’s eg because you’ve neighbours imposing exertion on your body above threshold all the time which you can’t control or stop . Because we have no advocate who steps in and stops this.

those around me nearly let this happen to me. Four years of letting bullying from noise and over-exertion (noone believed the impact of) feel like it was slowly killing me and advocates and family just not acknowledging it was killing me because stopping it is so hard. But it probably also gets to a point where even if you had the perfect of situations then your threshold is so low it is hard to be out of that zone.

I think that’s why all the crap got made up about us to try and pretend it our problem it never was. And never made sense. And medication doesn’t work for it because normally it’s being over exerted

 

Ivabradine is the biggest help for this that I have tried, prescribed off-label for POTS. It helps me with the immediate impact symptoms you mention, but also the "tired but wired" sensations post-exertion in the evenings. I realised that if I took a further dose in the afternoon it would also help prevent me waking up completely wired with reactive hypoglycemia-like symptoms at 5-6am every morning after exerting the day before. I haven't watched the video shared above but imagine its relatable for me.

Ivabradine is promoted as a cleaner alternative to beta-blocker and only very selectively lowers heart rate... this doesn't seem to be entirely true (luckily) and impacts the wider stress response.

 

I just let them run their course, maybe take a dose of magnesium (as bisglycinate) to help calm euphoria, if my head gets really crazy a measure of alcohol to act as a depressant, which can sometimes help stop febrile mentation, though the rest of the time I dont drink as a rule.

It may sound a bit wishy washy but my main method of management is to be mindful if an adrenal rush is in progress and simply make a mental note to self to keep calm and carry on and rest and pace even more carefully until it is over. Most important is not to follow any mad impulses I may get to be overactive.

I was caught out before diagnosis. Just after onset I went to doctors who had nothing to say about my recurring virus, sudden severe allergy and strange fatigue, so I turned to the alternative healing scene and was encouraged to process getting ME as somehow being "spiritual" change.

Consequently the first few adrenal episodes drove me over the edge as they lasted a long time, many days and I felt I could not continue normally but had no idea what to do, so during the first one I resigned the job I was trying to do as a forestry supervisor but then instead of resting I grabbed my knapsack to go walkabout and get away from it all, only to crash with an almighty relapse along the way a few days later.

That is an example of how harmful not having a proper diagnosis can be.

Now I have a diagnosis and guidance on management, I try to rest and pace as normal and wait for the rush to subside, which it does a lot quicker now I know it is an undesirable disease symptom.

 

We have a thread here re 'adrenaline rush'.

 

The only thing that really stops me are other people. When I have the adrenaline I feel like I'm starving at a buffet and I'm loading way too much on my plate and only realize it afterwards when my belly hurts.

Others see it and stop me. Myself, it feels like my brain is switched off and I don't forsee the effects of my actions anymore. I just impulsively "do" until I can't.

 

If at night P-serine but not too late as it can cause (even more than normal) grogginess the next day for me.

 

Things I've been taking in the last year...

1) Beta blockers - Bisoprolol 2.5mg per dose, one taken just before bed - every night, although I built up to this dose very slowly over several years.

2) Magnesium supplements taken at bedtime occasionally - magnesium citrate - when heart is going nuts, and my muscles are rigid and won't relax.

3) Potassium bicarbonate taken at bedtime - small dose and only occasionally - when I can't relax.

4) Holy Basil - 2 capsules at night, every night. Allegedly this reduces cortisol. Wouldn't be any good for someone with low cortisol.

 

It is interesting that, what others are envisaging as an adrenaline rush, I liken to an endorphin high.

My experience is that when I find myself able to engage in more physical activity than normal I can experience a high that results in my doing far too much, which is also associated with impaired judgement undertaking potentially risky activity. For example some years ago when I was in a period of relative remission, I was hill walking in the Falklands, I had a strong sense of euphoria, and started running up and down rocky outcrops and scree slopes. I was lucky I did not break a leg or worse my neck. To varying degrees I have experienced it a number of times when mild and it is later followed by a crash. Fortunately the Falklands experience taught me to be wary of the high and reign in any foolish actions arising from it.

 

Doesn't adrenaline rush release endorphins? I think we can push through and delay pain too. Kind of scary.

When I used to get “runner's high", it certainly didn't feel like an adrenaline rush.

 

Does anyone have a theory on why the impaired judgement occurs?

Is it just a "I just want to finish this/ I've missed out on so much/ seize the day" thing or do adrenaline and endorphins really impair judgment on a chemical level like when you're intoxicated?

 

Your description of an adrenaline rush actually sounds pleasant. My experience of an adrenaline rush is very unpleasant, and I will always try and stop it. I wonder if the people who've responded to this thread are all describing the same thing.

The main symptoms of what I think of as an adrenaline rush are tachycardia, sometimes my heart rhythm will miss beats, breathlessness, a feeling of a lot more pressure in my head than usual, tensing up of various muscles that won't relax, my face goes really bright red, I start sweating profusely, and severe nausea (although I never actually vomit). I suspect if I was to measure my blood pressure while this was going on that it would be sky-high, but I can't remember ever having done that.

 

I am familiar with runner's endorphin high from combining rowing training runs with zazen I first learned at Japanese temple kung fu (Shorinji Kempo) martial arts classes before ME onset. I would distinguish that from the adrenalin rush I sometimes get out of the blue since ME started which is different again.

For me the adrenal rush feels fluey, weak and shakey but sets my mind going, elevating the preparation for action a couple of notches which I think is probably part of what people call the "fight or flight" behavioural response.

IMHO You could fairly describe it as a kind of panic attack, more deranging at first when I didn't recognise it for what it was, as it encourages action on a try it and see basis with less deliberation and makes one forget the build up of malaise until you crash like the crest of a wave crashing on a beach, when you realise you can do no more and have done too much as the rush ebbs away.

I think the evolutionary basis for that is probably a fight or flight response prepares you to act and reduces slow but useful deliberations, possibly of the neocortex, in favour of the fast (birdlike) responses which might be attributable to the cortex, as you may need to react faster than an opponent in some situations or get out of the way of a natural hazard ASAP, so dont muck around with deep thought at such times. That might be why one can forget or disregard prior experiences with ME which normally govern one's behaviour.

The question imho is why and how adrenal rush is being triggered periodically, as if something is building up and then releasing an episode. I think that could be biochemical and I recall Nancy Klimas talking about a cytokine related molecule which seemed like a good candidate but I didnt make bookmarks and have lost track of the details, sorry.

As an aside, I also observe adrenal episodes related to IBS but these are different and don't affect my mind this way as they seem to get my gut moving after a period of not moving which leads to a heavy movement and I suspect this is an autonomic subsystem, which maybe can also be activated when the main fight or flight response is activated to dump weight rapidly i.e. when people get so scared they involuntarily poop. But my experiences suggest this can also be activated independently in a way limited to encouraging bowel movements.

I did something similar in one of my early remission phases, in the Brecon Beacons, jumping downhill, feet together between sheep flattened tufts, a bit like skiing slalom without skis, like Zebedee from The Magic Roundabout. I was actually quite careful but got some very odd looks from another hill walker passing by! Probably because I was smiling so much, as it was such a beautiful day and I was feeling euphoric and enjoying it.

IMHO ME related euphoria is also real and I think there are at least two cognition altering mechanisms at work here. I now think of euphoria as one pole of emotional lability, the other pole being irritability. I find euphoria often gives way to irritability as I tire. I think both are due to neurological hypersensitivity which Dr Paul Cheney considered a common response to brain injury, which changes the balance of response to sensory input significantly in PWME, may account for sensory hypersensitivity in more severe ME and seems to vary over a longer time frame than adrenalin which I would consider a different mechanism.

I think if you consider hypersensitivity combined with the natural endorphin high which endurance athletes and meditators typically experience, this might explain exceedingly euphoric experiences like that.

Personally I find phases of euphoria sneak up on me related to my inflammatory cycle state and I notice when I start to perceive everything as very beautiful and then start to respond emotionally to daytime TV etc so then I know its time to rest and shut down all media, apart from kitten videos, obviously.

TLDR - I think there are these two mechanisms at work, nerve hypersensitivity and adrenal activation via autonomic NS and some kind of cytokine related build up.

 

I agree that we're not necessarily all meaning the same thing when we use the term & i think we need to be really careful about this, because:

a) lots of people (including me) are describing something entirely different than whats described in the OP, when they use the term - not saying i am using it correctly and others arent - lol i dont own the term!

I use it to mean a rush of stress hormones one experiences when one is scared/senses danger or is angry - part of the fight or flight response.
I feel massively better when this happens, all symptoms are reduced and function (including sensory tolerance) is significantly increased. I am more alert, balance improves, energy improves, gait becomes normal, muscle power increases. Its really noticable and feels (if it werent for the emotions driving it) like a huge relief, its wonderful to feel so much better.

It feels real - i have no sense that it's false it feels absolutely like i did when i was healthier. The biggest, slightly more objective, marker is that i can read & understand even quite complex & academic topics. But it's a con - if i behave as if its real its a problem because when the PEM hits it is based on what i have actually done. Its as if the adrenline/stress hormone rush was like a pain killer & stimulant that let me feel as if i were doing no damage, when actually i was.

The reason i use adrenaline rush term to describe this is because that is, i believe factual - ie when the fight/flight response SNS is triggered by a sense of threat/rage etc adrenaline is actually definitely released. Stress hormones come, and we know they are powerful pain killers and alertness-bringers, because thats what they're designed for.

However the phenomena described in the OP i also experience, but it feels a bit different, i can tell its fake/false and is a result of over exertion because i feel simultaneously wired and tired, and my cognitive function is faster but its not accurate - i havent got sharper or got my iq restored to me (like when im anxious/angry), its just that everything is running too fast.

It feels similar to anxiety in that my heart is racing & i start to sweat but its unpleasant & feels like i have taken amphetamines. For me this experience is not as dangerous as the former emotionally driven state, because i can sense its not real and, as other have said, ignore it.

I call this 'feeling manic/hyper', like my body is over excited, i dont ever call this an adrenaline rush be cause i dont know that it is one - do we have any evidence that adrenaline levels are higher when this happens? (not saying we dont, i'm just asking). I dont think we should assign a biological name to it unless there is high quality evidence to support it - because otherwise its misleading - like "encephalomyelitis".

I also worry deeply about it getting mixed up in our terminology with the emotionally driven state because the world (especially the BPS crowd - which lets face it is the majority) - will simply hear it as 'we feel anxious after we do more than we're used to'.

So i just think we need to be careful ... because its like the difference between post exertional malaise & post exertional fatigue - loads of people use PEM when they are describing PEF. This confusion is incredibly unhelpful in a whole host of ways.

N.B. please do not interpret my post as something like "you're calling it the wrong thing".... thats not what i meant or said - i dont know what the right name is.

All i know is that currently the term 'adrenaline rush' is being used to describe 2 things, 1 which we know is an adrenaline rush, and one which i dont know what we know about it ???? & that the conflation of the 2 is problematic.

 

As mentioned in my post above i dont call this an adrenaline rush, but in terms of what i do to mitigate it.... i try to be really firm with myself and make myself rest.

I mean silent, dark, lying still. ITs taken me 20yrs but now i just usually force myself to do it, because the sooner i do that, the less bad the PEM will be.

The really hard bit is when the emotionally induced adrenaline rush & this other phenomena occur at the same time. Because i cant have silent darkness when i'm feeling really scared it makes the fear worse and so it leads to even worse PEM consequences.

 

I think we are talking about the same thing but we have a different starting point. I have had my cortisol levels tested with a 4-part saliva cortisol test, and I've had a 9am cortisol test done in blood and the results were all over the range, apart from one of the 4-part saliva test results, and even the one that was in range was extremely high in range. Anything which pushes my cortisol higher than it usually is makes me feel really ill.

It sounds as if your cortisol is usually low, and you feel better when it becomes closer to "normal", and mine is high and feel worse when it gets even further away from normal. But I'm just guessing.

 

interesting. I dunno... It has been suggested to me more than once by friends/family that 'why dont you see if you can get something that mimics adrenaline/cortisol'. But that wouldnt help me because i still can only do the same amount without PEM as when i feel calm and feel worse.

So it makes more sense to me that its just adrenaline doing its usual work - as i understand it, SNS activation has the same effect on every human body - its designed to make you run faster, see sharper, maximum alertness, part of which is adrenaline induced pain relief etc. It's just that i starting from being so disabled/debilitated its more noticeable. If you start from a function of 100 & add 5, the difference will be barely apparent, but if you start at 5 & add 5.... wow!

All i know is i only feel my worst when i am calm. Perhaps you're right in that my cortisol is lower, but i wouldnt want it rectifying because it doesnt help me do any more without going into PEM, so in a sense feeling better isnt particularly helpful. Its nigh on impossible to PACE when i'm like that because i cant stop myself. Its irresistible tbh.

When you say we are talking about "the same thing" do you mean that we both mean the same thing by the term 'adrenaline rush'?

Is the sensation you describe one that you get after over-doing things (before PEM hits) or is it the sensation you experience when in sympathetic nervous system activation (ie scared/angry)? or something else?

I was suggesting that unless we know something is caused by adrenaline we'd be better not calling it an adrenaline rush.

FWIW the sensations you described i also experience - after overdoing it.

ah wait, perhaps i see what you mean.... that when i feel at my worst cortisol is too low, then when i get SNS activation it gets raised, but the 'overdone' it bodily experience is when they then go too high?

I dont think so because if that were the case i couldnt experience both things at the same time which i often do.

When you have the 'tachycardia etc' experience how are your pain levels?

ETA: i dont think my cortisol can be low most of the time, because i dont have low appetite, weight loss or low BP which apparently are the major symptoms.