Posted by bleauberry on March 28, 2010, at 8:14:48
In reply to Severe anhedonia...I can't live like this anymore., posted by Economist on March 23, 2010, at 13:07:29
When it comes to anhedonia, I think it deserves mention that another component besides just meds is very important for potential recovery.
Let's assume someone has had a severe knife wound that damaged a nerve in the wrist. Now the hand is partially paralyzed with a lot of numbness and lack of feeling.
To heal that damaged nerve, no pill alone is going to do that. Certainly an anti inflammatory might help. Probably some other meds I'm not aware of. But it is not going to heal without physical therapy. That is, movement, exercise, routine, massage... To just let that injured hand sit in a sling indefinitely month after month, year after year, it aint gonna recover its feelings. That nerve however can recover in time if it is encouraged to do so.
I do not see the nerves in the brain as being much different. That hand may never recover completely, or it might, but it will certainly recover more thoroughly with encouragement and therapy than it will with merely a prescription.
That's why physical therapy plays such a large role in medicine. It's heals injured stuff and returns it to optimal function.I see the same thing with anhedonia. A part of the brain has gone numb. Don't know why, it just did. Maybe a pill can wake it up, maybe not. But for sure, exercising that part of the brain will encourage it to start working again.
That means going out and forcing oneself to do things that are almost universally fun to normal healthy people, regardless that you feel no emotion and no fun in it yourself. A roller coaster, a horse ride, a walk on the beach, some kind of game, movies of some kind, anything...force input into that part of the brain that is asleep.
It is forced behavior. It is exercise. It is actually not much different than going to the gym when you don't feel like it. The muscles still need work whether you feel like it or not. And they are not going to do anything except deteriorate if you don't.
Results I believe are slow, come in waves, and happen in tiny steps. But for sure, the brain can learn how to have pleasure again, and to feel again, but it has to be exposed to the kinds of environments surrounded by pleasures and emotions. It has to be challenged. It has to be exercised, no different than a muscle or a nerve. It has to be worked.
Just my thoughts on that.
Anhedonia is my primary symptom. Over 3 years I have gained back some of those emotions. The only pill that ever had any impact was Savella. Other than that, all my gains have come from forcing myself to do something that was supposedly fun even though it wasn't to me. Over time the brain learns and reconfigures itself. The brain has amazing recovery and adaptability powers, but it needs to be pushed in the desired direction to put the chain reactions into play.
Again, just my thoughts on the topic. Nobody ever said life was easy. Nobody ever said healing sickness was easy. They aren't. They take purposeful goal oriented forced work. Which is especially hard for us who are ill, but even more critical because of that. The harder it is for us to do something, the more we need to do it.
As for specific meds, I would focus on the noradrenergic and/or dopaminergic, especially the ones that do not have overwhelming sedating or anticholinergic side effects. Somewhere in there serotonin probably plays a role too, but will likely worsen things if it is manipulated more than the others.
Use it or lose it.
poster:bleauberry
thread:940577
URL: http://www.dr-bob.org/babble/20100328/msgs/941175.html