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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by ed nieg on January 26, 2019, at 4:23:05
I'll try to make this relatively succinct since I could go on and on about this: five years ago I started a combination of Prozac/Zyprexa known by the trade name Symbyax for stubbornly resistant OCD symptoms that weren't responsive to regular treatment. I noticed emotional numbness and anhedonia almost immediately after starting the Symbyax; however, the benefit on my OCD symptoms was so great and the feeling when I tried to taper off was so torturous I ended up on the med combo for 6 months. I expected to feel like my regular self again after stopping, alas, my ability to feel pleasure was noticeably absent. Five years later I still suffer from anhedonia constantly that really makes life quite pointless.
I am not trying to contend that psychiatric drugs can result in lasting mental/emotional ramifications: I know this for a fact. I am not trying to engage anyone in a spat over the ethics of psychiatric treatment, I simply would like to know how many of you have suffered similar unintended consequences of these medications and experienced any success treating these residual effects with further medication. I have ran the gamut of wellbutrin/more ssris/TCAs/MAOIs... I eventually turned to psilocybin, which I seemed to verge on a breakthrough with but no dice. I've almost completed a series of ECT treatments with no help. I'm 25 and feel like my life is over: is there anything I'm missing? Thanks.
Posted by bleauberry on January 26, 2019, at 11:06:19
In reply to Antipsychotic-Induced Anhedonia: Rare?, posted by ed nieg on January 26, 2019, at 4:23:05
This is a debatable topic and not settled science. Actually, most of the medical community doesn't even recognize the kind of drug-induced emotional numbness you spoke of. They chalk it up to the spectrum of depressive symptoms.
I happen to believe that most of the time, the drug-induced anhedonia is either partially permanent or totally permanent, that the patient never returns to their former state.
From many years of experimentation and study, I have discovered only 3 drugs in the entire world that can make that anhedonia go away, and return you to your former self with interest in hobbies, activities, social, etc.
Ritalin, Adderall, or Modafinil. In my opinion Ritalin is the most effective with the least side effects. Adderall is second. Modafinil is not as reliable but sometimes works magic when nothing else does.
I was on Prozac+Zyprexa for years - but I took them separately, not in the same pill. I had started prozac first and added zyprexa a few months later. Prozac created the anhedonia, though it was noticeably less than the anhedonia of others I had been on, such as Paxil, Zoloft, Celexa, Lexapro. Those were really bad for anhedonia. When I added Zyprexa it actually improved anhedonia a little bit, but not enough. Even though my depression was well under control, you just can't function right in life when your emotions are so numb.
The anhedonia itself - drug induced or not - is as crippling, if not more so, than major depression itself. It certainly is not as painful as depression. But in terms of crippling your life it is. Either depression by itself, or anhedonia by itself, will seriously disable your abilities to engage in life.
I then ordered an overseas med called Adrafinil, which is the parent drug of Modafinil. The first day I took it I was cured. That faded. Over the next month it slowly kicked in and a lot of the anhedonia was taken care of, but never all of it.
It wasn't until years later when I was on Ritalin that I realized the stimulants really should be first-line meds in psychiatry for depression, anhedonia, focus, energy, and in many cases greatly improved sleep and improved anxiety, despite being stimulant - there are scientific explanations why that happens. They should not be second or third tier choices, in my opinion. In my opinion the fastest way to lift a major depression patient out of the dungeon is with a stimulant, and there are clinical studies confirming that.
So anyway, yeah, I think the anhedonia is permanent, at least to some degree, maybe totally, and that in my experience the only meds or herbs that can overcome that and return you to your former self are the prescription stimulants. I have taken maybe over a hundred herbs and supplements, I take 30 as routine, and have studied hundreds of hours - in all of that I have never encountered a supplement that can do what the stimulants do, never encountered an herb that can erase anhedonia.
Your question was if it is rare? I say no, it is very common, almost universal. But that's just what I have seen.
> I'll try to make this relatively succinct since I could go on and on about this: five years ago I started a combination of Prozac/Zyprexa known by the trade name Symbyax for stubbornly resistant OCD symptoms that weren't responsive to regular treatment. I noticed emotional numbness and anhedonia almost immediately after starting the Symbyax; however, the benefit on my OCD symptoms was so great and the feeling when I tried to taper off was so torturous I ended up on the med combo for 6 months. I expected to feel like my regular self again after stopping, alas, my ability to feel pleasure was noticeably absent. Five years later I still suffer from anhedonia constantly that really makes life quite pointless.
>
> I am not trying to contend that psychiatric drugs can result in lasting mental/emotional ramifications: I know this for a fact. I am not trying to engage anyone in a spat over the ethics of psychiatric treatment, I simply would like to know how many of you have suffered similar unintended consequences of these medications and experienced any success treating these residual effects with further medication. I have ran the gamut of wellbutrin/more ssris/TCAs/MAOIs... I eventually turned to psilocybin, which I seemed to verge on a breakthrough with but no dice. I've almost completed a series of ECT treatments with no help. I'm 25 and feel like my life is over: is there anything I'm missing? Thanks.
Posted by ed nieg on January 27, 2019, at 2:50:30
In reply to Re: Antipsychotic-Induced Anhedonia: Rare? » ed nieg, posted by bleauberry on January 26, 2019, at 11:06:19
> This is a debatable topic and not settled science. Actually, most of the medical community doesn't even recognize the kind of drug-induced emotional numbness you spoke of. They chalk it up to the spectrum of depressive symptoms.
>
> I happen to believe that most of the time, the drug-induced anhedonia is either partially permanent or totally permanent, that the patient never returns to their former state.
>
> From many years of experimentation and study, I have discovered only 3 drugs in the entire world that can make that anhedonia go away, and return you to your former self with interest in hobbies, activities, social, etc.
>
> Ritalin, Adderall, or Modafinil. In my opinion Ritalin is the most effective with the least side effects. Adderall is second. Modafinil is not as reliable but sometimes works magic when nothing else does.
>
> I was on Prozac+Zyprexa for years - but I took them separately, not in the same pill. I had started prozac first and added zyprexa a few months later. Prozac created the anhedonia, though it was noticeably less than the anhedonia of others I had been on, such as Paxil, Zoloft, Celexa, Lexapro. Those were really bad for anhedonia. When I added Zyprexa it actually improved anhedonia a little bit, but not enough. Even though my depression was well under control, you just can't function right in life when your emotions are so numb.
>
> The anhedonia itself - drug induced or not - is as crippling, if not more so, than major depression itself. It certainly is not as painful as depression. But in terms of crippling your life it is. Either depression by itself, or anhedonia by itself, will seriously disable your abilities to engage in life.
>
> I then ordered an overseas med called Adrafinil, which is the parent drug of Modafinil. The first day I took it I was cured. That faded. Over the next month it slowly kicked in and a lot of the anhedonia was taken care of, but never all of it.
>
> It wasn't until years later when I was on Ritalin that I realized the stimulants really should be first-line meds in psychiatry for depression, anhedonia, focus, energy, and in many cases greatly improved sleep and improved anxiety, despite being stimulant - there are scientific explanations why that happens. They should not be second or third tier choices, in my opinion. In my opinion the fastest way to lift a major depression patient out of the dungeon is with a stimulant, and there are clinical studies confirming that.
>
> So anyway, yeah, I think the anhedonia is permanent, at least to some degree, maybe totally, and that in my experience the only meds or herbs that can overcome that and return you to your former self are the prescription stimulants. I have taken maybe over a hundred herbs and supplements, I take 30 as routine, and have studied hundreds of hours - in all of that I have never encountered a supplement that can do what the stimulants do, never encountered an herb that can erase anhedonia.
>
> Your question was if it is rare? I say no, it is very common, almost universal. But that's just what I have seen.
>
> > I'll try to make this relatively succinct since I could go on and on about this: five years ago I started a combination of Prozac/Zyprexa known by the trade name Symbyax for stubbornly resistant OCD symptoms that weren't responsive to regular treatment. I noticed emotional numbness and anhedonia almost immediately after starting the Symbyax; however, the benefit on my OCD symptoms was so great and the feeling when I tried to taper off was so torturous I ended up on the med combo for 6 months. I expected to feel like my regular self again after stopping, alas, my ability to feel pleasure was noticeably absent. Five years later I still suffer from anhedonia constantly that really makes life quite pointless.
> >
> > I am not trying to contend that psychiatric drugs can result in lasting mental/emotional ramifications: I know this for a fact. I am not trying to engage anyone in a spat over the ethics of psychiatric treatment, I simply would like to know how many of you have suffered similar unintended consequences of these medications and experienced any success treating these residual effects with further medication. I have ran the gamut of wellbutrin/more ssris/TCAs/MAOIs... I eventually turned to psilocybin, which I seemed to verge on a breakthrough with but no dice. I've almost completed a series of ECT treatments with no help. I'm 25 and feel like my life is over: is there anything I'm missing? Thanks.I appreciate your response. Dopaminergic medications do seem like "Occam's Razor" sort of: the most obvious choice to treat this condition. I experienced dramatic success with Modafinil at times but like you said the effect tended to be inconsistent: it work well the first day and the effect would be weak the next. I could never get a hold of medications like Ritalin or Adderall, doctors were always reticent to prescribe those. One medication you didn't mention trying is Pramipexole, which is in line with the methodology of jacking up dopamine you seem to be a fan of. I haven't tried it yet because it seems to work selectively for older people from what I've seen, so if you're older you might want to try that out!
Posted by bleauberry on January 29, 2019, at 9:27:17
In reply to Re: Antipsychotic-Induced Anhedonia: Rare?, posted by ed nieg on January 27, 2019, at 2:50:30
You mentioned Pramipexole but I think that is a bad choice.
It looks good on paper. Theoretically it should be a good dopaminergic substance. And it is. Just not for mood.
My doctor says Ritalin is her most prescribed medication because it helps so many people with so many different symptoms. There is no way anyone could say that about Pramipexole.
I've followed a few people who tried Pramipexole and none of them did well with it. Side effects are harsh, risks are high, and benefits low.
What I have concluded is that just because something is "dopaminergic" really doesn't mean that much. The important thing is the mechanism of how dopamine is manipulated not the dopamine itself. But the mechanism orchestrating it.
Posted by pedr on January 31, 2019, at 11:21:12
In reply to Re: Antipsychotic-Induced Anhedonia: Rare? » ed nieg, posted by bleauberry on January 29, 2019, at 9:27:17
> You mentioned Pramipexole but I think that is a bad choice.
>
> It looks good on paper. Theoretically it should be a good dopaminergic substance. And it is. Just not for mood.
>
> My doctor says Ritalin is her most prescribed medication because it helps so many people with so many different symptoms. There is no way anyone could say that about Pramipexole.
>
> I've followed a few people who tried Pramipexole and none of them did well with it. Side effects are harsh, risks are high, and benefits low.
>
> What I have concluded is that just because something is "dopaminergic" really doesn't mean that much. The important thing is the mechanism of how dopamine is manipulated not the dopamine itself. But the mechanism orchestrating it.In a nutshell I also have extremely TRD with TR OCD and anhedonia. And IBS. And chronic pain. Yay. Anyway, I experienced the above - Pramipexole recently did absolutely nothing for me. And I also experienced the below:
> Ritalin, Adderall, or Modafinil. In my opinion Ritalin is the most effective with the least side effects. Adderall is second. Modafinil is not as reliable but sometimes works magic when nothing else does.
I.e. that only stimulants raise me out of anhedonia. Except that for me Adderall is #1. Isn't it weird that all of us experienced the same inconsistent response to Provigil? One day it's world-beating, the next, nothing. Same for Nuvigil for me as well. I wonder why it's like that.
Right now I'm doing so-so (which means "extremely well" relative to my normal state) on Trintellix, Rexulti and 3x20mg Adderall. But when the Adderall wears off, I just SATW (State At The Wall) i.e. feel very anhedonic.
Oh, w.r.t. getting prescribed Ritalin, simply fake up ADD symptoms. Fuck them. Inattentive ADD is symptomatically very similar to anhedonia IMO.
FTR I've tried 60+ combos, ECT, dTMS, Ketamine, more. Psilocybin is next for me but I'm only going to do it with a guide present and I've *no idea* how to go about finding one.
Pete
Posted by ed nieg on January 31, 2019, at 12:36:04
In reply to Re: Antipsychotic-Induced Anhedonia: Rare? » bleauberry, posted by pedr on January 31, 2019, at 11:21:12
> > You mentioned Pramipexole but I think that is a bad choice.
> >
> > It looks good on paper. Theoretically it should be a good dopaminergic substance. And it is. Just not for mood.
> >
> > My doctor says Ritalin is her most prescribed medication because it helps so many people with so many different symptoms. There is no way anyone could say that about Pramipexole.
> >
> > I've followed a few people who tried Pramipexole and none of them did well with it. Side effects are harsh, risks are high, and benefits low.
> >
> > What I have concluded is that just because something is "dopaminergic" really doesn't mean that much. The important thing is the mechanism of how dopamine is manipulated not the dopamine itself. But the mechanism orchestrating it.
>
> In a nutshell I also have extremely TRD with TR OCD and anhedonia. And IBS. And chronic pain. Yay. Anyway, I experienced the above - Pramipexole recently did absolutely nothing for me. And I also experienced the below:
>
> > Ritalin, Adderall, or Modafinil. In my opinion Ritalin is the most effective with the least side effects. Adderall is second. Modafinil is not as reliable but sometimes works magic when nothing else does.
>
> I.e. that only stimulants raise me out of anhedonia. Except that for me Adderall is #1. Isn't it weird that all of us experienced the same inconsistent response to Provigil? One day it's world-beating, the next, nothing. Same for Nuvigil for me as well. I wonder why it's like that.
>
> Right now I'm doing so-so (which means "extremely well" relative to my normal state) on Trintellix, Rexulti and 3x20mg Adderall. But when the Adderall wears off, I just SATW (State At The Wall) i.e. feel very anhedonic.
>
> Oh, w.r.t. getting prescribed Ritalin, simply fake up ADD symptoms. F*ck them. Inattentive ADD is symptomatically very similar to anhedonia IMO.
>
> FTR I've tried 60+ combos, ECT, dTMS, Ketamine, more. Psilocybin is next for me but I'm only going to do it with a guide present and I've *no idea* how to go about finding one.
>
> PeteTripping with a guide isn't all that important; I went on a solo hiking "trips" and although there were definitely bad parts it was overall a rejuvenating experience. Personally, I wouldn't like to have some stranger tainting my trip with hocus-pocus sh*t but that's just me I guess, and I also tend to be pretty solitary anyways. Also, you might want to add the med Ezogabine to your to-try list, seems very promising for anhedonic-spectrum mental illnesses. It's only available in clinical trials though which sucks. I do have bona fide ADD wuth anhedonia (whole mesocorticolimbic system is shot), but I've always been blocked by the great gloved hand of institutional morality that presumes everyone to be a salivating crack addict the instant they ask for stimulants.
Posted by SLS on January 31, 2019, at 16:05:57
In reply to Re: Antipsychotic-Induced Anhedonia: Rare? » bleauberry, posted by pedr on January 31, 2019, at 11:21:12
I'm very glad you are doing better on Trintellix.
How would you compare Trintellix to the other antidepressants you have taken?
What dosage of Trintellix are you taking?
- Scott
Posted by pedr on February 1, 2019, at 21:48:27
In reply to Re: Antipsychotic-Induced Anhedonia: Rare?, posted by ed nieg on January 31, 2019, at 12:36:04
>> Tripping with a guide isn't all that important; I went on a solo hiking "trips" and although there were definitely bad parts it was overall a rejuvenating experience. Personally, I wouldn't like to have some stranger tainting my trip with hocus-pocus sh*t but that's just me I guess, and I also tend to be pretty solitary anyways.
Well that's certainly contrary to the guides I've read but I'm like you - I don't believe in energy and auras and all that horsecrap. I'm a scientist FFS. I'm also a solitary person but that's mostly down to the depression.
Given your language it seems that the trip(s) did not help you sufficiently. Was that the case? Did they help at all? (Please say "yes", that's all I have left to try (semi-joke) ).
>> Also, you might want to add the med Ezogabine to your to-try list, seems very promising for anhedonic-spectrum mental illnesses. It's only available in clinical trials though which sucks.
So that basically rules it out then. I will add it to my ever-shrinking list. If it passes trials and I'm alive at that point, I'll give it a whirl.
>> I do have bona fide ADD wuth anhedonia (whole mesocorticolimbic system is shot),
I strongly believe I have genuine ADD too. Just like I had severe - and I mean *severe* - TR OCD for 7 years whilst seeing MI professionals and none of them DX'd it. The useless twats. I was doing 8 hours of "ABC"'s (Action, Belief, Consequence) a day FFS. Sigh.
>> but I've always been blocked by the great gloved hand of institutional morality that presumes everyone to be a salivating crack addict the instant they ask for stimulants.
I face that every time I have to switch PDoc. "Stims are bad". "Stims are short term only". "Stims are addictive". Even better is that the only thing that helps my chronic pain is oxycodone. So you can imagine how that goes down in the current "Opioid Crisis" environment: precisely like a cup of cold sick.
Pete
Posted by ed nieg on February 2, 2019, at 14:02:01
In reply to Re: Antipsychotic-Induced Anhedonia: Rare? » ed nieg, posted by pedr on February 1, 2019, at 21:48:27
> >> Tripping with a guide isn't all that important; I went on a solo hiking "trips" and although there were definitely bad parts it was overall a rejuvenating experience. Personally, I wouldn't like to have some stranger tainting my trip with hocus-pocus sh*t but that's just me I guess, and I also tend to be pretty solitary anyways.
>
> Well that's certainly contrary to the guides I've read but I'm like you - I don't believe in energy and auras and all that horsecrap. I'm a scientist FFS. I'm also a solitary person but that's mostly down to the depression.
>
> Given your language it seems that the trip(s) did not help you sufficiently. Was that the case? Did they help at all? (Please say "yes", that's all I have left to try (semi-joke) ).
>
> >> Also, you might want to add the med Ezogabine to your to-try list, seems very promising for anhedonic-spectrum mental illnesses. It's only available in clinical trials though which sucks.
>
> So that basically rules it out then. I will add it to my ever-shrinking list. If it passes trials and I'm alive at that point, I'll give it a whirl.
>
> >> I do have bona fide ADD wuth anhedonia (whole mesocorticolimbic system is shot),
>
> I strongly believe I have genuine ADD too. Just like I had severe - and I mean *severe* - TR OCD for 7 years whilst seeing MI professionals and none of them DX'd it. The useless tw*ts. I was doing 8 hours of "ABC"'s (Action, Belief, Consequence) a day FFS. Sigh.
>
> >> but I've always been blocked by the great gloved hand of institutional morality that presumes everyone to be a salivating crack addict the instant they ask for stimulants.
>
> I face that every time I have to switch PDoc. "Stims are bad". "Stims are short term only". "Stims are addictive". Even better is that the only thing that helps my chronic pain is oxycodone. So you can imagine how that goes down in the current "Opioid Crisis" environment: precisely like a cup of cold sick.
>
> PeteIf you ask me SSRIs/antipsychotics can be as just as psychologically damaging as any recreational drug e.g. opiates but maybe the stigma isn't as high and they aren't associated with the dregs of society so there isn't any impetus to reduce their usage. I would have traded a heroin bender and subsequent hellish withdrawal for 6 months on antipsychotics which ruined me permanently.
Anyways, getting back on topic. Yeah, I didn't get remission from anhedonia with psilocybin, but I found it maybe unmasked SOME emotion or feeling. I think even in clinical settings they just prep you for the experience and stand out of the way iirc. I personally believe in autonomous self-discovery vs. sitting in a circle being led by an ancient shaman but I dunno. I am really hoping I get a stimulant prescribed eventually, I'm almost certain my brain is compromised and I'm not getting out of this w/o some kind of dopamine augmentation. I have bad OCD too. it's torture, the cruel irony is when you seek relief from anhedonia your OCD is almost certain to get worse; it's in these times where I feel like life is truly unnecessary.
Posted by sigismund on February 2, 2019, at 14:17:20
In reply to Re: Antipsychotic-Induced Anhedonia: Rare? » pedr, posted by ed nieg on February 2, 2019, at 14:02:01
From my experience it is good to have someone there, not as a guide, but simply as someone you like and respect to talk to if you feel like it. Whether they are taking it or not.
It was also necessary for me sometimes to simply be alone and wait for things to pass...maybe only for 20 minutes.
Posted by pedr on February 2, 2019, at 19:56:00
In reply to Re: Antipsychotic-Induced Anhedonia: Rare? » pedr, posted by ed nieg on February 2, 2019, at 14:02:01
> I have bad OCD too. it's torture, the cruel irony is when you seek relief from anhedonia your OCD is almost certain to get worse; it's in these times where I feel like life is truly unnecessary.
Wow. I said the very same thing to my PDoc last week. When I'm really depressed I just don't care if I suffer more and my OCD abates. When my mood lifts, it's as if my brain sniffs out that there's something to lose - something it can take away from me. And it does. I fucking hate my brain.
This is the end of the thread.
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