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itstrevor

Answers To Curing Anhedonia/numbness/apathy, No. 1

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I would like to start this thread for everyone to share their experiences with anhedonia (emotional numbness, inability to experience pleasure, apathy, dead sex drive, etc.) so that we may all collectively find the best solutions. The more experiences we have here, the easier it will be to make connections and narrow down useful strategies/medications/solutions, We all need to work together on this.

I would like to add my personal experience with anhedonia and what I have discovered about it along the way. I have been anhedonic now for 10 months due to major depression triggered by chronic stress. Anhedonia is my only persistent symptom and is occurring in the absence of any other depressive symptom (I do not feel "depressed," I do not "feel" at all). For this reason, many people experiencing anhedonia (me included) find fault with the technical association with "anhedonia" being only a symptom of another disease rather than a syndrome in itself. Firstly, what I have noticed about every person experiencing anhedonia (me included) is that they seem to mention the inability to experience the same list of things: music/art, sex/romance/dating, and emotional appreciation. To me, all of these are inter-related and so anhedonia really boils down to a flatness of emotional responsivity to anything and a general inability to experience pleasure. The best way to describe it is to make the analogy to the loss of interest in sex as similar to the loss of interest in sex a male might experience soon after ejaculating (refractory period)or the loss of interest in music to the loss of interest one might feel towards a song after having heard the same song repeatedly for several months. I have read many articles on anhedonia and have seen many theories that suggest that anhedonia is a result of the failure to anticipate pleasure rather than experiencing it and that it involves the neurotransmitters dopamine and norepinepherine. Firstly I would like to say that I can anticipate having a pleasurable response to something, but the only thing that is missing for me is the response itself. For example, I may get an adrenaline rush from something such as sex, but it is not accompanied by feelings of pleasure. I anticipate the pleasure, but I only experience the adrenaline, not the pleasure itself. I have had partial responses to stimulants and dopaminergic agents but no response to norepinepherine modulating drugs, though I have read many reports of people having success with norepinepherine drugs. Others left no noticeable effect.

Strangely, I would sometimes spontaneously and instantaneously get a “window” of normalcy where my emotional numbness would break for a few minutes and I would feel normal, as if a “light switch” was controlling my emotions and ability to feel pleasure. My libido, my numbed emotions, and that zombie-like feeling I was having – they were all related, they all came from that same part of me that was “turned off.” It’s the same type of sensation that I was missing – whether it was the feeling that I was not getting thinking about a girl, the excitement I was not experiencing thinking about my future, and the enjoyment I was not experiencing being around my family doing activities with them, they all (pleasure) were just “off.” As time passed, I would see fewer and fewer of these windows until they disappeared completely. At first, with much difficulty I felt two windows once while crying shortly after arriving at home and once during a car ride with my mother.

There seems to be two "camps" that psychiatrists fall under. In one camp are the psychiatrists who tend to disregard anhedonia as "just a symptom of the underlying depression/other illness" and not mainly a dopaminergic phenomenon saying "treat the underlying depression/other illness, and the symptoms go away with it like a cascade." These psychiatrists believe that SSRIs are most effective for any type of depression, regardless of symptoms, (usually calling me "obsessive" for researching or disregard science backing it up as "just theories,” and that “nobody knows what’s actually going on in the brain" etc.) and often deny that serotonergics make anhedonia worse (I've been with two of this type). The other "camp" is, in my opinion at least, more reasonable; psychiatrists falling under the second camp listen to symptoms and recognize anhedonia as mainly dopaminergic or to do with norepinepherine.

It's known that the activation of certain serotonin receptors inhibit the release of dopamine, (obviously shown in the blunting effect and loss of libido associated with SSRIs/SNRIs) and it is also known that dopamine plays a crucial role in the processing of emotional responses. Norepinepherine is another key part of the puzzle, in my experience sort of the "second banana" to dopamine, as it is shown in many studies that animals lose preference towards a reward with reductions in norepinepherine - norepinepherine is associated with motivation and arousal.

The treatments that I have found through research to be successful in treating anhedonia are:

Stimulants - Methylphenidate, Dextroamphetamine, etc.

Dopamine Agonists - Pramipexole, Ropinirole, Cabergoline, Apomorphine, Bromocriptine, Rotigotine, etc.

Low Dose Antipsychotics - Aripiprazole, Amisulpride, Sulpride, etc.

Serotonin Receptor Antagonists - Buspirone, Low dose Fluoexitine, etc.

SSREs - Tianeptine

Dopamine Reuptake Inhibitors - Amineptine, Bupropion, etc.

Norepinepherine Reuptake Inhibitors - Desipramine, Atomoxetine, Nortryptaline, Bupropion, etc.

MAOIs - Parnate, Nardil, Selegiline, etc.

Other - Amantadine, Nicotine, Testosterone, Levodopa, Phenylethylamine, Cyproheptadine, Thyroid Augmenting (lithium for example), L-Tyrosine, L-Theanine, SAM-E, St. John's Wort, etc.

Unfortunately several drugs are not available in the USA such as Tianeptine, Adrafinil, and Amisulpride, and many of these medications have significant drawbacks such as tolerance, addiction, long-lasting side effects, severe reactions, heart problems, heptatoxicity, blood pressure problems, and more.

I have tried Wellbutrin, Abilify, L-Tyrosine, L-Theanine, SAM-E, DLPA, Ritalin, Adderall, and Desipramine. My experience was that I felt no different on Wellbutrin even after being on it for 8 weeks at the highest recommended dose (450mg). Abilify (5-7.5mg) helped me to regain focus and the ability to do something for longer periods of time without feeling anxious, though had little noticeable effect on anhedonia and gave me random twitching and tremors. L-Tyrosine (500-1500mg) had no noticeable effect. L-Theanine (300-1000mg) made me extremely agitated and irritable. SAM-E made me more irritable. DLPA (1000-2000mg) had no noticeable effect. Ritalin (15-30mg 2x daily) was the closest thing to helping my anhedonia, but was unreliable, worked for only about an hour, quickly formed a tolerance, and raised my heart rate substantially. Adderall (5-15mg 2x daily) only raised my heart rate with no noticeable effect on the anhedonia, but I can't help but to feel that this was because of a cross-tolerance with the Ritalin (I had already become tolerant to the Ritalin after only a week, so thus I was also tolerant to other stimulants such as Adderall). Desipramine (200mg) left no noticeable effect besides dry mouth and tremors after several weeks, but I later found out that due to its heptatoxicity, my liver was reacting poorly to it and thus I have been forced to come off of it.

For anhedonia I would like to take next a combination of Pramipexole, Cyproheptadine, Busiprone, and Selegiline, though I am not a doctor so do not regard this as educated medical advice without consulting your doctor (just a legal disclaimer). I will be visiting my doctor tomorrow and will start a new medication regimen and let everyone know how it goes. Please post what your experiences have been, what works, what doesn't, if you've found relief or not, or just the details of your anhedonia.

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Posted

Hi Itstrevor

I do not suffer from anhedonia, but there are so many people here that do and thanks for creating this topic, as it is a good discussion for others that suffer with it. Hopefully you can all find some answers.

Trace

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Posted

Hi Itstrevor

I do not suffer from anhedonia, but there are so many people here that do and thanks for creating this topic, as it is a good discussion for others that suffer with it. Hopefully you can all find some answers.

Trace

Thank you very much for starting this! I have been looking for answers for a long time. Or atleast ways to cope with it.

I do not have the energy to go into details now but here is post I wrote a couple days ago: http://www.depressionforums.org/forums/topic/83277-empty/

Best of luck with your new medication regimen!

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Posted (edited)

I'm thinking about turning this thread into an "anhedonia how-to" guide. With everyone's contributions we might be able to get somewhere. Too bad I can't edit the first post to add material as I get it. Also the psychiatrist doesn't want to put me on anything new because of my liver! Noooo! Now what?

Edited by itstrevor
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Posted

thank you for your thought-provoking post itstrevor. I think anhedonia is a hallmark feature of depression, and in the past it is been an indication to me that my depression is lifting when I finally start enjoying things again. With my current episode of depression I have experienced anhedonia for a couple of years, and sometimes wonder if I'll ever enjoy anything ever again. So I'm very interested to hear what others have to say about this.

I was wondering what neurotransmitters are affected by the drugs "Pramipexole, Cyproheptadine, and Selegiline" ? I have never heard of them.

take care,

ellemint

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Posted

I dont think I can add much to the discussion other than to say this has given me something new to think about. Ive not been able to enjoy anything for two and a half years and similar to ellemint I can see no end to this.

I do feel though, constantly depressed (the depression itself has been ongoing for over 15 years) and being unable to enjoy things even for a short period means the sadness never lets up. I dont want to sleep as I hate waking up and tomorrow being same, and no matter what I try, my mood seems locked. Is the cure to my depression to treat the lack of enjoyment and how do you go about that. Being able to look forward to something and then enjoy it, if only for a couple of hours a week would be such an improvement on how things are now.

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Posted (edited)

Thank you for your input ellemint and whereisthis - I'd like to hear more about what your experience is with your anhedonia (like specifically how do you feel? Depressed or just nothing at all? Emotionally numb or sad? Anxiety?). For me at least, I would love to feel sad because sadness is an emotional connection to the world that I cannot experience; its a beautiful relief. I used to "get a release" from crying. Do you guys? I can't anymore due to the numbness.

It seems that there is often similarities in the experiences of people experiencing anhedonia (please comment on this):

1.) It usually begins after a traumatic experience such as severe panic, emotional distress, or due to chronic stress

2.) It can be described as feeling "emotionally flat," zombielike," "apathetic," or "numb"

3.) Strangely, many sufferers report anhedonia as sort of like a "switch" that is either "on" or "off" and changes instantaneously ("windows" being brief flashing moments of experiencing normalcy which often leave as fast as they arrive)

4.) Anhedonia can exist without any other symptoms of any disorder and often seems to "stand alone"

5.) Loss of interest in music and sex are two things that people with anhedonia most readily realize

6.) It seems to usually go on for a long time relative to other symptoms (I repeatedly hear people having anhedonia for years and years)

It seems that we have alot of information about anhedonia itself, but little about the circumstances surrounding recovery. Has anyone had anhedonia and recovered? How long did it take? What did recovery feel like? What were the circumstances? Is there any left over residual anhedonia?

It certainly is frightening, as I feel almost "half-alive" "zombielike" or "in a dream" due to this emotional flatness.There are often reports of this as a result of taking SSRI medications or from drug abuse, but there seems to be fewer reports of people encountering this just from depression.

What about libido/sex drive? For me one of the most troubling aspects of anhedonia is the inability to experience love, attraction, romance, and intimacy. There is no euphoria or joy in sexual situations, and there is no drive to participate in them - just a general apathy and indifference. Has anyone experienced complete loss of sex drive for an extended period of time during depression, and have it recover? I frequently hear about SSRI-induced sexual issues, but what about just from depression/anhedonia itself? Again, we have little information surrounding recovery here. To me, the difference is night and day. Many people report "gradual" changes, but I personally feel that if I don't notice the change, it's obviously not big enough, because the anhedonia is such a drastic change from my baseline.

Anyone find any effective medications for sex drive or anhedonia?

Here is my status update: I had more liver tests done today and it seems as though my liver is recovering from the use of desipramine (which did nothing for me) and am speaking with my psychiatrist tomorrow about my next plan of action (which meds to take next). She may not put me on them immediately due to my liver, but I will report in with the results of the new medications and what I am taking when I do.

I'm trying to compile a list of possible treatment strategies for the benefit of everybody experiencing this. By combining all of our individual experiencies we may generalize successful strategies. Anyone take any of the listed medications in my first post? I would like to compile a list of medications and their possible usefulness as well as drawbacks for each one.

Edited by itstrevor

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Posted (edited)

Here is the update: after seeing my psychiatrist I was pleased to hear that she prescribed me Mirapex (pramipexole), a dopamine agonist. She also said that she was most likely going to put me on Parnate (MAOI phenelzine) in about 2 weeks (waiting for the desipramine to flush out completely and also for my liver to restore itself).

The strategies that seem to be successful at treating anhedonia are:

Antagonization of serotonergic receptors 5HT1A, 5HT2 and 5HT3.

Agonization of dopamine receptors DRD2 and DRD3.

Lowering prolactin.

Blocking the reuptake of Norepinepherine/Dopamine.

Inhibiting Monoamine Oxidase.

Thyroid Augmentation.

Direct release of catecholamines from storage vesicles.

Enchancing the reuptake of serotonin.

Taking dopamine precursors or supplements.

ECT? rTMS?

I have already tried norepinepherine reuptake with Wellbutrin (bupropion) and Desipramine without any effect. I have also used stimulants Ritalin and Adderall for a direct release of catecholamines (dopamine, epinepherine, norepinepherine) from storage vesicles with marginal improvements. Taking Mirapex (pramipexole) will agonize DRD2 and DRD3 receptors and Parnate will inhibit monoamine oxidase to raise monoamine levels (dopamine, norepinepherine, etc.). This looks very promising, I will keep everyone updated. The doctor said that there should be some response within 4-8 or so weeks.

Hopefully I will see some positive results and report back with the good news for the benefit of everyone else experiencing this debilitating condition.

Edited by itstrevor
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Posted (edited)

thank you for your thought-provoking post itstrevor. I think anhedonia is a hallmark feature of depression, and in the past it is been an indication to me that my depression is lifting when I finally start enjoying things again. With my current episode of depression I have experienced anhedonia for a couple of years, and sometimes wonder if I'll ever enjoy anything ever again. So I'm very interested to hear what others have to say about this.

I was wondering what neurotransmitters are affected by the drugs "Pramipexole, Cyproheptadine, and Selegiline" ? I have never heard of them.

take care,

ellemint

When I am finished compiling my guide I will go into detail about every treatment and medication. Pramipexole (Mirapex) is a dopamine agonist; essentially it is a drug that binds to dopamine receptors, acting like dopamine. Cyproheptadine is a serotonin receptor antagonist. Essentially it blocks serotonin receptors so the "message doesn't get through." It is known that certain serotonin receptors inhibit the release of dopamine (this is why people often report getting anhedonia/numbness/zombielike symptoms/loss of libido on SSRIs or other serotonergics), and cyprohetadine blocks those receptors so they won't inhibit dopamine. Selegiline is an MAOI (monoamine oxidase inhibitor) but blocks monoamine oxidase B which breaks down primarily dopamine. Using selegiline, then, would prevent the breakdown of dopamine and increase dopamine levels.

Since it appears that dopamine and norepinepherine play the biggest roles (especially through the activation of dopamine receptors DRD2 and DRD3) in emotional responsivity, reward, motivation, and pleasure, the resultant increase in dopamine would theoretically help alleviate anhedonic symptoms.

While serotonin has been hailed as the "at-fault" neurotransmitter in depression, there is no evidence to support the exclusivity of serotonin, and most scientists agree that serotonin is only part of the puzzle. Most people have the mistaken belief that depression is simply "a deficiency of serotonin," because this view is perpetuated through antidepressant ads, but any scientist would agree that it is far, far more complicated. While serotonin can help alleviate anxiety, help with insomnia, and help with many other depressive symptoms, the limbic system seems to be most at fault with anhedonia, and thus the "at-fault" neurotransmitters seem to be primarily dopamine and norepinepherine. Depression is a mental illness that effects signaling of many different neurotransmitters, and each neurotransmitter is responsible for its own set of jobs. Well, it turns out that some of the major "jobs" of dopamine and norepinepherine are emotional processing, motivation, arousal, and reward.

Edited by itstrevor
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Posted

Itstrevor --- you are right, it is a lot more complex than simply a shortage of serotonin or of any one neurotransmitter. There is a technical article on the neurocircuitry of depression that includes a section on the neurochemical systems implicated in depression [ and I do mean technical ! :) ]. Here is the link:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2522333/?tool=pubmed

I would add, that if you read or even skim the article, take it with a grain of salt. A lot of it is theoretical and many of the studies need to be replicated before they can be accepted as "fact". Also, depression is not a unitary condition--- like most disorders or illnesses it is a range and continuum of different things in different people.

:)

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Posted

Yes thank you ellemint! That's what I'm talking about, thanks for contributing! I will certainly extract the information for the benefit of everyone else and insert relevant info from it into my "anhedonic how-to guide."

It seems that the main parts of the brain that are affected in the case of anhedonia are the prefrontal cortex and the nucleus accumbens. I will go into more detail about this at a later date.

I have been reading alot about pramipexole, and it seems that it is a very promising solution to this problem. It has good affinities for D2/D3, it raises libido, lowers prolactin, is neuroprotective, increases 5HT firing as well as DR firing in the long run, desensitizes autoreceptors (autoreceptors are a feedback mechanism that tells the brain to "hold back"), studies show promise as a clinical treatment for depression and anhedonia, and has a lower side-effect profile than that of other Dopamine Agonists! I can't wait to try it out, and hope it works. If not, I still have Parnate (phenelzine) to fall back on. I'm starting at a 0.125mg 3x daily dose. Wish me luck!

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Hey

I'm very pleased to see this thread. I personally have now struggled for over 1,5 years with anhedonia; other symptoms of depression are hardly present. Everything that you've described fits me very well, including the "windows" to normal emotionality - I can think of six emotional moments during the last 1,5 years lasting from a couple of hours to two days.

But here's what confuses me. You - just like many others here - are convinced that this must be somehow totally physiological, and that the one and only treatment of choice is medication. I searched for your threads and noticed that you blame stress and isolation for your anhedonia, yet still you are convinced that the anhedonia is not psychological.

It is obvious that the anhedonia itself is physiological, a chemical thing. The "on-off" nature shows that quite clearly, I totally know that thing. But it doesn't mean that in the long term psychological factors wouldn't make a difference. I'm afraid you're on the wrong - dangerously wrong - track with your drug explorations.

I haven't spent time examining possible medications at all. I've been prescribed Concerta, Strattera and Perphenazine for co-morbid attention issues based on various clinical arguments, but I haven't even tried them except Concerta. Instead, I have been figuring myself out for the whole 1,5 year period. I didn't realize it's depression until about a month ago, yet I understood I don't feel content with my life from the day I started to go numb. My numbness started years ago but it firstly progressed very slowly. Then in the very beginning of 2011 I started to numb quickly, and after couple of months I was in a whole new state of mind - and my life hasn't been the same since. Now, at this point, the anhedonia hasn't chcanged - perhaps gone a bit more severe.

I am determined to change my life. NOT cure the anhedonia. Why? Because I feel as if anhedonia is only a symptom, after all. Depression can be caused by multiple things, but one reason - perhaps the most common one - is unsatisfactory life. Anhedonia acts as a warning mechanism, it says that "you've had enough of your s***, now change it".

You've tried many drugs and got only small, temporary reliefs. Here's a nice scenario for you: you'll find a drug that works, fell emotional, and go on your life as it used to be. After six months you've grown resistant to the drug, and you're a zombie again. Then you decide to try different approach, you find out what are you longing for, and try to make a change. Too bad that no drug works for you anymore - you can't get any help on your mission of making that change. It can be difficult without medication.

Generally - what's with the determination with purely physiological reasons behind depression? My natural stance towards depression is the opposite.

P.S. I've lacked overall contentment for life for six years and the tendency to continue living in such an unfulfilling way is deep in my character. Not an easy thing to change. But it's all I can do. Not gonna go for drugs and pretend "it's not my fault". And I say this with a very strong self-esteem!

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Posted

Hey

I'm very pleased to see this thread. I personally have now struggled for over 1,5 years with anhedonia; other symptoms of depression are hardly present. Everything that you've described fits me very well, including the "windows" to normal emotionality - I can think of six emotional moments during the last 1,5 years lasting from a couple of hours to two days.

But here's what confuses me. You - just like many others here - are convinced that this must be somehow totally physiological, and that the one and only treatment of choice is medication. I searched for your threads and noticed that you blame stress and isolation for your anhedonia, yet still you are convinced that the anhedonia is not psychological.

It is obvious that the anhedonia itself is physiological, a chemical thing. The "on-off" nature shows that quite clearly, I totally know that thing. But it doesn't mean that in the long term psychological factors wouldn't make a difference. I'm afraid you're on the wrong - dangerously wrong - track with your drug explorations.

I haven't spent time examining possible medications at all. I've been prescribed Concerta, Strattera and Perphenazine for co-morbid attention issues based on various clinical arguments, but I haven't even tried them except Concerta. Instead, I have been figuring myself out for the whole 1,5 year period. I didn't realize it's depression until about a month ago, yet I understood I don't feel content with my life from the day I started to go numb. My numbness started years ago but it firstly progressed very slowly. Then in the very beginning of 2011 I started to numb quickly, and after couple of months I was in a whole new state of mind - and my life hasn't been the same since. Now, at this point, the anhedonia hasn't chcanged - perhaps gone a bit more severe.

I am determined to change my life. NOT cure the anhedonia. Why? Because I feel as if anhedonia is only a symptom, after all. Depression can be caused by multiple things, but one reason - perhaps the most common one - is unsatisfactory life. Anhedonia acts as a warning mechanism, it says that "you've had enough of your s***, now change it".

You've tried many drugs and got only small, temporary reliefs. Here's a nice scenario for you: you'll find a drug that works, fell emotional, and go on your life as it used to be. After six months you've grown resistant to the drug, and you're a zombie again. Then you decide to try different approach, you find out what are you longing for, and try to make a change. Too bad that no drug works for you anymore - you can't get any help on your mission of making that change. It can be difficult without medication.

Generally - what's with the determination with purely physiological reasons behind depression? My natural stance towards depression is the opposite.

P.S. I've lacked overall contentment for life for six years and the tendency to continue living in such an unfulfilling way is deep in my character. Not an easy thing to change. But it's all I can do. Not gonna go for drugs and pretend "it's not my fault". And I say this with a very strong self-esteem!

Well I guess but the primary problem is that in therapy or "talking out" my problems its usually not more than that: I talk it out, but I still feel numb. There, to me, doesn't really seem to be much of an advantage, as I have positive thinking patterns already and my life is going just great, so all I would really be doing in therapy would be rehashing the same issue over and over: "hey, I'm still numb." And I really don't think that serves much therapeutic benefit... It's clear, to me at least, that this is a physiological issue, and its also clear that psychological approaches, at least thus far, have provided no relief.

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Very interesting thread. I've had anhedonia for years and years, and figured it was part of my depression, although I haven't felt the other symptoms of depression in awhile. Since 1990 I've been on so many different meds that 'work' for awhile, then I drift back into that hopeless, energyless place where I wish I would wake up dead each day. I've been told I have 'treatment resistant depression', but try to get up each day and carry on. Some might say that if I were truly depressed, I couldn't even do that. I don't know, but I just don't enjoy anything, and I don't anticipate enjoying anything. There's nothing that gets me jazzed up and excited. Sometimes I can get 'jazzed up' about a problem at work, but it's a negative thing.

I don't know if anhedonia is separate from depression, or just a symptom. Whatever, I wish I could feel there is a reason to do something, I wish I could get some enthusiasm. I've tried volunteering, or participating in something I used to enjoy, like choir, or biking, or kayaking.....but it's just a chore. I once described it to a friend as being aware you should be happy about something (like running into an old friend), and the best you can do is act 'as if' you're happy to see them, then making an excuse about needing to be somewhere.

So I'm no help at all. I used to analyze all the chemistry, read a lot of books about how to get rid of this.....but I've given up. Seriously.

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Posted (edited)

Very interesting thread. I've had anhedonia for years and years, and figured it was part of my depression, although I haven't felt the other symptoms of depression in awhile. Since 1990 I've been on so many different meds that 'work' for awhile, then I drift back into that hopeless, energyless place where I wish I would wake up dead each day. I've been told I have 'treatment resistant depression', but try to get up each day and carry on. Some might say that if I were truly depressed, I couldn't even do that. I don't know, but I just don't enjoy anything, and I don't anticipate enjoying anything. There's nothing that gets me jazzed up and excited. Sometimes I can get 'jazzed up' about a problem at work, but it's a negative thing.

I don't know if anhedonia is separate from depression, or just a symptom. Whatever, I wish I could feel there is a reason to do something, I wish I could get some enthusiasm. I've tried volunteering, or participating in something I used to enjoy, like choir, or biking, or kayaking.....but it's just a chore. I once described it to a friend as being aware you should be happy about something (like running into an old friend), and the best you can do is act 'as if' you're happy to see them, then making an excuse about needing to be somewhere.

So I'm no help at all. I used to analyze all the chemistry, read a lot of books about how to get rid of this.....but I've given up. Seriously.

I guess this seems to reiterate my point... It seems that the people who experience anhedonia have it long term... I seldom hear people having it, then it going away, but instead read that they have it going on and on for years and years without relief. I do hope we can find someone who has gotten out of this and find some sort of relief.

Did you ever experience "windows?" What did you read specifically?

Edited by itstrevor
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Adonenhia stinks, in my case it blocks my attention from reaching the root of any experience or emotion, so emotions can't be released or experienced at their core. It gives the feeling of being blank, empty without sensation of depression. I believe it is caused by entangled emotions and thoughts that never got expressed properly. What's helped for me is to keep active, it helps to raise the frequency of my attention and allows more of a feeling of connection to self and surroundings. Other than that it really sucks the life out of you.

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As far as strategies that work to counter anhedonia, I find mindfulness helpful -- by that I mean focusing my attention as much as possible on the present moment, whatever I am doing, whether washing a dish or taking a walk. Approaching it non-critically, and not focusing on thoughts of the past or future. And if my mind wanders, which it always does, that's the nature of the mind, gently bringing it back to the present. Also focusing on the senses of sight, hearing, touch, vision and smell of the present moment. This happens naturally when you are really absorbed in a task --- but it is a useful skill that you can also PRACTICE anytime anywhere It's not like this makes me experience great enjoyment of that moment and whatever I'm doing, but it does seem to help a little.

:)

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Posted (edited)

Here is the update: after seeing my psychiatrist I was pleased to hear that she prescribed me Mirapex (pramipexole), a dopamine agonist. She also said that she was most likely going to put me on Parnate (MAOI phenelzine) in about 2 weeks (waiting for the desipramine to flush out completely and also for my liver to restore itself).

The strategies that seem to be successful at treating anhedonia are:

Antagonization of serotonergic receptors 5HT1A, 5HT2 and 5HT3.

Agonization of dopamine receptors DRD2 and DRD3.

Lowering prolactin.

Blocking the reuptake of Norepinepherine/Dopamine.

Inhibiting Monoamine Oxidase.

Thyroid Augmentation.

Direct release of catecholamines from storage vesicles.

Enchancing the reuptake of serotonin.

Taking dopamine precursors or supplements.

ECT? rTMS?

I have already tried norepinepherine reuptake with Wellbutrin (bupropion) and Desipramine without any effect. I have also used stimulants Ritalin and Adderall for a direct release of catecholamines (dopamine, epinepherine, norepinepherine) from storage vesicles with marginal improvements. Taking Mirapex (pramipexole) will agonize DRD2 and DRD3 receptors and Parnate will inhibit monoamine oxidase to raise monoamine levels (dopamine, norepinepherine, etc.). This looks very promising, I will keep everyone updated. The doctor said that there should be some response within 4-8 or so weeks.

Hopefully I will see some positive results and report back with the good news for the benefit of everyone else experiencing this debilitating condition.

Drugs that target the glutmatergic system of the brain show promise in alleviating depression --- here is a link to a scientific article on the topic. But as far as I know these agents are still in developmental stages.

http://www.ncbi.nlm....pubmed/20825266

Edited by ellemint

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Well I guess but the primary problem is that in therapy or "talking out" my problems its usually not more than that: I talk it out, but I still feel numb. There, to me, doesn't really seem to be much of an advantage, as I have positive thinking patterns already and my life is going just great, so all I would really be doing in therapy would be rehashing the same issue over and over: "hey, I'm still numb." And I really don't think that serves much therapeutic benefit... It's clear, to me at least, that this is a physiological issue, and its also clear that psychological approaches, at least thus far, have provided no relief.

Man, I hear you. I'm exactly the same; I'm actually very positive and I've got better things in m life than ever. If I'd just go see a therapist and say I'm numb I'd probably be told to not think negatively, look for good things in life, focus on the positive and then start to exercise, eat healthy, get more sleep and sunlight, go socialize, talk to caring people, work, keep busy. But I've got all that already! Well, not exactly anymore as the numbing has gotten so bad that I often find myself just sitting doing nothing for hours. Nothing seems meaningful. BUT.

I have a very problematic personality, possibly to the extent of a personality disorder. And because of that, despite all the good things in my life, I do not find emotional connection with people. This was already before the universal anhedonia, and I now know that when the anhedonia started, this started to bother me. So actually nothing changed in my life, I just had had enough of the lack of meaningful social relationships.

With a great probability, this is not the case with you. But perhaps something similar. What if you're lacking something else? Why are you so sure it's so purely physiological?

A lot of people say it's so permanent, they've had it for ******* decades. But here's a thing to consider: all they've done had been trying millions of meds. What about looking in the mirror and thinking maybe I'm doing something wrong? Why is this not a possibility? Why are you so certain you'r life is just fine and it's all a God's whim, nothing to do with your choices or the world around you?

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Well I guess but the primary problem is that in therapy or "talking out" my problems its usually not more than that: I talk it out, but I still feel numb. There, to me, doesn't really seem to be much of an advantage, as I have positive thinking patterns already and my life is going just great, so all I would really be doing in therapy would be rehashing the same issue over and over: "hey, I'm still numb." And I really don't think that serves much therapeutic benefit... It's clear, to me at least, that this is a physiological issue, and its also clear that psychological approaches, at least thus far, have provided no relief.

Man, I hear you. I'm exactly the same; I'm actually very positive and I've got better things in m life than ever. If I'd just go see a therapist and say I'm numb I'd probably be told to not think negatively, look for good things in life, focus on the positive and then start to exercise, eat healthy, get more sleep and sunlight, go socialize, talk to caring people, work, keep busy. But I've got all that already! Well, not exactly anymore as the numbing has gotten so bad that I often find myself just sitting doing nothing for hours. Nothing seems meaningful. BUT.

I have a very problematic personality, possibly to the extent of a personality disorder. And because of that, despite all the good things in my life, I do not find emotional connection with people. This was already before the universal anhedonia, and I now know that when the anhedonia started, this started to bother me. So actually nothing changed in my life, I just had had enough of the lack of meaningful social relationships.

With a great probability, this is not the case with you. But perhaps something similar. What if you're lacking something else? Why are you so sure it's so purely physiological?

A lot of people say it's so permanent, they've had it for ******* decades. But here's a thing to consider: all they've done had been trying millions of meds. What about looking in the mirror and thinking maybe I'm doing something wrong? Why is this not a possibility? Why are you so certain you'r life is just fine and it's all a God's whim, nothing to do with your choices or the world around you?

Well I guess when I try to look at myself and wonder what is "holding me up" I end up just getting frustrated, because I end up empty handed. I just really can't see there being any reason for feeling this way, and intuitively I know that I care about things, but the signal just isn't getting through. I mean, I have a good future, I have a great family, I'm not stressed anymore, I know it's possible to get into a romantic relationship, yet due to the numbness I just can't, I just can't seem to find anything to psychologically warrant a total numbing of my emotions. In fact, going to see a therapist is almost worse for me, since I go in and they tell me that I need to think a certain way, or do certain things better, as if I'm not already doing the best that I can, and as if my problem is my own fault and somehow under my cognitive control. I just end up getting frustrated with the therapist. I know people are often very reluctant to accept an emotional disorder as a purely physiological phenomenon because it leaves no accountability for the patient's actions and their contribution to the illness, and because of the cultural reluctancy towards psych meds, but honestly I continually try mustering every fiber of my mental being to being positive or getting out, socializing, exercising, and paying attention to my habits, but to put it in terms that people might understand; it doesn't matter how many times you flick the switch if the wires are disconnected from the light bulb. Regardless of the attitudes that I employ towards the world, my numbness just seems to be unaffected. That is not to say that some people might benefit more from therapy, as it statistically is shown that therapy has 60% efficacy in fighting depression, though I sometimes believe that there is a strong placebo bias in this "efficacy," which unfortunately does not affect me due to my higher reasoning, skeptical and critical nature. I have been the victim of the placebo effect before; I remember really wanting certain medications to work, so I was more inclined to say things like "my anhedonia is lifting," or "I think that I am starting to feel certain emotions again," when in reality I was not.

Now, often times the thought has crossed my mind that "perhaps the reason that I know I care about things but the feeling just isn't there is because all of the distress I've had has made me callous." The truth of the matter is that this is a false understanding of anhedonia. Studies repeatedly show that depression exists in all societies and cultures and does not discriminate by socioeconomic background. This tells us that in spite of how "stressful" life is, or how "bad off" we are, we can still adapt and be happy, provided that there is enough time for a gradual adaptation. Those impoverished in Africa do not experience more depression than people in wealthier countries. Think about this; in Kindergarten, most children are carefree and have life easy, but by the time they reach college, they have to study, work, have responsibilities and more. In Kindergarten the responsibilities of adulthood would have seemed overwhelming, and if imposed immediately on a Kindergartener, it would have been overwhelming and emotionally distressing, yet over a period of many years, a Kindergartener gradually learns to adapt to the responsibilities of adulthood. Though there is a significantly larger amount of stress, a college-aged person has the same emotional capacity as a Kindergartener. Both a Kindergartener and a young adult can still love, enjoy things, have interests, etc. An anecdotal example from my life would be that the loss of a relationship several years ago at the time would have seemed to be the end of the world, but over time there is acceptance, and I have been able to move on.

My point is that if you are experiencing anhedonia, it is most likely a symptom of a mood disorder, not the inevitable outcome of everyday stressors or a personal weakness.

Now, I would like to give an update with my Mirapex trial so far. This is my second day taking 0.125mg 3x daily, and I have to say the first day I felt exhausted and a bit drowsy. Today, not so much, but apparently this is a common side effect. I have heard that it could take a few weeks for it to fully kick in because of reverse feedback mechanisms (autoreceptors in the brain inhibiting dopamine due to the flood of pramipexole which later are desensitized to allow the pramipexole to work without the inhibition, or something like that). So far, I have not noticed any impact on my mood, emotions, or libido.

Now I am still waiting to begin my Parnate trial (sorry, the generic name for Parnate is actually tranylcypromine, not phenelzine as I previously posted). As I have written before, Parnate is an MAOI, and is often considered one of the most efficacious antidepressants available, as it raises levels of all major neurotransmitters in almost all parts of the brain, whereas other antidepressants usually focus on one or two, mostly serotonin, and only focus on certain brain regions. It is no wonder that Parnate is often referred to as the "nuclear bomb" of antidepressant medications, and has a good track record compared to others. Will Parnate live up to the hype?

Immediately I have mixed feelings towards Parnate, as there are inconsistent anecdotal reports/user reviews - some report it to help with libido/drive/emotional responsivity, while others report more emotional flatness/anhedonia. Well, unfortunately along with dopamine, norepinepherine, and others, Parnate also raises that ***** of a neurotransmitter, serotonin, which often ruins depressed people's fun, so it's no surprise that it doesn't universally help with the anhedonia. Serotonin is much like that prude cockblocker of a friend of yours that you can't get away from and who always seems to get in your way and steal away your fun. Seriously, I have to jump through hoops with some psychiatrists just to not get pummeled with drugs that raise this ***** of a neurotransmitter to make my anhedonia and zombielike feelings worse. I'm crossing my fingers and hoping for the best! If it does cause more blunting, there are always serotonin receptor antagonists or selegiline.

I went onto many drug review websites and polled all of the reviews and studied what each person was saying to determine the percentages of responses. For each response, I studied what the person was saying and categorized what they said and matched them based on what they most fit into into a few different categories:

18.75% SPECIFICALLY mentioned Parnate helping with anhedonic symptoms

18.75% SPECIFICALLY mentioned Parnate making anhedonic symptoms worse (though a vast majority saying this also said that they experienced significant help in their depression with it)

58.75% Had OTHER successes with Parnate in helping significantly with depression, not mentioning anhedonia or related symptoms in their review

3.75% hated Parnate and did not experience any benefit and/or had a bad experience with it

18.75% + 18.75% + 58.75% + 3.75% = 100%

So basically 77.5% said that Parnate either helped with anhedonia or said it helped with depression without mentioning anhedonic symptoms, and if you count people that mentioned it made some anhedonic symptoms worse, but overall helped with the depression, the number is well over 77.5%.

The most commonly heard things about this drug are:

"It gave me insomnia/sleep problems!"

"It gave me dry mouth!"

"I've tried everything out there (SSRIs, SNRIs, Wellbutrin, Remeron, Stimulants, Augments, Tricyclics, etc.), and this is the only thing that has helped me!"

"This was a miracle drug!"

"It worked within days!"

Okay, so what I gather from this data is that Parnate is equally likely to help with anhedonia as to make it worse, but has an overwhelmingly high chance of helping with depression overall, with the most common side effects being insomnia and dry mouth. The fact that people mentioning a worsening of anhedonic symtoms but paradoxically a lift in their depression at the same time seemingly supports my idea that anhedonia/apathy is more of a separate issue than most depressive symptoms and can't always be treated in the same way. Let's give this baby a whirl.

Edited by itstrevor
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Well I guess when I try to look at myself and wonder what is "holding me up" I end up just getting frustrated, because I end up empty handed. I just really can't see there being any reason for feeling this way, and intuitively I know that I care about things, but the signal just isn't getting through. I mean, I have a good future, I have a great family, I'm not stressed anymore, I know it's possible to get into a romantic relationship, yet due to the numbness I just can't, I just can't seem to find anything to psychologically warrant a total numbing of my emotions. In fact, going to see a therapist is almost worse for me, since I go in and they tell me that I need to think a certain way, or do certain things better, as if I'm not already doing the best that I can, and as if my problem is my own fault and somehow under my cognitive control. I just end up getting frustrated with the therapist. I know people are often very reluctant to accept an emotional disorder as a purely physiological phenomenon because it leaves no accountability for the patient's actions and their contribution to the illness, and because of the cultural reluctancy towards psych meds, but honestly I continually try mustering every fiber of my mental being to being positive or getting out, socializing, exercising, and paying attention to my habits, but to put it in terms that people might understand; it doesn't matter how many times you flick the switch if the wires are disconnected from the light bulb. Regardless of the attitudes that I employ towards the world, my numbness just seems to be unaffected. That is not to say that some people might benefit more from therapy, as it statistically is shown that therapy has 60% efficacy in fighting depression, though I sometimes believe that there is a strong placebo bias in this "efficacy," which unfortunately does not affect me due to my higher reasoning, skeptical and critical nature. I have been the victim of the placebo effect before; I remember really wanting certain medications to work, so I was more inclined to say things like "my anhedonia is lifting," or "I think that I am starting to feel certain emotions again," when in reality I was not.

Now, often times the thought has crossed my mind that "perhaps the reason that I know I care about things but the feeling just isn't there is because all of the distress I've had has made me callous." The truth of the matter is that this is a false understanding of anhedonia. Studies repeatedly show that depression exists in all societies and cultures and does not discriminate by socioeconomic background. This tells us that in spite of how "stressful" life is, or how "bad off" we are, we can still adapt and be happy, provided that there is enough time for a gradual adaptation. Those impoverished in Africa do not experience more depression than people in wealthier countries. Think about this; in Kindergarten, most children are carefree and have life easy, but by the time they reach college, they have to study, work, have responsibilities and more. In Kindergarten the responsibilities of adulthood would have seemed overwhelming, and if imposed immediately on a Kindergartener, it would have been overwhelming and emotionally distressing, yet over a period of many years, a Kindergartener gradually learns to adapt to the responsibilities of adulthood. Though there is a significantly larger amount of stress, a college-aged person has the same emotional capacity as a Kindergartener. Both a Kindergartener and a young adult can still love, enjoy things, have interests, etc. An anecdotal example from my life would be that the loss of a relationship several years ago at the time would have seemed to be the end of the world, but over time there is acceptance, and I have been able to move on.

My point is that if you are experiencing anhedonia, it is most likely a symptom of a mood disorder, not the inevitable outcome of everyday stressors or a personal weakness.

First of all, I have to say that who knows, maybe you're right about your condition. I really can't know what's your case, first because I'm not a psychiatrist and second because I don't know much about you. So even though the following text is all about "you" and gives "you" advice and suggestions, it's more of general pondering... not claiming I know anything for sure! So.

I have (mild) Asperger syndrome myself, so I have the rational mindset too and thus CBT is no use for me, just like it is no use for you.But there are different forms of therapy. There are therapies that are designed to relieve symptoms (CBT for example), and then there are therapies that are designed to find out about underlying causes for mental problems - psychodynamic therapies for example. I'm sure you know all this, but I want to emphasize the fact that not all psychology is about ways of thinking and behavioral patterns. If you want, here's a link to this very great article about Asperger depression: http://www.aane.org/asperger_resources/articles/miscellaneous/aspergers_depression.html It's short and pithy, nothing too scientific though, just experiences of a laywoman.

You say that "those impoverished in Africa do not experience more depression than people in wealthier countries". Not sure if you refer to those under the influence of war, dangers and badly functioning societies of the modern-day Africa or those living simply in the very original, ancient "poor" way. As for the latter, they actually experience depression LESS. This has been studied. So, lifestyle does effect depressiveness a lot. It can be argued if the old-school lifestyle makes people more happy than the modern way, but the clinical mood disorders are more common in our society than in collectivist cultures.

It is interesting that you say that people don't want to blame physiology as I've witnessed exactly the opposite; people are reluctant on accepting the possible psychological explanation. How many on these forums are NOT on meds? Not many... people say depression is an "illness", that it's not one's "fault", that it must be "cured". It's not easy to accept the fact that in order to overcome the s***ty mental state one actually may need to make huge changes. Change one's self or one's surroundings. Not an easy task. It's much easier to blame it all on physiology and drug oneself. But look at the people... who have actually found permanent relief from meds?

Let me say this again: you said that your depression is due to stress and isolation. How is this not psychological??? I understand that the stress and isolation are not present anymore. But if they triggered the depression, a link to psychology exists. Of course anhedonia itself is physiological, it's not an emotion but a lack of ability to feel. But it was caused by psychological factors. Perhaps you were not fully content with your life and when the stress and isolation got overwhelming, depression landed on you. Now your life may be better but it's still not as good as it should be, and since the depression already got the best of you, it won't let go until everything's fixed. Your needs must be met.

A question for you: if the anhedonia would be cured, would you be content with your life? Be honest with yourself, would your life be good then? If yes, then your depresison truly must be something physiological. But if you would feel that not everything is right, then whatever would be wrong is probably causing your depression.

For a long time I just wanted my anhedonia to go away. I felt everything's right except the anhedonia. But now I've realized that if I wouldn't be anhedonic anymore, things still wouldn't be good enough. Actually, I'd probably end up miserable in another way. If meds would make me feel again, then my body would find other ways to show me that not everything is right; perhaps I would become resistant to the meds, perhaps I would become depressed in the very emotional way.

This is all very hypothetic, but I think it's worth considering. Why? Because as we can see, meds have rarely if ever brought long-term help. They're a great help, but only for the worst times. I mean, who here has actually found long-lasting happiness thanks to pills?

Edited by Vieno
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Well I guess when I try to look at myself and wonder what is "holding me up" I end up just getting frustrated, because I end up empty handed. I just really can't see there being any reason for feeling this way, and intuitively I know that I care about things, but the signal just isn't getting through. I mean, I have a good future, I have a great family, I'm not stressed anymore, I know it's possible to get into a romantic relationship, yet due to the numbness I just can't, I just can't seem to find anything to psychologically warrant a total numbing of my emotions. In fact, going to see a therapist is almost worse for me, since I go in and they tell me that I need to think a certain way, or do certain things better, as if I'm not already doing the best that I can, and as if my problem is my own fault and somehow under my cognitive control. I just end up getting frustrated with the therapist. I know people are often very reluctant to accept an emotional disorder as a purely physiological phenomenon because it leaves no accountability for the patient's actions and their contribution to the illness, and because of the cultural reluctancy towards psych meds, but honestly I continually try mustering every fiber of my mental being to being positive or getting out, socializing, exercising, and paying attention to my habits, but to put it in terms that people might understand; it doesn't matter how many times you flick the switch if the wires are disconnected from the light bulb. Regardless of the attitudes that I employ towards the world, my numbness just seems to be unaffected. That is not to say that some people might benefit more from therapy, as it statistically is shown that therapy has 60% efficacy in fighting depression, though I sometimes believe that there is a strong placebo bias in this "efficacy," which unfortunately does not affect me due to my higher reasoning, skeptical and critical nature. I have been the victim of the placebo effect before; I remember really wanting certain medications to work, so I was more inclined to say things like "my anhedonia is lifting," or "I think that I am starting to feel certain emotions again," when in reality I was not.

Now, often times the thought has crossed my mind that "perhaps the reason that I know I care about things but the feeling just isn't there is because all of the distress I've had has made me callous." The truth of the matter is that this is a false understanding of anhedonia. Studies repeatedly show that depression exists in all societies and cultures and does not discriminate by socioeconomic background. This tells us that in spite of how "stressful" life is, or how "bad off" we are, we can still adapt and be happy, provided that there is enough time for a gradual adaptation. Those impoverished in Africa do not experience more depression than people in wealthier countries. Think about this; in Kindergarten, most children are carefree and have life easy, but by the time they reach college, they have to study, work, have responsibilities and more. In Kindergarten the responsibilities of adulthood would have seemed overwhelming, and if imposed immediately on a Kindergartener, it would have been overwhelming and emotionally distressing, yet over a period of many years, a Kindergartener gradually learns to adapt to the responsibilities of adulthood. Though there is a significantly larger amount of stress, a college-aged person has the same emotional capacity as a Kindergartener. Both a Kindergartener and a young adult can still love, enjoy things, have interests, etc. An anecdotal example from my life would be that the loss of a relationship several years ago at the time would have seemed to be the end of the world, but over time there is acceptance, and I have been able to move on.

My point is that if you are experiencing anhedonia, it is most likely a symptom of a mood disorder, not the inevitable outcome of everyday stressors or a personal weakness.

First of all, I have to say that who knows, maybe you're right about your condition. I really can't know what's your case, first because I'm not a psychiatrist and second because I don't know much about you. So even though the following text is all about "you" and gives "you" advice and suggestions, it's more of general pondering... not claiming I know anything for sure! So.

I have (mild) Asperger syndrome myself, so I have the rational mindset too and thus CBT is no use for me, just like it is no use for you.But there are different forms of therapy. There are therapies that are designed to relieve symptoms (CBT for example), and then there are therapies that are designed to find out about underlying causes for mental problems - psychodynamic therapies for example. I'm sure you know all this, but I want to emphasize the fact that not all psychology is about ways of thinking and behavioral patterns. If you want, here's a link to this very great article about Asperger depression: http://www.aane.org/...depression.html It's short and pithy, nothing too scientific though, just experiences of a laywoman.

You say that "those impoverished in Africa do not experience more depression than people in wealthier countries". Not sure if you refer to those under the influence of war, dangers and badly functioning societies of the modern-day Africa or those living simply in the very original, ancient "poor" way. As for the latter, they actually experience depression LESS. This has been studied. So, lifestyle does effect depressiveness a lot. It can be argued if the old-school lifestyle makes people more happy than the modern way, but the clinical mood disorders are more common in our society than in collectivist cultures.

It is interesting that you say that people don't want to blame physiology as I've witnessed exactly the opposite; people are reluctant on accepting the possible psychological explanation. How many on these forums are NOT on meds? Not many... people say depression is an "illness", that it's not one's "fault", that it must be "cured". It's not easy to accept the fact that in order to overcome the s***ty mental state one actually may need to make huge changes. Change one's self or one's surroundings. Not an easy task. It's much easier to blame it all on physiology and drug oneself. But look at the people... who have actually found permanent relief from meds?

Let me say this again: you said that your depression is due to stress and isolation. How is this not psychological??? I understand that the stress and isolation are not present anymore. But if they triggered the depression, a link to psychology exists. Of course anhedonia itself is physiological, it's not an emotion but a lack of ability to feel. But it was caused by psychological factors. Perhaps you were not fully content with your life and when the stress and isolation got overwhelming, depression landed on you. Now your life may be better but it's still not as good as it should be, and since the depression already got the best of you, it won't let go until everything's fixed. Your needs must be met.

A question for you: if the anhedonia would be cured, would you be content with your life? Be honest with yourself, would your life be good then? If yes, then your depresison truly must be something physiological. But if you would feel that not everything is right, then whatever would be wrong is probably causing your depression.

For a long time I just wanted my anhedonia to go away. I felt everything's right except the anhedonia. But now I've realized that if I wouldn't be anhedonic anymore, things still wouldn't be good enough. Actually, I'd probably end up miserable in another way. If meds would make me feel again, then my body would find other ways to show me that not everything is right; perhaps I would become resistant to the meds, perhaps I would become depressed in the very emotional way.

This is all very hypothetic, but I think it's worth considering. Why? Because as we can see, meds have rarely if ever brought long-term help. They're a great help, but only for the worst times. I mean, who here has actually found long-lasting happiness thanks to pills?

The thing is that yes, psychological factors contributed greatly to the onset of the depression and to the physiological changes that occurred, but now that those factors have been removed, my residual anhedonia/depression is not perpetuated by psychological factors, but by the unchanging physiological state left over from the psychological trigger. Since the psychological circumstances that led up to the depression (chronic stress, academic demands, failing relationship, moving from home to an uncomfortable environment, not having personal space, etc.) are now absent, it would not make sense that therapies aimed at resolving psychological factors would be useful, since the psychological factors contributing to the depression are now already absent, and I am now only dealing with the physiological changes brought about by the initial trigger. My thought patterns and behaviors are essentially unchanged from my previous pre-trigger state, with the exception that I am now unable to feel emotion (though I try to behave as if I do, just to eliminate any deviance from the pre-trigger state and thus the possibility of psychological contributions to the anhedonic depression). The spontaneous instantaneous "windows" also shows that the nature of the anhedonia is not under conscious control, is physiological, and is independent of thought patterns or other psychological factors.

The observation that medications often do not provide full relief demonstrates the limitations of chemical therapy in removing depressive symptoms but does not show that the alternative, psychological therapy, is necessarily more beneficial. That is not to say that I wouldn't prefer that psychological treatments be more beneficial, but in my case chemical treatments seem to be the only option left.

I would say that if anhedonic symptoms were removed, I would be very content with my life as of now, but am unable to emotionally attach to the present due to being emotionally disconnected. This is one of the most frustrating aspects of anhedonic depression.

And my update on my pramipexole Mirapex trial is that I am currently on day three of taking 0.125mg 3x daily and still do not feel any emotional/libidinal benefits. I am hoping to feel some progress once I elevate the dose or wait until the "adaption phase" is over.

Edited by itstrevor
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Also the pramipexole is making me feel extremely tired/drowsy

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Also the pramipexole is making me feel extremely tired/drowsy

Thanks for the update itstrevor --- I hope this combo proves helpful.

wishing you well,

ellemint

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All right this is day 6 on Mirapex. So far I have felt absolutely no effect on my mood, emotion, or libido whatsoever. The only thing I have felt is an increase in tiredness and a possibility that I am feeling more "zombielike," though I am not sure completely. I am only taking 0.125mg 3x daily, so perhaps I need to increase the dose, as many people take at least 10x that amount (more than 3mg daily), I have also read that it may take time before effects are noticed because "autoreceptors" must be downregulated/desensitized (these "autoreceptors" are dopamine receptors that act as a negative feedback mechanism and inhibit excessive dopamine release). It seems that the time this takes is around 2 weeks.

I did get my liver panel done again today and will get the results tomorrow to see if I am "in the clear" to take Parnate. I will also be speaking with my psychiatrist tomorrow.

Things have been very rough, and I am feeling increasingly more pessimistic. Positive anecdotal reports I have read online about Mirapex at first glance seem to be relatively common, yet it seems that they mostly stem from one user on psychobabble - a user named Chris or ChrisK or something. There are many negative experiences and many that seem to suggest that Mirapex paradoxically INCREASES anhedonia in addition to having severe withdrawal. Well, I guess I can only hope for the best.

I just find it really weird that I felt NO difference on wellbutrin, desipramine, abilify, effexor, adderall, ritalin (none on ritalin after the initial first week), and now Mirapex. I tried the highest dose on most of these meds... I just don't get it - are the antidepressants SUPPOSED to be this weak? What a joke! Like are they supposed to cause subtle little effects? I really need something to make a drastic change, and so far it seems that these ADs are too painfully weak.

Also, are the antidepressants supposed to just decrease feelings of sadness/anxiety/depression or do they also increase the ability to feel GOOD? So far it seems that ADs, especially serotonergics, are mainly just mood blunters (not to say that the norepinepherine dopamine meds are much better, they just seem to do nothing at all). Is this the best we have?? I am beginning to feel that unless a drug really makes me feel high I won't get any feeling comparable to the feeling of being high on life I had before this depression. And that's not a sustainable solution. So it pretty much looks like I'm just f****d. I mean, I don't want to not feel bad, I just want to be ABLE to feel GOOD when appropriate - to cry when appropriate, to laugh or mourn when appropriate. To just be normal. Not to just feel nothing at all. As far as I'm concerned blunting mood to create an "antidepressant effect" or the use of the placebo effect as a primary mechanism to fight this to me is really bulls**t.

Even if I find an AD that has a positive effect, will it make me feel "normal" or just a bit better and different? I really miss the old me and am not looking forward to a slightly improved "new me" that is marginally helped by ADs.

I mean, I'm 20 and I can't feel love or affection or attraction... What sort of bulls**t is this? I'd rather just take nothing at all than drugs that don't do anything or that have primary side effects "loss of libido" "flattened emotions" "apathy."

The depression doesn't seem to be changing at all in severity which probably means it's chronic. I wonder what people mean by "chronic?" Does that mean it won't go away and you just have to live with it? Or it just takes longer to go away? I don't know, it seems that I always get things sugar coated because nobody wants to make me feel worse. From most of the anecdotal reports I read about anhedonia, it doesn't seem to get better for alot of people. I feel like I'm on a sinking ship, and on several occasions I've listened to the military taps song thinking about my destroyed life to symbolize what I've lost.

God, if this parnate doesn't work, since it's supposed to be the most powerful AD available, and I don't get any improvements from this years from now, I'm seriously debating on whether or not I want to just ease my pain with some sort of illegal substance. I mean, the way I see it, if I'm f****d anyways, I might as well go out happier than to give in and just let it leave me with nothing at all until I die or grow old.

EDIT: Sorry for the negative post, I'm just having difficulty because the despair is so severe. And I know what some of you are thinking, "these thought patterns could really use some changing through CBT or therapy." Well, this despair isn't really generated much from thoughts. It's more from the chronic absence of any sort of joy or pleasure or reward. I highly doubt any time with a therapist would alleviate any of this sense of despair. Think of it this way; if you were a slave and were not paid for laboring all day every day without a break and were deprived of food or water and thus were experiencing intense longings/pain for those things then someone tells you "stop thinking so negatively about it, you could really use some CBT" do you think you would experience any less hunger/thirst pangs from thinking about it differently? Well, if you really think so I dare you to try it. EXCUSE ME FROM DYING FROM HUNGER AND THIRST. It's almost insulting, to me at least. It's like yeah, I can think about it differently, but the suffering is still there. Someone telling me to think it away or cope with it is just sort of infuriating. That's my opinion at least. It doesn't really get to the heart of the issue and it is really distracting from getting any real help by masking it with trying to just "cope with it" ("coping mechanisms," etc.). Believe me, I'm already "coping" the best that I can.

Edited by itstrevor

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