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


itstrevor

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I don't understand when people say they don't have feelings. I have all my feelings, they are there and believe me they are there all the way... I think there must be two forms of anhedonia, one with no emotions and one with a dead feeling. Whoever wrote that did not mention the dead feeling even once. If you have it then you know exactly what I'm talking about and it is not something you would overlook or fail to mention.

Of course this "dead feeling" is not an emotion. There just isn't any other way to describe it. To me it has to be a lack of consciousness because my emotions are there without a doubt.

Edited by IWantToFeelAlive
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Hey i wanttofeelalive, do you have blank mind and no sense of self also? I also think i have all my emotions too. I can cry and laugh depending on the situation. Best way i can explain it is that the intensity of my emotions is so low that it just appear to me that i have no emotions at all. As an analogy, compare emotions with a radio. You can change the channels on the radio the same way my emotions can go from bad to good. However turn the volume of the radio to 1% or maybe even 0.5% and then it wont really matter what channel you put the radio on. All will be the same. Its basically the same with my emotions. I have all of them. But the volume is just so low that it doesnt make a difference to my experience. Everything is just a non experience to me. Its not even dysphoric, its just purely nothing.

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I am really not surprised that Wellbutrin didn't do anything. It works mainly on norepinepherine, which, to put it simply, increases alertness and arousal, but not really emotions or reward salience directly. I would stay away from tonic dopaminergics like dopamine agonists. Didn't seem to do anything for me, and may have made things worse. I don't think there is any proof of effectiveness for them, and, if there is, it probably produces oppositional tolerance anyways.

I really think that most people will find relief if this is waited out and people try to avoid stress and live normally in the given timeframes. SSRIs and panic aren't neurotoxic (that I am aware of) and only produce dendritic pruning (which does not automatically equal depression, but may be a feedback mechanism to allow for the extinction of anxious memories) and receptors and receptor densities should, in theory, re-regulate to allow for proper monoamine signal transduction.

Stay away from benzos, opiates, too much MJ, stimulants, alcohol, too much caffeine, too much sugar, too much stress, overdoing supplements, and other counterproductive things like dopamine agonists. You will see my experience with them earlier in the thread. You have been warned.

Haven't tried buspar, but, again....oppositional tolerance

Anyways, as to how I am doing, it seems to be a bit "up and down" so to speak. I might get a little window here and there, but then there are a few days where I feel really slow (poor cognitive skills, short term memory, word-finding difficulties, blunting, etc.) and then spontaneously feel a lift for a few days. This does not seem predictable, but I am confident it will abate given a sufficient amount of time.

Edited by itstrevor
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This is a beautiful, original and simply amazing representation of anhedonia/emotional numbness...Please check it out... it offers some hope at the end. May we all find our piece of corn some day!

http://hyperboleandahalf.blogspot.be/2013/05/depression-part-two.html

I think she actually feels better now:

http://thehairpin.com/2013/11/allie-brosh

Thank you for that reminder sc2

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and trevor,

the tongue biting thing makes me think of pent-up energy. How much do you exercise? Do you run or do any kind of moderate exercise on a regular basis?

Anyone else - do any of you exercise on a regular basis?

Someday I'd like to graph the degree/frequency of exercise in relation to feelings of anhedonia. I'm sure there's probably a relationship, but it's hard to say what it means. I'm just curious as to how much the people on this forum exercise, how much they're willing and able to exercise. If it has any effect on their mental state.

I exercise as much as I can possibly can. Usually run for 34 min, elliptical for 20 min, then some mild-moderate weight lifting. Roller Derby has helped but for me, it's getting off the couch or out of bed to do these things. I know it'll make me feel better (for a few hours anyways), but mentally, I'm just not there. It really takes a lot of energy to convince myself that I need to go.

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This is a beautiful, original and simply amazing representation of anhedonia/emotional numbness...Please check it out... it offers some hope at the end. May we all find our piece of corn some day!

http://hyperboleandahalf.blogspot.be/2013/05/depression-part-two.html

If you haven't already, buy this book. Not only is it funny, but the writer is so relatable. Best 12 dollars I've spent in a LONG time.

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So I'm seeing my psychiatrist next week and my blunting has been pretty bad this last couple of days (not sure why, I guess it waxes and wanes). Anybody have any ideas of what to say? I'm pretty sure I know how it's going to go down.

ME: I have been off of the sertraline for about a month now after a 2 month taper and I saw gradual improvement, but I'm not really there and this past week the blunting has gotten really bad. In fact, I can't really say I feel much different than I did on the Zoloft after a slow taper.

POSSIBLE RESPONSES FROM HIM:

It's the underlying condition

Exercise

Wait longer

Stop worrying about it. Worrying makes it worse. Do you need to see a therapist about this?

Go back on an SSRI

It's in your head

If you don't feel like doing something don't do it. If you don't enjoy something you simply just don't enjoy it.

Try (Insert Mood Blunting or Tolerance Forming Medication Here)

You must be depressed

You must be anxious

Try doing the things you would like anyways

The truth is, I kind of want some answers from him just like all of us do, so maybe I can tease it out from him with the right words, but psychiatrists seem to be painfully difficult about this.

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It seems to me that there is a possible numbing on almost any antidepressant, including the ones acting on dopamine or norepinepherine (this happens commonly even during chronic exposure to stimulants like ritalin). I would describe the numbness on it sort of like a "not caring" attitude, and while this seems good, it really clips the ability to feel good or any type of euphoria. I felt a bit disinhibited because anxiety was less, which was nice, but felt as if I didn't enjoy it NEARLY as much, which is not.

It's sort of hard to describe what is being "clipped." It's sort of like there is a threshold, that, when reached/triggered, there is a cascade or "release." It's the "ahhhh" cleansing type of feeling. It is the feeling that rushes over you and cleanses your mind after crying, listening to good music, eating something tasty, being in love, and, well, almost anything that you can think of. To me, the "windows" is when that liiitttle trigger is finally hit and there is a cascade or rush of those good feeling emotions that wash over me. Before, it was a simple feat to do. I didn't have to struggle to get it. It naturally came, and it wasn't a problem because I was getting enough to stay satisfied. That rush/reward is calming and soothing, and the absence of it can be problematic because it terminates obsessive thoughts/worries and allows them to leave the consciousness. While on an SSRI, the obsessions are blunted as well, but anxiety can occur when the SSRI is discontinued too fast because the worries/obsessions/anxiety is no longer blunted AND the soothing response is still blunted (uncontrollable or hard-to-control fight-or-flight response).

I think I understand what is happening to me now - I think that it is probably cholinergic rebound (GI issues, mental fogginess, etcetera). Should pass this coming month, but if not, I know it will clear up eventually. I'll keep everybody posted, and, so far, coming off of sertraline has been easy compared to Parnate (tranylcypromine). Tongue biting should gradually subside (probably an indicator of dopamine re-regulation) as it has for me in the past.

Edited by itstrevor
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I cannot comment on all the drug effects and counter effects, I'm alive because of both..... Your question interested me as i have been under psychiatric 'care' for three years or more, visit twice a month for more pills. I think we are all guinea-pigs in a mind game played out at the doctor /pharmacutical company annual get togethers. Notes are compared and everything we say, and don't say is thrown into the pan to adjust marketing strategies. All these drugs have real effects but there is also a massive placebo effect, especially on all of us who are emotionally more sensitive.

My psychiatrist has never answered a question, but reframed my question so that I answer it. If i don't believe my own answer we discuss it again in two weeks..... So i believe i have all the answers but lack the ability to access them. The drugs prescribed simply make the pain in exposing our truths more tolerable. Not that i amke a lot of sense here but its my opinion for discussion. I am tending to believe more in myself than the system now, hoping that is a good direction, playing the game on the way to make it easier.

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If you need it, you need it, but SSRIs are meant more for extreme states of anxiety than "depression," and it takes a while for the brain to re-adjust without them. It shouldn't be permanent though. I remember changing my dose from 50mg up a bit, and I got SEVERELY depressed. I went back down to 50mg and it disappeared. Pretty obvious to me. The same goes for the stimulating "antidepressants" like NRIs. Increase the dose too high and get anxious. Decrease and back to normal. Hm.

Anyways, I have already found the weakness in this anhedonia and it is only a matter of time. I had a bit of mood brightening today as the day progressed, so there is more to come. It does wax and wane a bit before getting better.

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What if you're severely depressed and have anhedonia?

I'm on an SSRI paxil.

Ive already tried celexa and remeron and they made me numb.

How can you benefit from therapy if you cant feel the benefit of activities ?

Therapists and doctors just don't understand it. I learned yesterday that a work colleague committed suicide and it has really set me off and I'm worried about permantly being in this state.

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anhedonia is depression. Everyone experiences depression differently. I finally found a good doctor who said that ssri's wont be useful in my case, and he actually used the word anhedonia and said that is what Im experiencing. How about that, a doctor who gets it. But he said it is a form of depression.

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I don't know if this has been covered before, but does anyone not feel hunger or thirst? My mouth will get dry or I'll get to a point where I feel like I am going to pass out because I forgot to eat. I'm starting to feel hunger and thirst occasionally, but I feel like I'm missing the drive to eat. Thinking about a delicious cheeseburger doesn't really make me drool. I used to be constantly hungry and thirsty. I would eat out of boredom, but rarely anymore. It's also hard to tell when I'm full sometimes.

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I don't know if this has been covered before, but does anyone not feel hunger or thirst? My mouth will get dry or I'll get to a point where I feel like I am going to pass out because I forgot to eat. I'm starting to feel hunger and thirst occasionally, but I feel like I'm missing the drive to eat. Thinking about a delicious cheeseburger doesn't really make me drool. I used to be constantly hungry and thirsty. I would eat out of boredom, but rarely anymore. It's also hard to tell when I'm full sometimes.

Same here. I soooo miss feeling really hungry and thirsty... And the joy of relieving it with a delicious meal and an ice cold drink. Aaaaaa... All gone now. This ridiculous bulls*** condition really pi**es me off. Now it is like I rationally know when I should eat/drink and then I just feed myself. So boring. I am sick of this **** and being tortured 24/7. It has to STOP some day...SOON! I never feel tired/well rested anymore either. And alcohol doesn't affect me anymore. Exercise no longer gives me the endorphine-feeling afterwards. How sad is that? But I WILL beat this m*t*e*f*c*e*!

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h.

I really feel like the classic grouping of depression into "neurotic, melancholic, etc." is really stupid, confusing, and unnecessary. There should be a greater focus on the mental states of blunting, depression, and anxiety instead of categories that were developed on a whim years before people even had a clue how the brain worked.

The grouping of a separate melancholic subtype of depression was introduced in the Diagnostic and
Statistical Manual of Mental Disorders, third edition (DSM-III; American Psychiatric Association,
1980). Klein (1974) summarized the rationale for this distinction in patients who show a regular
impairment in the capacity to experience pleasure or to respond effectively to the anticipation of
pleasure. Klein described bneurotic depression, as a chronic emotional or personality disorder related
to low self-esteem, overly severe disappointment reactions, feelings of helplessness, reliance on external
sources of self-esteem, and an irritable, grasping, angry, unhappy, other-blaming, and histrionic attitude
(Klein, 1974, p. 448). He contrasted this with melancholic depression, typified by a loss of interest or
pleasure, anorexia, suicidal preoccupation, fearful perplexity, retardation, or agitation. Klein
characterized melancholia as endogenomorphic depression, that is, having the form or appearance
of endogenous depression. Klein believed that the key feature of true endogenous depression is
persistent and severe anhedonia, which he hypothesized results from inhibition of the brain’s bpleasure
mechanism
In the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV;
American Psychiatric Association, 1994), melancholia is a specifier for a Major Depressive Episode in
either unipolar or bipolar depression. It requires (A) during the most severe period of the episode that the
patient shows either (1) loss of pleasure in all, or almost all, activities; or (2) lack of reactivity to usually
pleasurable stimuli; and (B) three or more of the following: (1) distinct quality of depressed mood; (2)
depression regularly worse in the morning; (3) early morning awakening; (4) marked psychomotor
retardation or agitation; (5) significant anorexia or weight loss; and (6) excessive or inappropriate guilt.
Loss of interest or lack of reactivity is stressed as the essential feature
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Actually I think that most of the symptoms experienced by those in this thread 1) are different than those experienced by those experienced by the vast majority in the rest of the depression forum and 2) ttheir symtpoms appear to be descrbied pretty spot on by the melancholic depression construct. See post above.

And with that in mind I think that those fallingn into this rubric can consult studies on depression with melancholic features to inform themselves about their outcomes, treatment options etc.

Edited by sc2
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