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


itstrevor

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I am having severe chronic anhedonia that is there all the time as a result of a panic disorder and there are never brief moments of any pleasure. Now before anyone tells me that it will get better, I know that you would be compassionate and such in telling me that my anhedonia will get better and that many people have gotten better and even gotten over it, but I feel that it might not get better for me and there are 3 reasons I wish for you to address which are reasons why I feel that my anhedonia will never get better:


1.) Anhedonia can be a complete physiological change in the brain as a result of stress and not any negative thought causing it. For this very reason, it tends to linger on and not get better for many people despite every possible treatment. This is unlike depression because, for me, depression is just a normal response to a problem in life that passes over time.


2.) I'm thinking that if my anhedonia is not just simply a physiological change in the brain, then there is an obsessive thought that's there all the time that is causing my anhedonia to be there all the time. That thought would be me feeling uncomfortable allowing myself to experience these panic attacks from this panic disorder that is currently numbed by this anhedonia at the moment. If, let's pretend, that I were to feel completely comfortable, then that would be likely to bring back my panic disorder and my ability to experience pleasure as a result. But since I feel that I will never feel completely comfortable with such a thing (nor do I think any human being would either), this is the reason why I feel my anhedonia will never get better.


I do know for a fact that as my anhedonia goes down, my panic returns. I know this because in the beginning when my anhedonia was mild, there were moments in which it somehow went down and my panic returned as a result. But now my anhedonia is severe and there are never such moments. Also, even if my panic disorder were to be significantly reduced to an extremely small amount of fear, I would still feel uncomfortable and my anhedonia would still remain the same and not be better. I know this for a fact as well because there are moments where the thoughts that cause panic from my panic disorder aren't there, but my anhedonia still remains the same and does not ease up. So it's clear, I think, that my mind just simply feels uncomfortable no matter what and is not going to allow my anhedonia to ever get better.


3.) My anhedonia had to shut down (numb) both my fear from my panic disorder as well as my ability to experience pleasure for a very important reason. It could not just shut down my fear and allow me to experience pleasure. This would be because if my ability to experience pleasure were to be left on while my fear is shut down, that would cause serious problems such as seizures and such. Since this obsessive thought of me feeling uncomfortable having panic might be the cause of my fear being shut down and does not allow the fear to return to any degree at all, this is the reason why I feel that my pleasure can't return to any degree either because, again, if my pleasure were to return to any degree at all while my fear remains fully shut down as it is now, then that would cause those serious problems I mentioned and the brain would never allow such problems to happen because that is just how the mind works to protect you. So this is why I feel that no amount of positive thinking or focusing on other things in life is going to return my ability to experience pleasure to any degree as long as my fear remains shut down as it is now.


Now I realize that it is just human nature that thinking positive and focusing on other positive things in life helps ease up obsessive negative thoughts. But I feel that this is not the case for me and that this obsessive thought that is causing my anhedonia will always be there and never ease up no matter what. No matter how much I think positive and focus on other things over time, that does not ease up this obsessive thought (my anhedonia). This is because panic attacks are such frighful experiences that my mind cannot possibly let go of this obsessive thought of me not feeling comfortable having them no matter how much I think positive and focus on other things and such over time. Not even the medication I'm on is easing up my anhedonia (this obsessive thought) and I'm not sure if any medication will either because a panic disorder, for me, is where there are these other obsessive thoughts that cause the panic to happen.


Therefore, if I am treatment resistant in terms of these other obsessive thoughts pertaining to this panic disorder (which I'm thinking I really am and is something that isn't getting better on its own), then wouldn't that also mean I am treatment resistant in terms of this obsessive thought that is causing my anhedonia and that my anhedonia will also never get better? This is a very important question I wish to know even despite the fact that I have not yet tried every treatment available and everything else. Another very important question I wish to know is if the mind can somehow significantly or fully recover the ability to experience pleasure from anhedonia while the fear still remains fully shut down anyway in such a way that doesn't result in those serious problems I've mentioned.

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Another very important question I wish to know is if the mind can somehow significantly or fully recover the ability to experience pleasure from anhedonia while the fear still remains fully shut down anyway in such a way that doesn't result in those serious problems I've mentioned.

I haven't really looked into it much, but like you, I had a lot of fear, anxiety, and worry as an adolescent and young adult that I'm sure at least helped to predicate my current state. By that I mean that like you, I notice a direct correlation between the onset of anhedonia/blunted emotions/apathy and the complete abolition of the fear, anxiety and worry I used to suffer from. It even went on a contimuum as the anhedonia was setting in, meaning my brain seemed to exchange degrees of anxiety for emotional blunting and gradual loss of the ability to feel pleasure. Unlike you, though, I do have small, ephemeral windows of emotions and subdued pleasure, but they almost 100% correlate to drug use, or in the case of negative emotion, drug withdrawal or acute alcohol intoxication. Without any medication, supplements, or recreational substances, I am 100% flat and zombie like. That is to say that there is some sort of neuro-pharmacological mechanism that allows both the zero anxiety and small, ephemeral windows of emotions and pleasure in contrast to the paradigm of anhedonia. The $25 million question is, what is this mechanism and how do we boost it beyond just small windows?

I'm also well past deluding myself that this problem will ever go away on it's own, and even doubt it will ever improve in a marked way, in spite of many conventional and out-of-the box attempts at treatment; it's as though the anhedonia, blunted emotions, and apathy have taken root in my brain and personal experience in such a way that this is a life sentence. I think when you just let go and abandon the prospect of "getting better," and embrace the apathy and numbness that is your current reality, it's a lot less work, futility, and negative conditioning to acheive the exact same end.

Edited by Dichotohmy
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It's good to see that the OP (itstrevor) is still fighting his illness and not giving up, been following this thread on and off, for a few years I guess....

I've recently started taking Seroquel (about 2 months ago) and I'm getting a little relief from my symptoms. For whatever reason, it feels like the worst is over for me, that it's not going to get any worse. Only the last 2 months can I say this so it could (or could not) be from the help of meds. I did stop taking Seroquel for 3-4 days around week 2 or 3 and felt my symptoms go back to what they were in late June, so maybe there's something to the Seroquel that's actually helping, only time will tell.

For the first time in a long time I was able to look back over the last 3 and half years and it blows my mind. I mean, I actually don't remember much of 2011 - early 2014. The depression literally took several years from me. Kind of surprised suicide didn't happen but never did get to that point, plus couldn't do that to my family. I really hate that I am having to take meds, but they seem to help some at this point so going to continue on. Earlier in my illness the meds did ZERO, they were NO help at all but now they seem to lend a small but noticeable "helping hand". Personally, I partly blame my doctor (I go to local mental health center, docs aren't the best), I think there's things that could have been done differently earlier on to help me, but I don't think he thought that my illness was severe enough, lack of experience on his part probably. Plus, maybe he didn't give a f*** either, who knows.

Right now, as of the last couple of months Ive started back going to school for an Associates of Electronics degree. Lately, I've experienced, very briefly and mild "natural highs" when it comes to synthesizers and normal stuff like excited about supper and a good baseball game on. Still, the high is very brief and the anhedonia is still severe, it's depressing that it doesn't last longer but it's nice to have a reminder that it may be possible to experience natural highs again. To me, that's the most devastating, not have natural highs. I'm not talking about some BP mania, just everyday, normal highs. Anyway, I seem to have found a little interest in learning and reading about electronics so I hope the interest continues. First time I've read in years.

So, because of these few things that have happen the last month I feel like the worst is over and I'll only get better. I have a doctors appointment on Tuesday and we'll discuss about dosage adjustment and/or adding something. I hope we all get better soon.

Edited by james555
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What I've noticed now that I've reached month 5 of total abstinence, is that I now have windows of increasing frequency and intensity.

I will feel very strange and sensitive to everything and my mind will start to race with fears and insecurities - even ridiculous ones. Sounds will sound much "crisper," louder, and more surprising. Sometimes I will get tinnitus when this happens or I will feel dizzy. This is when my brain begins to feel out of control like I am going crazy, and usually this follows from a long period or "plateau" of feeling flat for a few days.

At this moment I can choose to either have a panic attack or redirect the attention/energy and let go, and it is when I let go that often this becomes a window. It feels really strange because old emotions are coming back, but they are scary when they first reappear. This can cause me to cry heavily over something ridiculous.

This is good evidence that it is temporary at least and that the trend follows a sort of "punctuated equilibrium" pattern as opposed to linear change.

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My anhedonia seems to specifically affect my ability to enjoy things and still get that "buzz" from doing them. It doesn't make me completely emotionless, I have a strong drive to get rid of my depression because it's preventing me from enjoying or having a functional life.

Once in a while, when my depression improves (even if it's only slightly) I am able to feel slight enjoyment out of things again. If it improves greatly I am able to get the same level of enjoyment out of things I used to get. But this hasn't really happened since March. This has happened loads of times in my life, long before my depression started to get really bad. But it started to get really bad due to a variety of factors, mainly not being able to get the right treatment because I was under age and no one seemed to figure out what was wrong with me. Hence the anhedonia became chronic along with the depression. Sometimes my depression may go down (at least, I can think more positively) and I still feel anhedonic, but then it may go down completely with the other symptoms (the low energy and issues focusing). It's definitely one of the cognitive symptoms of depression rather than a psychological one. It's very weird.

I doubt it's permanent since it has gone down as recently as this year.

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I am unsure what you mean when you say there is a "physiological change" to the brain in response to stress that results in permanent anhedonia...

There are changes in the size of the hippocampus, but that is not surprising, because the hippocampus is the center by which new brain cells are proliferated, especially in the production of new memories. In depression, the brain will tend to "block out" memories of the time period, but there is no reason to assume that this is permanent.

An increase in BDNF correlates with remission from depressive illness and the anhedonic syndrome described in this thread, which makes sense because the hippocampus begins proliferating cells again. Would it have been evolutionarily useful for the brain to rewire itself to be permanently anhedonic after chronic exposure to stress? The answer is obvious.

Other physiological changes include changes in receptor densities in different regions of the brain as well as SERT density and enzyme production, but this is by no means permanent damage, as seen by studies where reduced receptor densities, transporter sites, and enzyme production correct themselves over a period of months. REM sleep latency corrects itself as well.

The only type of damage which may become an intractable problem is axonal damage in the case of a stroke, anoxia, or massive drug overdose of a neurotoxin. Even in these cases, the brain can actively heal itself over time.

The problem with depression and anxiety is that the changes that chronic stress creates to the brain through excessive secretion of glucocorticoids can take months and in severe cases years to correct (sometimes unnatural "triggers" such as drug abuse over several years can become the case that would take years to correct). The specter of permanence causes those this this terrible syndrome to become worried and anxious, and the uncertainty becomes something that they fixate on, prolonging it's natural course. Use of psychotropics may hinder progress, and many assume that their only two choices are to take medications or face the possibility of never feeling "good" again, not realizing that the antidepressants, while controlling (the) anxiety, themselves blunt emotions.

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In my opinion, it appears that the brain will purposefully turn off reward circuitry while it performs maintenance on it, almost as if it is some sort of highway - the construction workers cannot work with a bunch of cars running through, so it is closed down for a period of time.

In fact, I am noticing a pattern where my consciousness is forced into a part of my brain that I really do not like - an anhedonic part that bombards me with repetitive obsessive almost paranoid thinking. After an intense period of this, I am invariably given a "window" where there is a sudden release of intense relief and emotional lability that I welcome - in this state my consciousness is in the moment only.

I only eat when I am hungry - when my brain gives me a reward incentive for it - I "feel" what my body needs rather than mindlessly eat or eat unhealthy food. During these periods where I feel anhedonic and obsessive, I am usually fasting. When I finally am hungry, the meal I eat taste so much better. I feel that this intermittent fasting helps re-regulate the brain's reward circuitry - only eating until you feel that you have to or would actually like to.

Perhaps these intense periods of distress and anhedonia are necessary - the brain pushes one into it - so that it can build an immunity or oppositional tolerance to stress and reach it's baseline euthymia, almost like it is working out. Taking benzodiazepines and antidepressants prevents this progress, or at least slows it down (sometimes it is too intense so one might prefer to slow it down).

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I am without a doubt seeing progress - this is my fifth month free of psychotropics, and my third year of bondage to this terrible syndrome. It is remarkable how much I have discovered about this condition, and I hope that I have brought faith in the prospects of healing to everybody in this community. At times there are plateaus, and it is hard to see progress, but over long periods of time, the progress becomes clear.

I do not believe that long periods of anhedonia cause the brain to destroy reward circuitry (the "use it or lose it" mentality), but rather quite the contrary - the brain attempts to bring itself back into balance, subconsciously working to mend circuits to reach a baseline euthymia in the absence of the meddling of our conscious selves. The brain will do this even if one does not actively pursue it - all a person has to do is "let go," and avoid anxiety spikes. Therapy and meditation revolves around this, and is based completely in methods to get the self to do this. Those who have spent years on thymoanesthetics report a return of emotions just as those who have only taken them for months.

I know this to be true for myself, but the individual may only arrive at this conclusion through personal experimentation and research so that one's standard of evidence is satisfied.

Edited by itstrevor
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My psych appointment went well. Thankfully, we both decided on no longer trying antidepressants, so nothing was added to my current med dose. I've nearly tried them all with no success anyway. The med I take now (Seroquel) is helping so we upped the dosage to 200mg at night. So weird that an anti-psychotic is what works for me. And don't get me wrong about the Med, it only helps you just a little bit, the rest you have to do on your own. I was hoping to find something that put me back to normal with just a pill but that won't happen. It'll only help you so much, you have to do the rest. I can help some, but not all.....too bad I didn't start off with antipsy or I might have gotten some relief sooner. But **** antidepressants, they didn't work for me.

That also reminds that we all different in a our illness. We all have varying levels of illness, some are milder, some moderate and some severe. Some type of "treatment" that helps one person will almost NEVER work for that next person, so my advice is that if you are just starting out, you'll unfortunately will have to find what's right for you. Eventually, regardless if you find the right type of treatment you'll get well. You'll go through HELL but you'll eventually get better. It's taken me 4 years (started late 2010) to get to a point where I see that the worse is over with, I can't get any worse and I can only get better now and it's happening as I feel better than I did 2 and 1/2 months ago. First time I can say this in a long time and I owe it because of a couple of things, 1) the medicine, which helped me to start doing things again, and 2) me started back to college and using my brain again to solve problems, believe it or not, it's just as important as taking the medicine. I had stopped using my body and brain for almost 3-4 years. And also, socializing to a lesser extant. It's only helped in a bit but it does help in the area of depersonalization that I've had along with the depression....hopefully by December I can really start bragging about getting well even more...I hope I can...

Edited by james555
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Nope, probably depressed with lack of assertiviness. When in the deepest s*** (without SSRI) I got material enough to start a religion. Some norepinephrine RI might help to make onself to state ones business.

I noticed that when adding Reboxetine to fluoxetine,, some commented I become more "declaring".

Any luck with your endo-doctor? I just imagine some thyroidhormone could help but if not that there's usually Reboxetine, Duloxetine or Venlafaxine. However I am one of those that wants my penis somewhat intact (for sentimental reasons) and therefore choose Selegiline as a dopaminergic/norepinephrine boost.

I imagine Venlafaxine Buspirone could do the same but I rather suspect Dopamine D2 agonist at Buspirone low doses than HT-1a agonism. Fluoxetine + Buspirone had me prosocial (though not even relieving social anhedonia).

The bad/good thing with Selegiline is that it always has me whipped. The guy who prescribed med recommended me to use higher doses that I feel fine settling on and also asked me to workout at least 30 minutes a day(no problem). I am restless as crap, but at least make things finally happen-

I've sort of accepted I have to go on and see if I find some meaning in anything at all as all my past interests is long gone but when I see someone reflecting about himself imagining he's a psychopath (as a nail in the coffin I just can't imagine you being exploitative from what I've read at least) I just relate to that guiltridden state one gets into when depressed.

If you have not I'd get into touch with a doc if I were you. I am having a problem keeping track of all your previously taken drug(s). Maybe everyone should list them at the bottom of their entry (almost every forum apply that format). It would also be interesting to know if there's any truth in skinaging related to Wellbutrin. As I mentioned before it really helped for social anhedonia and it would suck for those without non allergy. I am not into fearmongering but when even my old doc was surprised I went allergic to Wellbutrin which seems to be like 3/100 I suspect one should be alert.

Edited by General_Failure
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I'm going the endocrine route right now and just had all this tested...
Cortisol
Dehydroepiandrosterone (DHEA) Sulfate
Estradiol
Follicle-stimulating Hormone (FSH) and Luteinizing Hormone (LH)
Growth Hormone, Serum
Hemoglobin (Hgb) A1c
Insulin
Insulin-like Growth Factor 1 (IGF-1)
Progesterone
Prolactin
Prostate-specific Antigen (PSA), Serum
Testosterone, Free and Total
Thyroid-stimulating Hormone (TSH)
Thyroxine (T4), Free, Direct, Serum
Vitamin D, 25-Hydroxy
It will be 3-4 days for results.

I got my results in from my blood test. I ordered the test myself through walkinlab.com. Please help me interperet the results.

Test Result Reference Range

------------------------------------------------------------------------------

Testosterone 420 348-1197

TSH 4.52 HIGH 0.45-4.5

LH 5.1 1.7-8.6

FSH 6.4 1.5-12.4

Hemoglobin A1c 5.3 4.8-5.6

Thyroxine (T4) Free 1.46 0.82-1.77

DHEA-Sulfate 229 138.5-475.2

Cortisol 35.6 HIGH 2.3-19.4

Prolactin 20.3 HIGH 4.0-15.2

Estradiol 8.9 7.6-42.6

IGF-1 156 115-355

Vitamin D, 25-Hyd. 26 LOW 30-100

Growth Hormone <0.1 0-10

Progesterone 0.8 0.2-1.4

Insulin 7.4 2.6-24.9

--------------------------------------------------------------------------------

Hypothalamus or pituitary tumor?

TSH - is thyroid stimulating hormone, a bit high...been eating lots of iodine or kelp lately?

Cortisol is high - do you drink coffee everyday? energy drinks? amphetamine use? Mine was high too - lot more then yours....in the 90's. No, not a tumor but intense stress combined with abuse of amphetamines and energy drinks led to depression. They say depression is the result of high cortisol....so there...look into adaptogens such as holy basil, ashwagandha, rhodiola rosea.

Prolactin is high - are you a male or female? In males this causes "bit*es tit*" - commonly increased by SSRIs or TCAs. Been taking any of those for a long time? Time to lower your dose or get off those meds completely.

Vitamin D is low - this is implicated in depression. Interestingly enough, mine was low as well. Been taking Life Extension brand of vitamin D - 5,000 i.u. every other day. Must be taken with fatty food. Really does help with mood and reduces daytime sleepiness.

If you aren't already - I suggest adding high quality fish oil, Omega-3 fatty acids. 4-6 grams/day works great.

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I ate a larger than normal dose of ibuprofen today, having taken a months long break from it, and developed an unmistakable opiate-like euphoria for around 1.5 hours. The effects were similar to a small dose of hydrocodone or codeine, obviously without the motivational boost that comes from harder opiates.

When I "came down," I'm just left with the further reinforcement that, for me, this zombie-like, emotionally-dead condition is not psychological, but instead rooted in some sort of systemic inflammatory disease and my anhedonia is, in fact, really some sort of low-grade encephalitis. At this point, I really don't give a s*** anymore that NSAIDS don't agree with my GI tract thanks to my overuse of them over the years.

This deduction isn't so preposterous as anhedonia is common in lyme disease, CFS/ME, PANDAS, and other inflammatory diseases. Inflammation of the ventral striatum (and other brain areas involved in reward) is positively linked to anhedonia. For instance:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025604/

Edited by Dichotohmy
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Hi everyone,

Sorry to jump in in the middle of everything, I just had a question for the scientific minds here - I don't know who else to ask. I want to take N-acetylcysteine before I have a CT scan, it is supposed to help protect one's kidneys from the dye that you have to ingest before the test. I recently did one of the experimental infusions of ketamine for treatment-resistant depression and had a severely adverse reaction involving extreme agitation and panic. I should know more about amino acids at this point, but of course depression has made it very difficult to focus and learn. Maybe someone here can tell me if there'd be any danger of a reaction along similar lines if I took N-acetylcysteine, which apparently is glutathione precursor? (I apologize for being so clueless. I know that's a different thing than glutamate, but I don't really understand it.) Obviously, there would also be a huge difference in degree of dosage, like 400 or 600 mg of N-acetylcysteine once or twice a day vs. the .5 mg/kg 40 minute infusion of ketamine.

Displaying my scientific stupidity here in the hopes that someone can help me out and enlighten me a bit. N-acetylcysteine also looks like an interesting supplement try regardless, has anyone here tried it? Thanks so much, and continued good luck and well wishes to all of you, I hope we all find a way out of anhedonia.

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NAC is thought to modulate glutamate levels, but is not at all comparable to a full-blown NMDA antagonist like ketamine. It is a very worthwhile supplement in regards to providing a good, bioavailable precursor to glutathione, which whether or not you are concerned about oxidative stressors in your body, would make it something very worth trying.

That said, I did around 600-1800mg of NAC twice daily, for many months, and it didn't do diddly squat for anhedonia or anything else psychological.

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Okay, so I'm on month 6 without medications. Depression (the sinking feeling of dreading getting up or doing anything) is gone, anhedonia breaks once and a while, windows are getting larger, bad days are getting less severe. I had a pretty good week last week, but this week has been sort of "fuzzy" (feel like I have poor memory and vertigo/anhedonia increasing) but everything I've read points to this being reversible.

As with most perturbations of the central nervous system, it takes time to reverse. Here is another success story from a long-term anhedonia sufferer (Antti) from paxilprogress:

Like I said, complete. No erections, no libido, nothing. I have had few days when PSSD lifts but it always comes back. Time between those good days gets longer and longer. Quite opposite to other symptoms.

I'm 15 months off meds. It's difficult to say when anhedonia, emotional numbess, etc. went away, but during last 4 months I have only had couple of bad days. I think I had similar bad days even before taking SSRIs. So I consider myself recovered from those. Key to my recovery is definitely exercise and sports.
__________________
Took 10mg Cipralex for a month in december 2009. Quit cold turkey and been off all medication after that.

It was quite a ride but after 3.5 years I'm 99% recovered. Success!!
Edited by itstrevor
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