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


itstrevor

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Prozac seemed to lift the grey cloud over my conciousness the best. It brings back smells. but it takes away something very important too. feeling of presence, and emotional response.

Moclobemide doesn't seem too good at lifting the cloud, but it's more stimulating, and better for emotions.

I think, overall, Moclobemide is the ideal drug for our condition. It doesn't numb us. That's the problem with SSRIs.

Edited by jaiho
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Nostromo i dont think moclobemide short half life is that much a factor. Your supposed to take it twice a day i think and even if it has a short half life, serotonin will still build up over time by taking it. So even if its not currently active in you, you still gonna have increased serotonin compared to normal. I think moclo slighly increase dopamine and noradrenaline too. Mayb you could try an irreversible maoi that has a longer half life?

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it definitely seems that when you get on something that deals with your anxiety, your brain heals much quicker, the better the anxiety cure the faster you will heal.

don't lie to yourself and say, oh I can deal with it without medication. I believe anhedonia is a clear sign your anxiety is out of control, and doing you damage. these medicines and supplements will help.

I don't think I have had anxiety for years. I am not 100% sure what it feels like so I am not sure if I suffer from it. I am just totally numb right now. I recall when all this started I had what I would describe as anxiety. However I overcame that in a few months if I recall. Once a psychiatrist suggested I might have generalised anxiety however I never believed it. If anhedonia is caused by out of control anxiety and the anhedonia now masks the anxiety that I don't feel it any more would you suggest that treating for anxiety despite not having symptoms of anxiety cure anhedonia. Personally I won't mind experiencing light under control anxiety as it will mean I can feel something again.

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At the moment, i have not much if any response to it because of Prozac. However, on moclobemide i was definitely more present and felt emotion watching it.

iamnumb, i find prozac is increasing my numbness but its a happy numb. I think i'll move back to moclobemide.

I have been on Zoloft and it increased my numbness too.

I once tried moclobemide and after about 1 week or less if I recall I started suffering from the worst fatigue ever. By 2pm I would be yawning and struggle to make to 6pm to leave work. I had to stop it as a result. I read about a lot of people benefiting from it however. Is the fatigue normal? Does it go away? If so how long does it last. To add since the anhedonia started I started suffering from progressively worse mental fatigue since there is no pleasure to stimulate my happiness and keep me interested in things.

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Im just wondering, did you take moclobemide in dark winter? Because dark winter will turn more serotonin into melatonin which makes you sleep. If you are in places like california you wont get that problem of course. Maoi like moclebemide can increase both serotonin and melatonin. But if its dark winter, you may have more of your serotonin turned into melatonin and therefore produce more melatonin which makes you tired and sleepy. Thats just a theory.

I want to try moclobemide but im scared it may make me more sleepy too as i know it can increase both serotonin and melatonin and its getting darker here and winter is coming. I always feel more tired and depressed in winter(less serotonin, more melatonin).

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This is something I wrote out to show my psychiatrist which explains my anhedonia and what caused it. I wish for others to answer my questions here, give me advice, and tell me if it is likely to get better or fully recover:

I am unable to experience any amount of pleasure whatsoever and there are never brief moments (even a few seconds) of pleasure. This is because my mind has become completely numb as a result of a traumatic event (which would be that panic disorder I was having in the past). I know this for a fact because this numb feeling is something that has happened immediately once I had this panic disorder and isn't just a side-effect from the medication. I never had this numb feeling at all being on this medication. The exact moment I had this panic disorder is when I immediately became numb. This numb feeling not only numbed my ability to experience pleasure, but it also numbed the fear from the panic disorder I was having as well. However, I'm thinking that if this numb feeling were to somehow eventually go away or ease up, my panic disorder would then return.
Becoming emotionally numb is very commom for people with post traumatic stress disorder and even panic disorder and is something that has happened to me as well. This numb feeling (anhedonia) is there all the time 24/7. At first when I was depressed, my anhedonia was only mild at the time and I did have the ability to experience pleasure. But as my depression went away and I became more calm and relaxed, my ability to experience pleasure went completely down. So it's clear that as the function in my brain responsible for feeling calm and relaxed goes up, the function in my brain responsible for experiencing pleasure goes down.
Therefore, this might give you an idea of what is going on in my mind and what medication I might need to address this issue. The SSRI medication I'm on does not help this anhedonia. It only helps the depression I think. Therefore, I need a medication that can bring back my ability to experience pleasure instead. I need different medication besides SSRIs such as an MAOI medication known as Parnate that is known to help with anhedonia.
I realize that you said that anhedonia gets better and that my own anhedonia will get better. Although I know you are being compassionate and such in telling me that my anhedonia will get better, I feel that it might not get better and that you are aware of this possiblity, but did not want to tell me because it would be unethical to do so. 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 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.
I'm not sure, but I'm thinking that this anhedonia is just a normal response and not a physiological change in my brain. I think this because I never had anhedonia in my life and then, all of a sudden when I felt that these fears were too much and that they might be treatment resistant and not get significantly better, that is when these fears were immediately shut down as though to numb them as a natural protective response in preventing them. At that exact moment, I also had severe chronic depression after making the realization that these fears were too much and might never get better. So I am unable to tell whether it was the severe chronic depression itself that caused a physiological change in my brain, or if this anhedonia was just a natural response that would of occurred on its own after making this realization even with no stress or depression associated with that realization. Furthermore, each and every one of these fearful thoughts I felt I would have to live with on a constant daily basis, all of these fears from these thoughts are numb. But I am able to have fear towards everything else in life. I also developed a fear of open spaces recently. This fear was allowed to be experienced when I was in a public place. But, sure enough, when this fear became a part of my constant daily life at home just like how those other fears were that became numbed, that is when this fear became numb as well despite the fact that there was no additional stress this time associated with the realization that it was a part of my constant daily life. This suggests that this is a natural protective response because if it was a physiological change in my brain, then this one specific fear would be allowed while all the others remain numbed.
But even if this is just a natural response and not a physiological change in the brain as a result of stress or some other mental disorder, it is now a serious problem because, now that my brain has a means of protection against these fears, my brain absolutely refuses to let go of this protective response and now insists on making constant use of this protective response. I even told myself many things to try and get rid of or ease up this protective response so that I can face my fears and have my pleasure back. I told myself that we don't know what is going to happen in the future and that there are people who do overcome their fears through medication and just by being exposed to them. I also told myself that if I can handle one panic attack, then I can handle many. But not even this eased up my anhedonia. The fact is, I feel uncomfortable having these panic attacks and that is, what I think, is causing my brain to now make constant use of this protective response. Anyone would feel uncomfortable having panic attacks regardless of how much coping skills and other things they have. The only way I see my anhedonia getting better is if I felt completely 100% comfortable having the panic which is impossible since there will always be a very small amount of feeling uncomfortable anyway. I know this for a fact because even when there are moments of me feelng almost completely comfortable having the panic, the anhedonia still doesn't ease up at all.
Even if my fears were to somehow be gone right now, my mind would still feel uncomfortable taking the risk of easing up my anhedonia to see if my fears are truly gone in the event that the panic does return. So even if we were to take care of the panic through anti-anxiety medication, that is not going to ease up the anhedonia. I know this for a fact as well because the anhedonia is there all the time 24/7 always protecting me because if my anhedonia were to go down for just one given moment, that might cause my panic to return in that given moment. So this anhedonia is always going to be there all the time protecting me from panic no matter what. I had very bad constant panic all throughout the day each day in the very beginning and now my mind is not ever going to take the risk of that ever happening again even if it is just a few panic attacks a day this time or later on.
Since this anhedonia might be a natural response and that there might be nothing wrong with my brain that needs to be fixed through medication, how is any medication going to help fix something that doesn't even need to be fixed in the first place? Not to mention, as long as my fears remain shut down as they are now, then no amount of pleasure will ever return (based on what I stated earlier in my writing) whether it be through medication or anything else. But even for a natural response, this is quite severe and there are never brief moments of any relief which sort of suggests that this is a physiological change in my brain.
But in the event that there is something wrong with my brain that needs to be addressed through medication, the medication I suggested was Parnate. But if that doesn't work, then I think I would need Wellbutrin to increase dopamine because anhedonia, in terms of a physiological change in the brain, might purely be a dopamine issue and that SSRIs only tend to make anhedonia worse or not help at all (which is something someone has stated here who has done a lot of research regarding anhedonia):
"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."
But this might not be an issue with dopamine or even any other neurotransmitter for that matter. It could be something to do with melanocortins which turn off the brain's ability to experience pleasure. Also, there are many moments of me feeling completely comfortable having the panic now, but that still does not ease up the anhedonia at all. So it could really be a physiological change in my brain or just an extremely powerful natural defense mechanism that does not ease up at all. The thought of me feeling uncomfortable having the panic might of been the cause of this anhedonia, but I'm not sure if there is any thought that is causing this anhedonia to perpetuate now. It could now be something completely different that is causing my anhedonia to still fully remain.
But since you are the psychiatrist here who has done years of research, you might know what medication I need. You might even be able to tell me whether what this person saying here about anhedonia not being a natural response is true or false and if it really is just a physiological change in the brain and whether my own anhedonia is just a physiological change in the brain, a natural response, or both of these things:
"A “DEFENSE MECHANISM,” SUPPRESSAL OF EMOTIONS, OR ACQUIRED CALLOUSNESS?
To an outside observer, it may be tempting to label the loss of emotions/numbness as a natural “defense mechanism,” the result of personal efforts to suppress emotions, or callousness acquired due to age. While studies have shown that repeated exposure to violent imagery may desensitize individuals to a certain degree(such as in playing video games), it does not prevent an individual from feeling good. The healthy mind works to regulate emotions so that if there is too much exposure to a stimulus that invokes a certain emotion, there will be greater tolerance. The corollary to this is that in the relative absence of such a stimulus, the smaller the tolerance. These mechanisms work to keep emotional responsivity at a certain level regardless of external stimuli. 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 capacities 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.
When chronic stress and other factors disrupt normal emotional regulation, and one can no longer experience love, sadness, laughter, etc. this is not a normal reaction to everyday stressors; this is a mental health issue. Anhedonia does not increase evolutionary fitness in cases where there are no longer any stressors present, but actually is detrimental to it (disinterest in procreation and social interaction as well as food, etc.) suggesting that it is not a natural defense mechanism."
In conclusion, if this is just a natural response, I think I would need the most intensive therapy training in the world to help ease this anhedonia. But not even that might work. So I would have to resort to getting electric convulsive therapy or deep brain stimulation which is a pacemakeer that sends electrical signals to the brain. But that might not even work since there might be nothing wrong with my brain that needs to be fixed or shocked in the first place. I do not feel that I am just being overly dramatic and overly serious in saying all of this. I feel that I am being very realistic here.
But aside from that, I would need to know what therapies there are that might help ease my anhedonia in my specific situation. Anhedonia is caused by an overly active subconscious that causes your ability to experience pleasure and other emotions to turn off. So if we know what the right therapies are that might help calm down my overly active subconscious, then that might be likely to cause my pleasure to return as well as my other emotions.
Feelings of love an pleasure are the most precious things to me and I would never accept living a life without them. Despite the fact that I would technically be classified as a human being for having a mind and body, I am nothing more than the equivalent of a highly intelligent and well-designed biological robot from the future that has no ability to love or feel pleasure regardless of who I am as a person, how much my family and everyone else loves and values me, what great things I do in life, and how much I help others. I am an atheist and this one and only life I have is now worthless and being wasted away without my ability to love and feel pleasure.
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I tried it in early spring. However our winters are not dark either. Daylight is shorter in the winter time by maybe 2-3 hours. However generally we receive sun all year round. I did not realise it can increase melatonin. I have supplemented melatonin in the past and have never felt quite as tired as I felt on moclobemide. If moclobemide had that effect on me later at night maybe I would be happy with it and it might even help my sleep. However I did not find that supplementing melatonin helps my sleep at all, it might even make it worse since the doses available to me are actually way too large.

However what I am wondering about is the 6 days I was on it was probably not long enough for my body/brain to adjust to it so I have no idea if the tiredness will pass once the theraputic effects kick in. During those 6 days I did feel much more numb tough again I have no idea if that would change either had I taken it longer.

So I would like to try it for a longer period, I am just not sure I am up to the disabling tiredness since I am unable to work just 4 hours into my day while on it.

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I did experience the sleepiness problem but it only happened from time to time. I noticed that if i take 450 morning and 150 afternoon the problem was almost non existant. I tried taking 600morning but it makes me wired, probably because combined with my usual big cup of coffee (which is something i got so used to as a morning ritual that i can not drop anymore. i wouldnt know what to do at the kitchen table). also 600mg in one single dose might be suboptimal due to half life etc

Edited by nostromo
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Prozac seemed to lift the grey cloud over my conciousness the best. It brings back smells. but it takes away something very important too. feeling of presence, and emotional response.

Moclobemide doesn't seem too good at lifting the cloud, but it's more stimulating, and better for emotions.

I think, overall, Moclobemide is the ideal drug for our condition. It doesn't numb us. That's the problem with SSRIs.

I totally understand what you mean. I almost feel excited to have confirmation that its not just some strange conviction of mine. The fluoxetine DID do something very particular and unique, made colors more intense, literally! I always use to wear dark colors like black gray darkblue darkgreen but when i was on fluoxetine i bought colorful shirts and jackets... i really was aware of how better and "more real" the colors appeared. do you think Fluoxetine and moclobemide could be a combination? OFC low dose and such, but ive seen a paper or two on the topic and it has been combined succesfully, ill try to find them.

on the moclobemide + wellbutrin combo im a bit skeptic, i feel the wellbutrin has plenty of noradrenergic effects by himself (side note: on theory, havent tried it myself), and wellbutrin is known to be heavily inclined towards noradrenaline himself... I have tried Moclobemide in combination with Methylphenidate under my shrinks supervision, and the Methylphenidate finally worked. Some of you might recall i claimed 2 years ago that methylphenidate had absolutely zero effect on me, and so it was. But combined with moclobemide, it does work. It is stimulating and makes me work much, but on the emotional level it didnt help me and my "motivation" wasnt really intrinsic, so to speak. there was no desire to do things, i just did them. I still combine the two from time to time, but its like being overclocked... doesent feel right after a while

I had better but milder and "more spread on the spectrum" results by combining moclobemide with L-tyrosine from time to time

Edited by nostromo
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yes it does, even though i have the impression its effect wane a bit from day to day, but it might be subjective and just to the fact i have improved. And on the majority of days, it still does his thing.

I also think it is common to believe that a medication is "not working anymore" when one feels better

i really would just try it, its not a "risky" medication that is worth researching in depth before starting. I can literally see nothing that could go wrong...

try it for a month and see if it suits you

Edited by nostromo
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I haven't posted here in a while. While I am currently in a pretty bad place, I have made some progress over the last few months.

I strongly suspect that the only cure for this disease is to stop fighting it. Stop looking for that magic pill, stop thinking that you have to get better before you can live your life again. Your emotions probably went dull in the first place after a period of intense stress or a sudden traumatic event. Like a gazelle captured by a lion we're wired to 'play dead' when we feel highly threatened. Anhedonia/depersonalisation is really the psychological partner to that physical response. However, due to the miracle&curse of self-awareness, we humans are able to interpret internal cues as themselves threatening, thus maintaining the initial shut-down response. It makes sense that if you adopt a more welcoming attitude towards your symptoms, over time they will lessen and you will find yourself again.

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Hi friends I'm new in this I start to feel like this like 3 weeks ago and I'm really scare besouse I want my emotions back I don't know what to do I start teraphy but is not giving me any hope

Hi chris. Please, please read this: http://anxietynomore.co.uk/blog/2008/06/05/35/

Thanks I read it and help me I think you are right is better to calm and stop over thinking

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Question to everyone: do you think we should have our own forum?

This thread is no longer a thread, its a whole forum with one thread. Its very hard for someone new to access all the informations on this thread unless he is willing to browse the 80 pages of this thread. Perhaps we could ask depressionforums to make a new subforum for anhedonia? They could move that thread there and we could start new threads with more specific topics.

What you guys think?

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Hi friends I'm new in this I start to feel like this like 3 weeks ago and I'm really scare besouse I want my emotions back I don't know what to do I start teraphy but is not giving me any hope

Hi chris. Please, please read this: http://anxietynomore.co.uk/blog/2008/06/05/35/

Thanks I read it and help me I think you are right is better to calm and stop over thinking

Not only better; it's essential. Don't sink into the fear hole, like most people in this thread. Improve your attitude before the habit gets entrenched. Just get on with your life. As Paul David says, your mind just needs a break from all the worry and stress. Give it that break.

Edit: that's not to say that people who've suffered for years cannot be cured. But like any long-term habit, it can take long while to change. I think to truly get over this, however, one must be fully prepared to live with their symptoms for however long it takes. Frequent mindfulness meditation can help you get to this point.

Edited by noravank
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Question to everyone: do you think we should have our own forum?

This thread is no longer a thread, its a whole forum with one thread. Its very hard for someone new to access all the informations on this thread unless he is willing to browse the 80 pages of this thread. Perhaps we could ask depressionforums to make a new subforum for anhedonia? They could move that thread there and we could start new threads with more specific topics.

What you guys think?

Personally, I do, because even though there is a ton of great information in this thread, the shear size makes it intimidating. Anhedonia is also so fundamentally different than "sad" or "anxious" forms of depression, that I'm all for any progress that allows distiniction and separatation. Just look at the pitifully whiny and petty-natured posts in the rest of this subforum, than come back to this thread. Case closed.

Then again, who's going to have the motivation to write a concise FAQ for new vistitors if we do get an anhedonia subforum?

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Well I havent read your latest input. I ought to say that Selegiline turned me into a petitbourgise. It's like having a stick over ones head with a banana. I'm pending between 2.5 mg Eachj Other Day and and well it doesn't matter.

There wasn't much of whininess coming from it before someone started to talk about "hedonISM being the way of life"..

If you want hedonISM there's always the fscking syringe. Don't expect to build somekind of life.

You "have" to build up your hedonictone if you want something different from this state. You might get to that point by using Selegiline (MAO-B Inhibitator) but you have to pay the price with anxiety. I'd expect another way would be using a MU-opioid partial agonist like buprenorphine. Good luck with that..

Another thing factor like what I see as a bright contributor Iamnumb(I think) would be that HT-2a(mglu 2) agonist regarding the playfullnessfactor regarding things.

Edited by General_Failure
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I ought to say for those finding Fluoxetine somewhat anything. Fluoxetine is an HT-2c antagonist it increases dopamine and norepineprhrine in the frontal cortex by doing something funny by detaching the GABAneurons from the serotoninterminals. Documented by Stephen M Stahl and I had the opportunity and permission to write that into wikipedia.

Edited by General_Failure
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It will be helpful if there are some testimonies of persons that are fully recovered from this that will give some hope. The things that help me is to do the things that I love even if I dont feel the same. If someone want to talk by Skype I'm here not to talk abut the problem just to socialize and try to think optimistic and sorry for my bad grammar

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