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


itstrevor

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Anyway, you guys want a succes story?

Bear with me here please, English is not my main language.

I'm recovering from Anhedonia.

Now this might be interesting for the hopeless handsup.. Yes I did took SSRI's.

I'm 19 years old.

Had rough childhood.

Seen some messed up :).

Took SSRI.

Could all have been a reason for my Anhedonia, I don't know for sure.

I was not able to feel any emotion. No pleasurable feelings.

But next to that, also no negative emotions. No sadness, no anxiety, anger, empathy, fear and even.. No frustration. Just really nothing. I did not care about anything at all.

I could speak and act perfectly normal, without even having to put an effort in it.. Like my mind when on auto-pilot. I would speak and act like I always did.. But without any emotion behind it. Just the rational speaking and the fact that I knew what I liked and disliked.. I just knew. I knew I love some members of my family, I knew I like my dog and I knew I liked certain activities.

But I couldn't feel it.

There was no connection anymore between me and my beloved ones.

Next to that I was constantly tired, had brain fog, could not concentrate, memory loss.. I would think about the most random things that did not even make sense.

When I was talking with somebody, I would just say the right words without thinking about them.. The weird thing is, I could speak normally, act normally but my mind was just blank!

When I was listening to somebody else, my mind would wander off after a few seconds..

I got a car accident that should have killed me but by a miracle I came out without a scratch.

Hah, I wasn't even impressed, just slightly shocked for a few seconds when I crawled out of my wrecked car.

I have been going through this for 1.5 years.

What is helping me to recover?

No drugs, meds, supplements or whatever you want to call them.

No analysing or trying to understand my disease.

What is recovering me is.

Simply letting it go.

Those emotions are there. But they're not coming out because you're constantly thinking about 'Am I feeling something now?"

Well of course you aren't. If you go outside and play some tennis and you're constantly asking yourself "Am I having fun?" ... Well nope. Because you're not focused on the tennis, you're just focusing on the empty feeling that you have.

In my humble opinion (I'm not a pro here), you're all making your disease worse. If you keep focusing on "I can't feel anything", you're making that feeling/the condition/disease even worse. You're making it stronger.

You're allowing yourself to remain in that state of mind.

Get outside, get to sports. If you can't because you're tired.. Change your diet! Find out what makes you tired so badly. In my case it is chronical hyperventilation, I'm stil trying to find a proper treatment for it, tho it can be easily cured. It causes the concentration problems, brain fog and fatigue. Meanwhile I already changed my diet to a very healthy one and I try to get out.

And slowly, my emotions came back.

At first fear and anxiety. Then slight anger and frustration..Very slight happiness and a fair amount of libido.

All so slightly and weak, but they were there.

Then, something traumatic happened. My grandfather passed away. He was the person in my life that I loved the most. My hero.

I cried, felt immense pain. Only for an hour or so.. Then I went to numb again... Then some more moments of intense crying and pain.. Numb again.

A week later was his funeral and I was scared to death that I would be numb during his funeral.

So I spent some time thinking. Remembering about how I used to be and how much fun I had with him.. It triggered sadness and feelings of missing him.. And boy they were intense.

I wrote a text for him, from the deepest of my soul.. Where I knew those emotions were hidden. I don't know how I did it, I just went in the moment and did it.

During the funeral, I cried my eyes out. Feeling real pain and sadness.

This was one month ago.

So how am I now?

I'm still aphatic, I still have troubles with empathy and my concentration problems are troubling me too.

BUT..

My emotions are coming back. A little more everyday.

I just don't try to think about it when I feel numb.. And when I catch myself doing so.. I try to be productive.. Go clean my room, go search for some projects that I might have no motivation for at that moment but I still just DO it because I know I like it. I get on with my life and I try to exercise.. I try not to find an excuse and just go.. Guess what? It's working.

I got myself into my first relationship 2 months ago, yup I know I like him.. Tho I don't always feel ike it. (Let's say that I don't feel it 80% of the time.. The 20% is a nice change!) Yes I feel sexual tension when I'm with him.. Tho it is only in stages that last for a few minutes.. I always snap out of it and then get back.. snap out of it.. get back in it.. It is there and it will become better!

Now you're asking yourself "How do you just forget about it?"

Well, block it out of your mind everytime you start thinking about "I feel so numb". Make an effort to it.

And most of all, believe that YOU are able to beat this. Don't try to find succes stories. Hell, why do you need another opinion? I guess it's comforting to know that there is a cure.. But you know what? Not so long ago, everybody thought that the world was flat.. Only a few brave ones said that it was round.. Guess who won at the end?

It's like you have a cancer and people say that you only have 5% to survive.. You have two different kinds of people.. The ones who say "Damn.. 5 procent.. Well that's it, I'm screwed. My life is over."

And then there are the people who say "5 procent? HAH let's kick this thing right back from where it came from."

I don't know if I made any sense at all, I also write this to motivate myself again, tho I'm not feeling any emotion now. My boyfriend is sitting next to me, making cute faces and I'm laughing at him.. With no emotion at all.. Tho some sexual tension (yay).. But I know it is coming back more and more.. Because I believe in myself. Even on those moments when I don't feel like I believe in myself, I keep telling myself.

I will beat this, and that's it.

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You guys aware of the following study?

Anterior cingulate cortex γ-aminobutyric acid in depressed adolescents: relationship to anhedonia.

In this study they found a pretty significant correlation (0.50) of GABA levels in the Anterior cingulate cortex and self reported anhedonia scores, suggesting that low levels of GABA are implicated, specifically in anhedonia. Moreover their results showed that only patietns with major depression WITH anhedonia had lower levels of GABA than controls. The group of paitetns with major depression withouth anhedonia had relatively normal GABA levels. Even though thhis is just an observational study, the results are quite striking.

Now gaba is a neurotransmitter that is involved in anxiety. More specifically, benzodizepines produce they anxiolityc effects by raising the level of GABA in the brain. unfortnunately, the design of this study doesnt allow much interpretation as the results could indicate that anhedonia caused anxiety and the other way around, or that they have a shared cause.

Nevertheless, it is something to keep in mind. I will keep looking in to this

And overactivity in Anterior Cingulate Cortex (supposely Glutamate, but the usual activating "substances" tend to be noradrenalin and dopamin. The only implication I get out of this would be that OCD and anhedonia might be connected that is if the OCD hypothesis is correct for starters. We all know the "treatment" of OCD and is sure as hell not psychostimulants which despite ackording to my Doc and friends did improve overall wellness and gave me a break of total 5 or 7 days from this shady little condition..

Underactivity might be connected with "adhd" and those don't tend to be anhedonic but thanks fuxk to that when theyre given the only "candies" which at least works for at least as long as a week.

Tbe benzodiazepine just made to walk around quite careless as well as taking away the TINY tip of derealization which actually is caused by ANXIETY. That other part of mount blanc might be considered as something else like opioid-overactivity or maybe Glutamate-hypoactivity in about 20 or so years. Long live science! science the king!

They didn't help me much except for perhaps relieving some anxiety but if you think OCD is of importance then take a free stroop-test somewhere and try chewing (don't actually,, I am not picky but just don't) some Clomipramine.

But okidoki, it seems that MAO-B rises during stress and perhaps stay that level afterwards..

Nardil got some GABA-actions,, But I just wonder what will happen by increasing the quantity of Dopamin and its "friend". Shouldn't there be some downregulation? or maybe there's autoreceptors involved .

@PW1981 Any news?

Edited by General_Failure
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Nulyra. Your strategy probably works for many, just like behavioral modification works often for OCD. We ain't denying the significance of stress and your strategy is definitely worth trying, probably works for many. But the way you claim everyone is in the same boat is ignorant. The cognitive functions preceding feelings are dependent on many physiological phenomena, and for some those phenomena may be so deeply damaged that stress has nothing to do with them anymore. Or maybe, instead of the one year or whatever it took for you, it would take ten years for someone else to get the anhedonia go away. I'd rather go dependent on amphetamine than just take it easy and not think about it for a friggin decade. I don't think anyone in the world can know whether all anhedonia is curable by just removing stress or not. How could you know.

What about those people who have suffered from anhedonia for decades? I bet they haven't obsessed with it constantly, that would lead to suicide. So there are people, who have accepted and probably even have positive outlook on life, go to church to get some strength. And it just doesn't go away.

Your strategy might be the best of all, it might work very well. I stand behind my suggestion on taking a long absolutely stress-free vacation, focusing on the rare little pleasures that even an anhedonic can obtain, be it the sound of ocean or candy. I suppose an anhedonic typically is not completely unable to get some good vibes from these, I may be wrong though. But anyway, this may not work for all. This thread is over twenty pages long, and some people have been struggling with anhedonia for a longer time than you. They have learned everything about it and about themselves, and a great deal about brain. Maybe some of them are blind and don't see how they're damaging themselves when they could just relax and let their bodies recover. But how can YOU know this for everyone? How can YOU know that Trevor would recover simply by stopping the obsession? You're ignorant. What if some here actually have such serious brain damage that the brain has became virtually immune to the psychology, immune to the variations in stress. Have all the faith in natural healing you want, but it ain't gonna make cancer better. Or my neurological disease. It might make anhedonia better. But not necessarily, for everyone.

Edited by Vieno
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@Nulyra proverb of the day. "Don't kick in open doors". I've only read the beginning but you seem to assume everyone is ruminating all night and day about their condition. I can tell you that I don't after these 15 years. I will probably read the rest but judging from another comment I'll better take my downers first..

I guess more "assumption" will come and I will get some flashback from a psychologist I met which also was assuming a s***load without probably even knowing what anhedonia and/or derealization was.

"just eat your apple and sleep well!, no that IQ discrepancy of 30 points is totally normal!"

Alright, that wasn't that bad though, maybe it's just avolition but I don't see what there is to "beat" or "fight" against.

Sure it gets a bit depressing getting maxpoints at all anhedonic scales..

"battling" "diseases" just "exhausts" one self.. Letting go isn't that bad..

I just pretty much don't care I assume..

Edited by General_Failure
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Yeah it is a shame that the condition is so poorly understood. I wish they would do more studies on the naturalistic course of anhedonic symptoms and that more trials would evalute outcomes on anhedonia as a seperate outcome.

I don't think anhedonia's physiological mechanisms are that badly understood, but the horrible semantics of the terminoligy cause misunderstandings and slow down the research. For example, the relation of anhedoni and depression is not clear even though it could be clarified simply by some semantic analysis. So in terms of anhedonia, we know the involvment of dopamine and possibly of serotonin, opioids and glucocorticoids. That's pretty generic, but it allows us to narrow down the medication choices.

To be honest, I'm sure the remedy is out there. Maybe it's the stress relievement, maybe it's a dopaminergic drug you just haven't tried yet. Remember that Parkinson's decreases emotionality... http://www.iherb.com/Now-Foods-Dopa-Mucuna-90-Vcaps/8673

But knowing the relation of stress and anhedonia, I actually might first try the Maledives :)

Edited by Vieno
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Yeah it is a shame that the condition is so poorly understood. I wish they would do more studies on the naturalistic course of anhedonic symptoms and that more trials would evalute outcomes on anhedonia as a seperate outcome.

I don't think anhedonia's physiological mechanisms are that badly understood, but the horrible semantics of the terminoligy cause misunderstandings and slow down the research. For example, the relation of anhedoni and depression is not clear even though it could be clarified simply by some semantic analysis. So in terms of anhedonia, we know the involvment of dopamine and possibly of serotonin, opioids and glucocorticoids. That's pretty generic, but it allows us to narrow down the medication choices.

To be honest, I'm sure the remedy is out there. Maybe it's the stress relievement, maybe it's a dopaminergic drug you just haven't tried yet. Remember that Parkinsonin's decreases emotionality... http://www.iherb.com/Now-Foods-Dopa-Mucuna-90-Vcaps/8673

But knowing the relation of stress and anhedonia, I actually might first try the Maledives :)

I wasnt talking about the physiological mechanism perse, which is probably less well understood than you assume, but rather about the clinical course of symptoms of anhedonia in general, but also in the course of mood disorders such as depression Anhedonia/loss of interest is a core symptom of major depression according to DSM and oher systems (research diagnostic criteria and the ICD-10 for example). I would like to know the degree of anhedonia experienced by patients with various depressive disorders, their course and their respective response to treatment.

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Yeah it is a shame that the condition is so poorly understood. I wish they would do more studies on the naturalistic course of anhedonic symptoms and that more trials would evalute outcomes on anhedonia as a seperate outcome.

I don't think anhedonia's physiological mechanisms are that badly understood, but the horrible semantics of the terminoligy cause misunderstandings and slow down the research. For example, the relation of anhedoni and depression is not clear even though it could be clarified simply by some semantic analysis. So in terms of anhedonia, we know the involvment of dopamine and possibly of serotonin, opioids and glucocorticoids. That's pretty generic, but it allows us to narrow down the medication choices.

To be honest, I'm sure the remedy is out there. Maybe it's the stress relievement, maybe it's a dopaminergic drug you just haven't tried yet. Remember that Parkinsonin's decreases emotionality... http://www.iherb.com/Now-Foods-Dopa-Mucuna-90-Vcaps/8673

But knowing the relation of stress and anhedonia, I actually might first try the Maledives :)

I wasnt talking about the physiological mechanism perse, which is probably less well understood than you assume, but rather about the clinical course of symptoms of anhedonia in general, but also in the course of mood disorders such as depression Anhedonia/loss of interest is a core symptom of major depression according to DSM and oher systems (research diagnostic criteria and the ICD-10 for example). I would like to know the degree of anhedonia experienced by patients with various depressive disorders, their course and their respective response to treatment.

Perhaps I didn't make my point clear. I don't assume we know how dopamine etc. work in anhedonia. I simply assume that we know that it is involved, and that makes dopaminergics viable treatment agents. Law largely prevents us from experimenting, but a stubborn soul will find ways :)

As for anhedonia's relation to "mental disorders", don't even want to think about that semantic chaos ;)

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Well, I did not ment to say that it works for EVERYBODY.

Of course it doesn't.

Everybody is different and there are always exceptions (duh, common sense.)

I just tell it in a very "judging" way so some people might get triggered by it. (in a positive way)

And well, I worry more about the people who care so little that they don't even come to this topic...

You see, some people here (I'm not going to call names and I'm not going to say everybody, just "some people") are focusing their energy on trying to find a cure.

It means for me that they are able to engage in something. Really engaging in something -> Emotions attached, tho they might be really weak

Wouldn't it be great if they could focus their energy on something more positive? Something that pulls them away from the disease.

And by the way, that I'm called ignorant actually tells me that I stepped on somebody's "feelings"... So they are there..

Anyway, I get that it's frustrating and depressing and for some people it might not work.

But for other ones, and maybe new people who come to this thread.. Don't assume too soon that you have to take drugs to beat this.

There is nothing wrong with it if you do need them! But it might be the best if you try to put a real effort in changing your point of view first.

So once again, I did not ment to hurt anyone.

Hah sorry, my skill to empathise can still use a lot of work sometimes.

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@Vieno: hey, what did I wrote that made you think I'm giving up? =P

I want to reach 'neutral' so that I am in a better position to go up.


Regarding Nulrya's post, you have no place to call her ignorant.

S/he hasn't said that it would work for anyone.

She said that if you stress on it, you make it more real than it needs to be.

And this is true even if you plan to take meds.

You can't ignore your psychology while you cure your physiology.

And it is something you can do withous side effects.



@Nulrya: I think you found something important.

"Letting go" it is still not straightforward for me, but dwelling in it certainly doesn't help.

You are right in many ways.
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I think that it is important to not dwell on the negative aspects of the "illness," but I do not believe that it is reasonable to assume that one can just simply forget about it and not feel uncomfortable with it. For example, if a person was being put into a fire, it would be pretty difficult to ignore the pain of the fire burning the skin - yeah, you can accept that you are getting burned, and perhaps try not to think about it, but you are still suffering it - in the same way, with depression/anhedonia it is pretty difficult to just ignore the pain/uncomfortableness/numbness. I would say that I have accepted it to the best of my ability.

I'm not saying dwell on it and make yourself feel worse. I try to distract myself with school, looking for a job, seeing friends, etc. What I am suggesting is that if a person is truly struggling with depression/anhedonia, someone telling them that all they needed to do was stop pitying themselves and not stress so much, that person might feel a bit insulted. I don't think that the main issue for alot of people suffering with anhedonia/depression is stress - I think that the problem is that depression/anhedonia robs the individual of ways to resolve psychic tension and deal with stress, so that even normal everyday stressors become overwhelming. Don't get me wrong, stress can cause a depression to start, but once a person is in depression, the depression can go on once the initial stressors are removed - essentially once you are in it, you are in it.

One approach would be to completely remove all stressors - I guess that sort of works, but sooner or later we have to return to our lives. As the saying goes, it is better to give a person the ability to fish (or in this case, to resolve psychic tension) than to give a person a fish (or in this case, to just take away a stressor). If the ability to resolve psychic tension returns, then I believe that my life would be just fine. I have personally dealt with far worse things in my life and still been happy than I am now because I was able to deal with them. If I felt sad about something, I would maybe cry and feel better. If I was stressed about homework, I would just take a break and play a game or something and feel better. What depression/anhedonia does is it takes away the ability to feel better. I would say that my life is pretty easy right now, so what is different about now and before? I have to conclude that there is some sort of problem or disorder.

Anyways, here is my Parnate Update for 3/4/2013 (Day 7):

Today is my last day of taking 20mg of Parnate - tomorrow I raise my dose to 30mg. So far I cannot say definitively if I have seen any sort of impact on my mood. Perhaps it is too early to tell. It is possible that my moods are not dipping as low as before (I really don't know for sure), but I have not seen any improvements in my anhedonia/numbness/libido. So far, there have been no side effects. My blood pressure is unchanged. My heart rate is stable. I do not feel any sort of "stimulation," orthostatic hypotension, insomnia, dry mouth, or drowsiness/tiredness. As I said before, there was one day that I felt a bit tired, but I don't know if that was really because of the Parnate, and I haven't noticed that sort of tiredness since.

Again, I have heard that the effective dose is usually 30-50mg, and that people usually see something after 2 weeks, so I still have alot of hope in this medicine.

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I get angry myself when I am told that.

But this is different.

This is "you're better able to address anhedonia if you also take care of the rest. "

I've been able to do this only recently, after more than a year to make my life life very stable.

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For me, this is a very unstable part of my life - for example, I haven't found my place in the world yet, but I can't find it while I am like this - I can't go to college, I can't date, etc. So it's sort of like an unavoidable problem while I am still depressed. Ideally, I could stabilize my life before I got better which would also debatably help me to get better, but in my case, my life is pretty much frozen until I get better and have the ability to move on with things (continue college, find a job, date, move out, etc.).

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Update on my experience with Phenelzine / Nardil... Day 24

Not quite as high a mood as I had a week ago but in hindsight I was bordering on manic. No significant side effects and I'm finding it easier to sleep now than the first 2 weeks. Still a significant improvement in my depression and anhedonia and this is now just past the point where other medications that have (initially) worked have failed.

There is one side effect I have noticed though... Gential anaesthesia. It's worse than the SSRIs I've taken and I suspect it's because I've had to raise my serotonin levels significantly in order for the MAOI to raise my dopamine.

I feel more or less normal at the moment however I'm having to re-learn what I like and what I don't. I had a reasonably successful night out on Saturday but I got bored after a while and realised the bar we were in for 5 hours bored me. I've been there loads of times but with the anhedonia making me feel deflated in any venue I hadn't realised that place actually bores me.

I'm taking 4 tablets a day and I've tried 3 in the morning and 1 at night but its too much during the day. I hoped once i reached a steady state i could move to once a day doses. I end up feeling signifcantly over stimulated and lose my clarity of thought so need to continue with split doses.

I've continued to eat small amounts of mature cheeses without any noticeable reaction but I don't intend to push my luck in that area!

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It's good to hear that you have had some success with Nardil Pw1981. If you felt pretty close to manic, I would say that is a big improvement! I have heard alot about Nardil's sexual side effects - I'm wondering if it is the serotonin or if it has something to do with Nardil's effect on GABA systems (or maybe both). I think that for some people, those side effects go away, but I haven't looked into it too much. Parnate raises serotonin alot too.

The good news is that I don't think MAOIs are known for post discontinuation sexual dysfunction like the SSRIs (and with the SSRIs, I think it is quite rare anyways), so it should go away if you choose to discontinue it.

Edited by itstrevor
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@Pw1981 Your side effect was expected. There are some "stupid" contraindication of augmenting with Remeron. Sure there may be some indirect extra Serotonintransfer by indirectly stimulating HT-1a by antagonizing Alpha 2 and possible 1 but it's not even sure Mirtazapine works that way and even if it does it's probably about small quantities anway. Someone called Euphoria was using Mirtazapine + Nardil with success at at socialanxiety forum.

It's about pushing Serotonin or Hydroxytryptofan away. I wonder if you even may add Cyproheptadin. That could possible help sexual sidefeffects though it's antihistaminergic as well is Mirtazapine which might get you tired. And if that's not allowed what about Ritanserin or Ketanserin or if that Pimavanserin has been released yet?

Though you might get lucky and it get better after a while some of those drug listed and maybe not maybe could help.

Edited by General_Failure
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<p>@Nulyra, I don't think you have to worry about those not coming here to be honest. Those few result good result I had from drug came about after some reading about dopamine  and perhaps SSRI iatrogenic anhedonia. My first bet was that Wellbutrin would be helpful. </p>

<p>It really was, until I got urticaria and had to stop. My next bet was Ritalin which was a lot of better with less anxiety though I didn't get them prescribed for certain "reasons" and then I just had pills for a week. </p>

<p>Last time my doc said that if I stopped provigil we could try concerta but after that I heard he is about to quit after been having him as a doc 5 years or more. Those other docs I had at most 1 or 2 years and sometimes I only saw one of those once and then there was a new. </p>

<p>I had like 5 or 6 docs before him if not more. And the next dr psyche will be another Marathondoc. I would be suspicious if he would prescribe ritalin and I would be suspicious if he don't. At least the Doc I have now which is a real Doc and not a Dr Psyche seemed to care about the patients. The one I will get is probably just another s***doc who put more importance in quick fixes and getting their patients "patched up" with some quick fix which will make them "productive" until they burn and crash again. It's the mammonic wind of change which is blowing in EUssr.</p>

<p> </p>

<p>And if I get ritalin and it works it's at least 5 years too late anyway.  Too late for what?  I just had some dreams to bury nothing else.</p>

<p>I am just basically living in my head anyway and usually in the past. Maybe I just don't like this world and it's shallowness. </p>

<p>I don't see why whitecoats should have some saying about drugs anyway. They just want everyone to "adapt" to become alike. </p>

<p>It's the lowest common denominator all the time. The individual may not be special but she is supposed to specialize into some profession and confusing what she is with what she does.</p>

<p>There's some "study" noticing that many people who has used illegal drug suffer from anhedonia! But they are not sure about the cause and effect. </p>

<p> </p>

<p>Which mean what is probably likely, the whole psychiatry is bunch of "n0000bs" pretending to know more about the people they meet than the patient in herself. At least that's what will become of it all. </p>

<p> </p>

<p>I know a low of people I grew up with smooking garden shrub. I didn't. I lacked social contacts. They're all in a "better" situation that I am in now.</p>

<p>Sure maybe my problems was graver.. but what it exposes is more this. I didn't trust myself as much as I've should. I didn't trust my instinct. I tended to intellectualize instead of "feal".</p>

<p> </p>

<p>And that's the recipe for ending up with asswipes thinking they know more of oneself after a possible brief 5 minutes in worst case. </p>

<p>Not to say that there is decent people working at the psychiatry.. </p>

<p> </p>

<p>I am just p***** overall about the so called "expertise" which is touted everywhere. There's the journalist with their expertise in "etiquette" and how to copulate. People are even forced to pay for their propaganda here. One of the radioprogrammes is having lessons how to fistfuxking anuses.. </p>

<p> </p>

<p>And if you haven't guessed it by now,, I live in Sweden. Nice to meet you.</p>

Edited by General_Failure
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@itstrevor: While this will probably offer only minor relief for now, probably your situation will improve a lot once your life becomes more stable.

I notice that a common refrain of yours is the inability to date.

Since I may experience similar problems, I would be interested in your take on it.


I find most people and most discussion boring, I can't let myself go and can't participate in the fun.


This makes it very hard to connect with people in general.



More to the specific, I do believe that anhedonia is directly connected to my lack of confidence.

If my brain never gets any reward, how can I feel confident about anything?

This is a huge problem when approaching to opposite sex.



Also: has anyone tried to address depersonalization and derealization apart from anhedonia?
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@itstrevor: While this will probably offer only minor relief for now, probably your situation will improve a lot once your life becomes more stable.
I notice that a common refrain of yours is the inability to date.
Since I may experience similar problems, I would be interested in your take on it.
I find most people and most discussion boring, I can't let myself go and can't participate in the fun.
This makes it very hard to connect with people in general.
More to the specific, I do believe that anhedonia is directly connected to my lack of confidence.
If my brain never gets any reward, how can I feel confident about anything?
This is a huge problem when approaching to opposite sex.
Also: has anyone tried to address depersonalization and derealization apart from anhedonia?

You might want to give behavioral activation a try. It is a treatment aimed at reconnecting depressed people (particualrly severe and chronically depressed) with rewarding events. The basic idea is that psychologists noticed that people with longstanding or severe depresison tend to withdraw from potentially rewarding experiences. This is because on the one hand loss of interest makes the experiences less rewarding and on the other hand depressed people often experience negative consequences in otherwise pleasurable experiences. For instance, while dating: being bored, yet anxious. According to modern conceptualizations of dperession, in the first place it robs you of the ability to experience pleasure, to an extent, and makes you experience exagerated levels of negative emotions(anxiety for example). Over time this causes a person to lose motivation to engage in once pleasurable experiences. As more and more energizing postive activties are ceased, depression increases (as people need positive/pleasurable experiences to energize themselves) and with ith also non-helpful beliefs about experiencing pleausare can develop. For instance thinking that you have a chemical imbalance that you are helpless against or that you not going to enjoy it anyway etc. Over time, this can develop into more persistent anhedonia, since you are not experiencing pleausre, the body adapts homeostatically. Kind of like how muscular tone disintegrates if one ceases to exercise etc.

In behavioral activation a forceful approach is taken to reconnecting people to rewarding experiences. Strikingly a very famous, quite large clinical trial showed that, particularly in those with severe depression, behavioral activation was signifcantly more effective than medication and cogntive therapy in terms of remission rates. 56% of patients randomzied to BA achieved remission compared to 36% of CT and 23% for SSRI antidepressant (1). The level of depression in this groups was severe, with 33% being patietns wit melancholic depression and average BDI scores of 35.1 and HSRD of 23.6. In the long run it was even more significantly superior (2). those whoe responded to the treatments were followed over time to evaluate relapse in one year and of those randomized to BA who responded 50% relapsed, compared to 60% in the SSRI condition. Also, in the second year the rate of relapse,recurrence stayed at about 50% comapred to >90% of patients withdrawn from their SSRI.

When I read your posts it appears to me that you still have at least the capacity for pleasure, since you wrote that you still experience positive emotions regarding your earlier life and in the previous post that MOSt people and conversation bores you. To me this suggests that your problem, although longstanding, mighr not be purely biochemical.

(1)Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.

(2)Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression

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@itstrevor: While this will probably offer only minor relief for now, probably your situation will improve a lot once your life becomes more stable.
I notice that a common refrain of yours is the inability to date.
Since I may experience similar problems, I would be interested in your take on it.
I find most people and most discussion boring, I can't let myself go and can't participate in the fun.
This makes it very hard to connect with people in general.
More to the specific, I do believe that anhedonia is directly connected to my lack of confidence.
If my brain never gets any reward, how can I feel confident about anything?
This is a huge problem when approaching to opposite sex.
Also: has anyone tried to address depersonalization and derealization apart from anhedonia?

I like how you try to seek in to your own psychology behind this.

It's just a theory but I believe that anhedonia can also be caused because you lost the connection with yourself. In my case, there are no feelings behind what I do or say because I'm insecure and question every little thing (way too much). I'm not comfortable in my own skin so I can't let my true colours shine. I still talk like I used to do but the feeling behind it is gone. Pleasure feelings are for me something that you feel when you're safe with yourself. When you're relaxed with who you are.

It's like I don't know anything anymore, I have no real opinions anymore, something that I really stand for, so of course I don't feel the emotion that comes with it.

I think this came because of post-traumatic stress from a very big trauma that completely changed my world. I also suffered from living in a fantasy world to escape the hell where I was in, so when I got pulled out of that world, the real one had become alien to me.

I believe I need to find a good therapist that helps me to connect to my inner self, deep down in the core, it is still there, I just lost touch with it. Sometimes I get panic attacks and feel like I'm going insane. I feel like this is how a psychopath is made.. Talk about a high-stress level there! Of course I'm not a psycho, of course I still have feelings.. I'm just very lost and need to find the way again.

That's just my story tho, I do believe that some people can suffer from a chemical inbalance or brain damage or maybe something else that we can't explain yet..

Gah, my English could use some work.

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Nulyra, what you describe sound like dissociative symtpoms to me, this is common in PTSD and other stress related disorders . Depersonalization to be more specific. Often there is also the loss of emotions and emotional connection with the surroundings (derealization)

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interestingly, anhedonia can also develop following chornic 'mild'life stress. Like most here experience. However in these cases the personal integrity is often intact and people 'only' feel emotionally paralyzed. derealization on the other hand often follows more intense acute stress. Considering that the symptoms of derealiation are similat, but more severe, perhaps they are related things that also share some common pathogenic biochemical pathways.

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@sc2: this looks very promising. Thanks!

I think I have definitely to address my social anxiety.

I'll try to collect some information.

Do you know whether it is something I can do by myself or I require a therapist?


Regarding derealization/depersonalization, my therapist got baffled by my symptoms, he expected me to have suffered some trauma of sort.

I don't recall anything like that.

I had a bad period, but am not sure I could call it traumatic.



@Nulyra: I am definitely disconnected from myself.

And yes, I do question every little thing myself.


Unlike you however, I am very opinionated.

I think I actually get some excitement from rational arguments, which is where I usually feel confident.

At the same time, I don't know what I like and what I don't.

What is my fav meal?

Is that girl attractive?

Do I like this song or not?


Technically, psychopaths just lack any for of compassion, I believe it's not the case for any of us.

Also, your english is pretty good.
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@sc2: I had a brief look at Behavioural Activation and I am not sure it's what I need.

It seems mostly a treatment against inertia, which is not a huge deal for me.

Also, it assumes that I can recognize whether something is pleasurable or not.

Still, it makes a good point about starting with small things to feel some satisfaction, which I will keep in mind.

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Well the goal of the treatment is not only to treat inertia, but to cultivate the capacity to enjoy things. I can imagine that from reading how it works, especially the theoretical underpinnings, that it seems to be a therapy that is most useful for those who have it extremeley bad. however, there is also some evidence of its efficacy in PTSD (1), specifically to alleviate anhedonia symptoms. As you might have noticed I like to stress the behavioral/psychological aspects of the condition sometimes, especially when there seems to be the capacity to feel. Here is a case study, in which a patient with severe anhedonia as a result of PTSD and major depression was treated using BA and afterwards the anhedonia was completely cured.

(1) A pilot study of behavioral activation for veterans with posttraumatic stress disorder

(2) Behavioral activation for comorbid PTSD and major depression: A case study

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