Thursday, December 06, 2012

How To Cure Anhedonia

How To Cure Anhedonia? I would like to start this thread for everyone to share their experiences with anhedonia (emotional numbness, inability to experience pleasure, apathy, dead sex drive, etc.) so that we may all collectively find the best solutions. The more experiences we have here, the easier it will be to make connections and narrow down useful strategies/medications/solutions, We all need to work together on this.
I would like to add my personal experience with anhedonia and what I have discovered about it along the way. I have been anhedonic now for 10 months due to major depression triggered by chronic stress.

Anhedonia is my only persistent symptom and is occurring in the absence of any other depressive symptom (I do not feel "depressed," I do not "feel" at all). For this reason, many people experiencing anhedonia (me included) find fault with the technical association with "anhedonia" being only a symptom of another disease rather than a syndrome in itself. Firstly, what I have noticed about every person experiencing anhedonia (me included) is that they seem to mention the inability to experience the same list of things: music/art, sex/romance/dating, and emotional appreciation. To me, all of these are inter-related and so anhedonia really boils down to a flatness of emotional responsivity to anything and a general inability to experience pleasure.
The best way to describe it is to make the analogy to the loss of interest in sex as similar to the loss of interest in sex a male might experience soon after ejaculating (refractory period)or the loss of interest in music to the loss of interest one might feel towards a song after having heard the same song repeatedly for several months. I have read many articles on anhedonia and have seen many theories that suggest that anhedonia is a result of the failure to anticipate pleasure rather than experiencing it and that it involves the neurotransmitters dopamine and norepinepherine.

Firstly I would like to say that I can anticipate having a pleasurable response to something, but the only thing that is missing for me is the response itself. For example, I may get an adrenaline rush from something such as sex, but it is not accompanied by feelings of pleasure. I anticipate the pleasure, but I only experience the adrenaline, not the pleasure itself. I have had partial responses to stimulants and dopaminergic agents but no response to norepinepherine modulating drugs, though I have read many reports of people having success with norepinepherine drugs. Others left no noticeable effect.

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

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

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

The treatments that I have found through research to be successful in treating anhedonia are:
Stimulants - Methylphenidate, Dextroamphetamine, etc.
Dopamine Agonists - Pramipexole, Ropinirole, Cabergoline, Apomorphine, Bromocriptine, Rotigotine, etc.
Low Dose Antipsychotics - Aripiprazole, Amisulpride, Sulpride, etc.
Serotonin Receptor Antagonists - Buspirone, Low dose Fluoexitine, etc.
SSREs - Tianeptine
Dopamine Reuptake Inhibitors - Amineptine, Bupropion, etc.
Norepinepherine Reuptake Inhibitors - Desipramine, Atomoxetine, Nortryptaline, Bupropion, etc.
MAOIs - Parnate, Nardil, Selegiline, etc.
Other - Amantadine, Nicotine, Testosterone, Levodopa, Phenylethylamine, Cyproheptadine, Thyroid Augmenting (lithium for example), L-Tyrosine, L-Theanine, SAM-E, St. John's Wort, etc.

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

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

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

Taken From : depressionforums.org


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