my 2 cents to the discussion:
current hypothesis regarding pssd is that ssri downregulates post-synaptic 5ht1a serotonin receptor, which is self regulatory receptor, regulating serotonin flow to the rest of the brain. Downregulation results in loss of control over serotonin flow to the rest of the brain. 5ht1a pre-synaptic receptor is localized mainly in 1 part of the brain called raphe nuclei. This part is responsible for projecting serotonin to every other part of the brain. There are most likely other receptors involved in pssd such as 5ht2a and 5ht1b. They 'communicate' with other parts of the brain such as ventral tegmental area which projects dopamine to the nucleus accumbens. This part of the brain is responsible for libido and is most likely involved in pssd. Now it might explain why st john wort has high rate of success in pssd sufferers. It is known that it upregulates post-synaptic 5ht1a, there is no data if it is involved with pre-synaptic 5ht1a but it cannot be excluded. It is likely that it takes action there, because every antidepressant is somewhat involved with raphe nuclei. 5ht2a receptors increase dopamine in ventral tegmental area to set dopamine to nucleus accumbens which might explain why people experience windows. 5ht2a is positively regulating another neurotransmitter called glutamic acid, which is the most abundant neurotransmitter in the brain, appearing in approximmately 70% of neurons . Glutamate activates neuron and makes it permeable for ions to excitate the neuron. NMDA is glutaminergic receptor and it reliefes anhedonia directly, (pregnenolone, psychodelics, marijuana)although it may be responsible for other syndroms such as loss of enjoyment from previously exciting activities, not libido related pssd issues. Now it might be another mechanism by which 5ht2a could be involved in periodic windows of normalicy. Activating 5ht1b receptor is killing libido and reducing agression. Yohimbine, well known aphrodisiac is 5ht1b antagonist. The problem is no matter what happens uncontrolled flow from downregulated 5ht1a will eventually kill all progress from st john wort. There is no known fda approved drug that is known to directly upregulate pre-synaptic 5ht1a in raphe nuclei. There is no drug, but there is other thing that can be done - exercise (running) has been found to upregulate pre-synaptic 5ht1a
https://www.ncbi.nlm.nih.gov/pubmed/25833478.
Now by stating these facts i would present you by my humble opinion best possible pssd treatment taking into account current knowledge of the disease:
1. Taking sjw(recomennd Perika), if it produces side effects lower the dose, if it does not help lower the dose by cutting pills to half or quarters ( i reccomend being persistent and not quitting in 1-2 months). It's work on serotonin and NMDA will provide improvement
2. Running, running, running - long distances, can be jogging, can be HIIT, preferably both, jogging mixed with intervals. This is crucial, without running and thus upregulating 5ht1a in raphe nuclei, exceed serotonin from downregulated pre-synaptic 5ht1a will ruin most of the progress, or at least slow it considerably.
3. Taking ginkgo biloba - it upregulates 5ht1a, but also prevents stress-induced 5ht1a downregulation which might happen because perhaps overexercising by running long and with moderately strong rate is stressful biologically speaking to the organism.
4. Do not test yourself constantly. do not masturbate if window appears
tl;dr Take SJW, Run long distances HIIT/Jogging, take ginkgo, dont jerk off
Pregnenolone is NMDA allosteric modulator (just as alcohol is allosteric modulator of GABA), i do not recommend it because it's short-way solution, but in conjunction with sjw (after at least 2 weeks of treatment) it will (at least in my case) induce 100% remission 100% of the time i take it.
It's best, most complete theory regarding pssd i could formulate
thank you for your time,
''This informatnion is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.''