Thoughts on my psychopathology?

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emcr1991
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Thoughts on my psychopathology?

Unread post by emcr1991 »

Hi,

First-time poster, male in early 30s. My history in a nutshell: I took fluoxetine 20mg for ~8 years from late teens to mid-20's for OCD/GAD. After several failed attempts to quit I finally succeeded and I've now been SSRI-free for ~3.5 years and with PSSD that I strongly suspect started creeping in already when I was on the drug. Before I finally quit I tapered down over ~2 years so it's been more than 5 years since I was on the full 20mg.

My main symptoms are cognitive - I suffer from poor short-term memory, focus and aphantasia. Secondary symptoms are issues with vision (difficulty focusing, lots of floaters) and muted emotions. I've been spared sexual symptoms or at least they aren't noticeable to me. I feel my symptoms have improved somewhat during the past years but not enough to conclude that any homeostasis is taking place.

I have made a few observations about my condition and I'd be keen to hear if these give rise to any thoughts for you guys.
First, I feel some relief from dopamine supplementation. For example if I smoke when I'm drunk (which is only time I smoke) I feel slightly sharper and (maybe as a result) I feel an extreme urge to smoke. Very big fan of coffee as well. I tried L-tyrosine supplements and felt quite a bit smarter for 1-3 days but sadly effect didn't last. Tried buproprion for a few weeks years ago but all I felt was a high level of anger and sexual urges.
Second, and slightly more curiously, when I'm hung-over I feel slightly more emotions but I also get very melanchol. I also have a higher libido and stronger erections - although as mentioned status quo isn't really problematic for me.
Finally, during one of my failed attempts to quit the drug I was forced to reinstate to 10mg and I felt positively manic at the time. Out-of-control happiness and energy levels. Nevertheless can't say I felt any smarter.

Wondering if anyone has any medication/supplements or techniques to suggest to someone with my pathology? I've been looking into both ADHD medication and vortioxetine but I'm hesitant to pull the trigger and risk a crash.

Thanks a lot in advance. On a personal note I just wanna say I am very grateful for all you guys. This can be a very bleak existence and sometimes I feel like I would have given up unless I knew there were others fighting this fight.

E
sylv
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Re: Thoughts on my psychopathology?

Unread post by sylv »

Don't obsess with getting to 100%, but try to live a rewarding life with everything you have spared.

Occasional ( 2x per week ) methylphenidate seems safe, chronic daily may cause problems. Vortioxetine is the worst option possible. Reistantation is only advisable if your OCD is so bad you cannot live with it without meds. SSRI may crash you again and to different thing than PSSD like Withdrawal Akathisia or worse Tardive Akathisia. Crashing very much complicates recovery and may end bad. Generally it's best to stay away from all akathisia or emotional blunting inducing medications ( antidepressants, antipsychotics, mood stabilizers, chronic benzodiazepines). Take care of mental health to do not need them. Beside MPH you may try Mirtazapine / Cyproheptadine rebound ( 1x low dose per week, never chronic ) and acute piracetam.

Best wishes
PEUS_DEUS
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Joined: Mon Sep 12, 2022 3:05 pm
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Re: Thoughts on my psychopathology?

Unread post by PEUS_DEUS »

sylv wrote: Sun Sep 11, 2022 9:16 am Don't obsess with getting to 100%, but try to live a rewarding life with everything you have spared.

Occasional ( 2x per week ) methylphenidate seems safe, chronic daily may cause problems. Vortioxetine is the worst option possible. Reistantation is only advisable if your OCD is so bad you cannot live with it without meds. SSRI may crash you again and to different thing than PSSD like Withdrawal Akathisia or worse Tardive Akathisia. Crashing very much complicates recovery and may end bad. Generally it's best to stay away from all akathisia or emotional blunting inducing medications ( antidepressants, antipsychotics, mood stabilizers, chronic benzodiazepines). Take care of mental health to do not need them. Beside MPH you may try Mirtazapine / Cyproheptadine rebound ( 1x low dose per week, never chronic ) and acute piracetam.

Best wishes
Why the recommendation for only 1x of Cypro or Mirtazapine per week?
sylv
Posts: 200
Joined: Thu Apr 27, 2017 6:32 am
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Re: Thoughts on my psychopathology?

Unread post by sylv »

PEUS_DEUS wrote: Mon Sep 12, 2022 4:02 pm
sylv wrote: Sun Sep 11, 2022 9:16 am Don't obsess with getting to 100%, but try to live a rewarding life with everything you have spared.

Occasional ( 2x per week ) methylphenidate seems safe, chronic daily may cause problems. Vortioxetine is the worst option possible. Reistantation is only advisable if your OCD is so bad you cannot live with it without meds. SSRI may crash you again and to different thing than PSSD like Withdrawal Akathisia or worse Tardive Akathisia. Crashing very much complicates recovery and may end bad. Generally it's best to stay away from all akathisia or emotional blunting inducing medications ( antidepressants, antipsychotics, mood stabilizers, chronic benzodiazepines). Take care of mental health to do not need them. Beside MPH you may try Mirtazapine / Cyproheptadine rebound ( 1x low dose per week, never chronic ) and acute piracetam.

Best wishes
Why the recommendation for only 1x of Cypro or Mirtazapine per week?
Acute Mirtazapine may mimic ( depending on individual and his mental state) an alcohol hangover effect on emotional processing. This is called 5-HT2a Mirtazapine or Cyproheptadine rebound, depending on which substance was used. Increased emotional processing may be exploited for psychological and cognitive rehabilitation. Chronic mirtazapine acts as classic antidepressant, but has no use for OCD. While planning treatment you have to consider your pre-PSSD conditions. Appearance of PSSD and worsening of emotional blunting might be signs of worsening of OCD or depression so check r/OCD and r/anhedonia for any clues what to do.
Acute methylphenidate because harm reduction. This is stimulant and it's hard to expect from chronically taken stimulant any beneficial action on emotional blunting, aphantasia or anhedonia. It may make all worse.

In alleviating emotional blunting forced intense exercise has some effect. When emotional processing improve aphantasia improve as well.

Take in mind there is no "cure" for Post SSRI Syndrome. There are only a certain agents useful for specific situations to boost rehabilitation and psychological techniques.
PEUS_DEUS
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Joined: Mon Sep 12, 2022 3:05 pm
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Re: Thoughts on my psychopathology?

Unread post by PEUS_DEUS »

sylv wrote: Wed Sep 14, 2022 10:33 pm
PEUS_DEUS wrote: Mon Sep 12, 2022 4:02 pm
sylv wrote: Sun Sep 11, 2022 9:16 am Don't obsess with getting to 100%, but try to live a rewarding life with everything you have spared.

Occasional ( 2x per week ) methylphenidate seems safe, chronic daily may cause problems. Vortioxetine is the worst option possible. Reistantation is only advisable if your OCD is so bad you cannot live with it without meds. SSRI may crash you again and to different thing than PSSD like Withdrawal Akathisia or worse Tardive Akathisia. Crashing very much complicates recovery and may end bad. Generally it's best to stay away from all akathisia or emotional blunting inducing medications ( antidepressants, antipsychotics, mood stabilizers, chronic benzodiazepines). Take care of mental health to do not need them. Beside MPH you may try Mirtazapine / Cyproheptadine rebound ( 1x low dose per week, never chronic ) and acute piracetam.

Best wishes
Why the recommendation for only 1x of Cypro or Mirtazapine per week?
Acute Mirtazapine may mimic ( depending on individual and his mental state) an alcohol hangover effect on emotional processing. This is called 5-HT2a Mirtazapine or Cyproheptadine rebound, depending on which substance was used. Increased emotional processing may be exploited for psychological and cognitive rehabilitation. Chronic mirtazapine acts as classic antidepressant, but has no use for OCD. While planning treatment you have to consider your pre-PSSD conditions. Appearance of PSSD and worsening of emotional blunting might be signs of worsening of OCD or depression so check r/OCD and r/anhedonia for any clues what to do.
Acute methylphenidate because harm reduction. This is stimulant and it's hard to expect from chronically taken stimulant any beneficial action on emotional blunting, aphantasia or anhedonia. It may make all worse.

In alleviating emotional blunting forced intense exercise has some effect. When emotional processing improve aphantasia improve as well.

Take in mind there is no "cure" for Post SSRI Syndrome. There are only a certain agents useful for specific situations to boost rehabilitation and psychological techniques.
The OCD correlation is interesting to here. As for the dosing, I still am confused as to why the acute dosing unless you’re specifically trying to play a rebound. I agree the rebound is a result of action at 5HT2A. But I think it’s a result of secondary messenger / signal transduction pathway up-regulation acting in a compensatory manner for the action at 5HT2A. You may not get immediate relief, but it seems to me like dosing more than once ( to a point) would create a rebound greater in duration. 5HT2A internalizes after 6 hours anyways.
sylv
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Joined: Thu Apr 27, 2017 6:32 am
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Re: Thoughts on my psychopathology?

Unread post by sylv »

PEUS_DEUS wrote: Mon Sep 12, 2022 4:02 pm
But I think it’s a result of secondary messenger / signal transduction pathway up-regulation acting in a compensatory manner for the action at 5HT2A. You may not get immediate relief, but it seems to me like dosing more than once ( to a point) would create a rebound greater in duration. 5HT2A internalizes after 6 hours anyways.
It may or may be not. That could as well be the effect on the microcircuits by the structural neuroplasticity like modifying synaptic connections ( synaptic numbers and synaptic strength could change in a manner of hours / days ) or by functional neuroplasticity like LTP and LTD. Could be an interplay of all mentioned.
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