New therapist, new theories

This is for hypothesis and even educated speculation.
Thomas
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New therapist, new theories

Unread post by Thomas »

After (already!) 3 years of PSSD (my main symptom is emotional blunting, including no libido) with little to no improvement (except for sleep, which is now manageable through medication), I decided to seek out a new therapist.

She presented two interesting theories:
1) My strong reaction to a very low dose of antidepressant was highly unusual and not the expected effect of such drugs (I experienced almost euphoria with only 5mg/day of escitalopram or 7,5mg/day of mirtazapine). She concluded that it's possible I may be suffering from a chronic overdose of antidepressants. However, this theory is not well-documented...
2) She believes that my condition resembles someone stuck in the "low" phase of bipolar disorder (despite the absence of depression), and suggests that lithium could be a potential treatment option.

What are your thoughts on these theories?
Based on my research on this forum, it seems that lithium is rarely tried to alleviate PSSD symptoms, but some individuals have reported success with it.
Escitalopram, 10mg/day, Jan-May 2019. Fluoxetine, May-Sept 2019. Mirtazapine 7,5mg/day, November 2019-January 2020. Escitalopram, 5mg/day, Feb-May 2020.
Symptoms: sexual & emotional numbness
arahant
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Re: New therapist, new theories

Unread post by arahant »

Thomas wrote: Wed May 24, 2023 10:20 am After (already!) 3 years of PSSD (my main symptom is emotional blunting, including no libido) with little to no improvement (except for sleep, which is now manageable through medication), I decided to seek out a new therapist.

She presented two interesting theories:
1) My strong reaction to a very low dose of antidepressant was highly unusual and not the expected effect of such drugs (I experienced almost euphoria with only 5mg/day of escitalopram or 7,5mg/day of mirtazapine). She concluded that it's possible I may be suffering from a chronic overdose of antidepressants. However, this theory is not well-documented...
2) She believes that my condition resembles someone stuck in the "low" phase of bipolar disorder (despite the absence of depression), and suggests that lithium could be a potential treatment option.

What are your thoughts on these theories?
Based on my research on this forum, it seems that lithium is rarely tried to alleviate PSSD symptoms, but some individuals have reported success with it.
There's not much to theorize here.

SSRIs are potent numbing agents for the majority.
People who get euphoria taking it, which is sometimes a symptom of triggering hypomania or full-blown mania, are primarily people with undiagnosed bipolar, of which there are many types.
Some can get hypomanic episodes even from sleep deprivation, which feeds a vicious circle.

Thankfully, bipolar is well-documented to improve tremendously on mood stabilizers.

You can test your "new PSSD theory" by experimenting with a fair trial of mood stabilizers and keeping a regulated sleep schedule.

For reference: https://psychcentral.com/bipolar/antide ... uced-mania

Best,

Arahant.
Wellbutrin (2007 - 2018)
Wellbutrin + Sertraline (2015)
Wellbutrin + Ritalin (2016 - 2018)
Wellbutrin + Ritalin + Sertraline (3 months in 2018)
Buspirone (Feb 2019 - Today)
Ritalin + Buspirone (Nov 2019 - today)
Thomas
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Re: New therapist, new theories

Unread post by Thomas »

Thanks for your kind and smart (as always ;) ) answer.

It makes sense about how I was feeling while taking AD, although I am not fully convinced of what it implies (I would have suffered all my life from undiagnosed bipolar disorder, without a single manic phase and stuck in a "depressed" state - without noticing it until AD switched me to hypomania).

But I am not sure I see the link with my current symptoms. Do you mean I switched back to a depressive state? I haven't read anything about bipolar depression without feeling anything.
Escitalopram, 10mg/day, Jan-May 2019. Fluoxetine, May-Sept 2019. Mirtazapine 7,5mg/day, November 2019-January 2020. Escitalopram, 5mg/day, Feb-May 2020.
Symptoms: sexual & emotional numbness
arahant
Posts: 564
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Re: New therapist, new theories

Unread post by arahant »

Thomas wrote: Thu May 25, 2023 5:30 am Thanks for your kind and smart (as always ;) ) answer.

It makes sense about how I was feeling while taking AD, although I am not fully convinced of what it implies (I would have suffered all my life from undiagnosed bipolar disorder, without a single manic phase and stuck in a "depressed" state - without noticing it until AD switched me to hypomania).

But I am not sure I see the link with my current symptoms. Do you mean I switched back to a depressive state? I haven't read anything about bipolar depression without feeling anything.
I am not discussing your case specifically; that would be better discussed with a psychiatrist and psychologist.
There's no black-and-white diagnosis in psychiatry, but some portion of trial and error and fuzzy categorization.
There are many types of bipolar. Common sense thinks it is necessary to have a full-blown manic/psychotic episode to be bipolar; that is the case only for type 1.
It is a bit fuzzy, but hypomanic states are followed by less need for sleep. There are even "mixed states" with hypomanic and depressive states simultaneously.
But it seems familiar that all of them react euphorically after taking SSRIs.
Given that mood stabilizers are used successfully, and the side effect profile is far from the ones of SSRIs.

That's why I mentioned a fair trial of mood stabilizers.

Best,
Arahant
Wellbutrin (2007 - 2018)
Wellbutrin + Sertraline (2015)
Wellbutrin + Ritalin (2016 - 2018)
Wellbutrin + Ritalin + Sertraline (3 months in 2018)
Buspirone (Feb 2019 - Today)
Ritalin + Buspirone (Nov 2019 - today)
Thomas
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Joined: Thu Jul 09, 2020 6:32 am
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Re: New therapist, new theories

Unread post by Thomas »

arahant wrote: Thu May 25, 2023 1:25 pm I am not discussing your case specifically; that would be better discussed with a psychiatrist and psychologist.
I already have a psychiatrist and that's exactly the process I am following.
There are many types of bipolar. Common sense thinks it is necessary to have a full-blown manic/psychotic episode to be bipolar; that is the case only for type 1.
It is a bit fuzzy, but hypomanic states are followed by less need for sleep. There are even "mixed states" with hypomanic and depressive states simultaneously.
But it seems familiar that all of them react euphorically after taking SSRIs.
Given that mood stabilizers are used successfully, and the side effect profile is far from the ones of SSRIs.

That's why I mentioned a fair trial of mood stabilizers.
Thanks for your answer, it make sense. That's probably the process I will follow.
Escitalopram, 10mg/day, Jan-May 2019. Fluoxetine, May-Sept 2019. Mirtazapine 7,5mg/day, November 2019-January 2020. Escitalopram, 5mg/day, Feb-May 2020.
Symptoms: sexual & emotional numbness
r4ndom
Posts: 34
Joined: Wed Oct 21, 2015 1:59 am
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Re: New therapist, new theories

Unread post by r4ndom »

arahant wrote: Wed May 24, 2023 2:17 pm
Thomas wrote: Wed May 24, 2023 10:20 am After (already!) 3 years of PSSD (my main symptom is emotional blunting, including no libido) with little to no improvement (except for sleep, which is now manageable through medication), I decided to seek out a new therapist.

She presented two interesting theories:
1) My strong reaction to a very low dose of antidepressant was highly unusual and not the expected effect of such drugs (I experienced almost euphoria with only 5mg/day of escitalopram or 7,5mg/day of mirtazapine). She concluded that it's possible I may be suffering from a chronic overdose of antidepressants. However, this theory is not well-documented...
2) She believes that my condition resembles someone stuck in the "low" phase of bipolar disorder (despite the absence of depression), and suggests that lithium could be a potential treatment option.

What are your thoughts on these theories?
Based on my research on this forum, it seems that lithium is rarely tried to alleviate PSSD symptoms, but some individuals have reported success with it.
There's not much to theorize here.

SSRIs are potent numbing agents for the majority.
People who get euphoria taking it, which is sometimes a symptom of triggering hypomania or full-blown mania, are primarily people with undiagnosed bipolar, of which there are many types.
Some can get hypomanic episodes even from sleep deprivation, which feeds a vicious circle.

Thankfully, bipolar is well-documented to improve tremendously on mood stabilizers.

You can test your "new PSSD theory" by experimenting with a fair trial of mood stabilizers and keeping a regulated sleep schedule.

For reference: https://psychcentral.com/bipolar/antide ... uced-mania

Best,

Arahant.
Do you know which specific mechanism caused by SSRI's lead to the numbing effect?
Thomas
Posts: 306
Joined: Thu Jul 09, 2020 6:32 am
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Re: New therapist, new theories

Unread post by Thomas »

After some further consultations, she prescribed lamotrigine.
I haven't come across any negative or positive reports about it here (unlike the rather positive feedback about lithium), but I will start the trial.
Escitalopram, 10mg/day, Jan-May 2019. Fluoxetine, May-Sept 2019. Mirtazapine 7,5mg/day, November 2019-January 2020. Escitalopram, 5mg/day, Feb-May 2020.
Symptoms: sexual & emotional numbness
Thomas
Posts: 306
Joined: Thu Jul 09, 2020 6:32 am
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Re: New therapist, new theories

Unread post by Thomas »

After six months, we decided to stop lamotrigine because the benefits (slightly improved sleep and feelings, but far from normal) / side effects (tremors - which are documented side effects) ratio wasn’t good enough
Last edited by Thomas on Sun Jan 28, 2024 6:04 am, edited 1 time in total.
Escitalopram, 10mg/day, Jan-May 2019. Fluoxetine, May-Sept 2019. Mirtazapine 7,5mg/day, November 2019-January 2020. Escitalopram, 5mg/day, Feb-May 2020.
Symptoms: sexual & emotional numbness
Thomas
Posts: 306
Joined: Thu Jul 09, 2020 6:32 am
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Re: New therapist, new theories

Unread post by Thomas »

Btw, lamotrigine seems to be a good way to manage depression for people who are afraid of antidepressant sexual side effects (lamotrigine has none) or any PSSD usual suspects (works differently from SSRIs)
Escitalopram, 10mg/day, Jan-May 2019. Fluoxetine, May-Sept 2019. Mirtazapine 7,5mg/day, November 2019-January 2020. Escitalopram, 5mg/day, Feb-May 2020.
Symptoms: sexual & emotional numbness
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Determined-Mind
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Re: New therapist, new theories

Unread post by Determined-Mind »

That's interesting. Some people experience better sexual pleasure with lamotrigine.

Were you taking it alone? At what dosage?

When you say your sensations were improved: are you talking about mechanical perceptions (temperature, pressure, movement) or pleasure?

What was your base level out of 10?

Which parts of your body were involved (sex, breasts, whole body?).

Out of 10, what were your improvements with lamotrigine?

Have you retained the improvements you experienced after stopping the drug?

Do you think you could write a full report with lamotrigine here?

Personally, if I were to try this drug and had no major side effects, I would try combining it with other drugs to see if any synergistic and beneficial effects appear.

For example:
- What would be the effects of lamotrigine + bupropion: two drugs that can act on sensations?
- And for lamotrigine + bupropion + buspirone?
- And for lamotrigine + flibanserin?
- And for lamotrigine + flibanserin + bupropion?

In short, you understand the principle: the field of possibilities is vast when you start combining drugs.
:arrow: You're looking for a cure or want to help the community? I've created an interactive table listing possible treatments for PSSD.

Feel free to contribute anonymously and share your experiences with different substances (+150 options)!
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