Suggested Treatment Plan

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Ghost
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Suggested Treatment Plan

Unread post by Ghost »

PSSD Suggested Treatment Plan

This thread is devoted to standardizing a treatment plan that gives someone starting with PSSD the crash-course in treatment options. It's based off of several years of theory that I've been working on and includes the work of Dr. Goldstein. I'll be editing this post and the thread to keep it clean, but I encourage anyone to give feedback on it. It uses the assumption that PSSD needs three factors to be initiated:

PSSD Risk Factors
1) Extreme Psychological Stress
2) Genetic Susceptibility
3) SSRI antidepressant


Side Notes:
a) PSSD is more common in males.
b) PSSD is more common in ages 15-25
c) PSSD is more common in previously hyper-sexual individuals


I don't think that PSSD will ever find a singular "cure". Instead, I think that the best treatment will be a refined protocol that works through several common contributing factors. Last year I began my Diagnostics page on my site. In it I listed 4 contributing factors to PSSD: Psychological, Physical, Hormonal and Neurological.

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Psychological: Anxiety, Depression, Stress, OCD, Relationship Issues.

Physical: Physical damage or blockage that prevents function of genitalia.

Hormonal: Hormonal irregularities or damage to structures releasing these hormones.

Neurological: Damage to sexual parts of brain, or to the nerves throughout the body.
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These categories aren’t mutually exclusive. For example, a neurological problem could lead to lack of sexual thoughts, and therefore blood flow to sex organs. This would trigger a physical problem as the genitals no longer have correct flow of blood. These symptoms could cause anxiety surrounding performance. This performance anxiety could release stress hormones that lead to the shutdown of sex hormone synthesis. You can see how all four categories can quickly be enlisted, and the problem complicated. Most treatments listed below could fit into multiple categories.

As I currently see it, the most logical order to treat these possible causes is in the order I list them above. That means that you must master one level before moving to the next one (the exception here being that a complete physical/psychological/hormonal work-up should be completed ASAP. Treatments mentioned link to their associated forum thread.


Psychological: Exercise, Meditation, Cognitive Behavioral Therapy (CBT), CBD, Inositol, Ashwagandha, St. John's Wort, Atypical Antidepressants, Bupropion/Wellbutrin, Mianserin, Tianeptine), Ketamine/Psilocybin (with care), Buspar, etc. (Some other tested PSSD treatments include Choline, Yohimbine, Ginkgo Biloba, Piractetam)

Physical: Stretches, Pelvic Floor therapy, PT, MRI, Visiting Dr. Goldstein for testing, etc.

Hormonal: Complete hormone panel (info on my site), Herbs to correct hormone issues(T/E/Prog etc).

Neurological: Dopamine Agonists (Cabergoline, Pramipexole - Proceed w/ caution: DAWS), 5HT1A drugs (Buspar/Buspirone, Addyi/Flibanserin), etc.

Many people seem to want to jump to neurological causes of PSSD. I definitely did too when I got PSSD back in 2014. I think that this is an important place for us to keep looking for answers, but it's not the best way to treat your PSSD from day one. Many PSSD cure cases have included a anti-depressive and anxiolytic compound (SJW/Inositol/Mainserin/Low-Dose SSRI). It's important that you shut off the negativity and keep a calm head. Take each day one at a time. Read my page on PSSD Resources page. At some point you have to give up the anger towards doctors/pharma/other PSSD sufferers etc.

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From: "So You're New to PSSD?" - PSSD Lab

My first piece of advice to those on the first steps of their PSSD journey is to keep hope. Hope that PSSD will resolve, but even more so hope that they can grow to be happy again. Millions of people are miserable even without PSSD (that’s why antidepressants are even around in the first place), and I know plenty of people with PSSD who lead happy and fulfilling lives. If you make happiness contingent of the status of your PSSD, you might never find it again. That doesn’t mean that it comes easy, or that the path is always clear. It simply means that regardless of what happened yesterday, nothing done today can ever change the past. This is most important on the days when you feel that nothing is left.

My next piece of advice is to stop reading the sob stories. There are many of them. Marriages ruined. Lives destroyed. Careers ended. STOP. Stop. It is addicting when you first get PSSD. It was for me at least. If I’ve learned anything from PSSD, it’s that nothing in life is truly certain besides birth and death. Everything in-between is a mystery. Don’t fill yourself with absolutes and stories written from unknown people from around the world. They are not you. They do not define you or your experience with PSSD.

Finally, don’t let PSSD stop you from living your life. I say that for the days when it’s easier, but especially for the days when it’s hard. Run blindly into the unknown, and do not fear it. If you do fail, you will do so knowing that you’ve tried. If you are unsure if you should ask the cute girl at the party for her number: do it. Do it fearlessly. Do it unapologetically. You are you no matter what has happened from an SSRI.

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Ghost's 3 step program to an improved outlook on life:

1) Cease reinforcement of hopelessness: Stop reading sob stories. If it's a sob story post, immediately stop reading it.
2) Treat pharmacological/psychological barriers: Ketamine / Psilocybin / Psychedelics in general are perspective-changing tools that will reshape how you view grief and acceptance. If you can't use these drugs, look for other mental illness treatments mentioned above. Use these tools alongside meditation/therapy and lifestyle changes such as running/volunteering/healthy eating.
then proceed to...
3) Acceptance of the situation despite how horrible it currently is (nearly impossible unless you finish steps 1&2).

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Last Edited: 10/01/20 [Fixed links from .com forum to .org - All should once again be active]
Last edited by Ghost on Thu May 09, 2019 8:39 am, edited 17 times in total.
- Medical Student & Friendly poltergeist - Lexapro Sept '14. [Hx] [PSSD Lab] [r/PSSD] [Treatment Plan] - Add "Ghost" in replies so I see it :)
been_too_long
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Re: Suggested Treatment Plan

Unread post by been_too_long »

I may strongly disagree on some your theories both in cause and treatment (though Im convinced your spot on with one.) But I applaud the approach and work your putting in Ghost. Sincerely hope this leads us closer to our goals :)
Numbtomind 2
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Re: Suggested Treatment Plan

Unread post by Numbtomind 2 »

Hello I've had pssd caused by anafranil 50 mg that I took 6 months ago and I'm still is experiencing extreme sexual disfunction. I'm losing hope in treatment, I'll follow these steps and test to see what works. Thanks
75mg Clomipramine. june-july 2018
(Anxiety/Ocd)

Current symtoms I'm experiencing.
Emotional numbness, Pleasurless activities, Complete sexual system shutdown.
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Ghost
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Re: Suggested Treatment Plan

Unread post by Ghost »

Numbtomind 2 wrote:Hello I've had pssd caused by anafranil 50 mg that I took 6 months ago and I'm still is experiencing extreme sexual disfunction. I'm losing hope in treatment, I'll follow these steps and test to see what works. Thanks
Nice! Just keep in mind that this list is ver preliminary and it will be changing a lot. I'm really interested in the input from people and the other mods/admins etc.
- Medical Student & Friendly poltergeist - Lexapro Sept '14. [Hx] [PSSD Lab] [r/PSSD] [Treatment Plan] - Add "Ghost" in replies so I see it :)
Blueturtle
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Re: Suggested Treatment Plan

Unread post by Blueturtle »

Thank you so much for this post, this is a nice clean list of facts and treatment protocol.

I saw a psychiatrist recently and talked to him about this, he’s going to refer me to see a urologist and an endocrinologist.

Then we’ll go from there.
PSSD from citalopram.
Took it Winter 2012-Summer 2016
Cut cold turkey. Symptoms include genital anesthesia, ejaculatory anhedonia, low libido, Burning/tingling genital pain.
My story: http://www.pssdforum.com/viewtopic.php?f=14&t=2536
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afx
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Re: Suggested Treatment Plan

Unread post by afx »

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Last edited by afx on Mon Aug 08, 2022 6:20 am, edited 13 times in total.
Blueturtle
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Re: Suggested Treatment Plan

Unread post by Blueturtle »

I think that’s a tad bit too negative about the dopamine agonists, I think some folks have had improvements with those as well as the PFS community has had improvements with dopamine agonist, but you’re right they don’t do much for others sadly.
PSSD from citalopram.
Took it Winter 2012-Summer 2016
Cut cold turkey. Symptoms include genital anesthesia, ejaculatory anhedonia, low libido, Burning/tingling genital pain.
My story: http://www.pssdforum.com/viewtopic.php?f=14&t=2536
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Ghost
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Re: Suggested Treatment Plan

Unread post by Ghost »

RE DA's

They have helped several people that I know but they are largely a bandaid.
I've seen good results also from 5HT1A agonists, not always negative.

However, this is the bottom of the treatment list and why I suggest treating the neurological problems the last resort in PSSD treatment. The results are inconsistent and the treatments are less safe.
- Medical Student & Friendly poltergeist - Lexapro Sept '14. [Hx] [PSSD Lab] [r/PSSD] [Treatment Plan] - Add "Ghost" in replies so I see it :)
Trazohell
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Joined: Fri Jan 26, 2018 11:46 am

Re: Suggested Treatment Plan

Unread post by Trazohell »

Ghost wrote:PSSD Suggested Treatment Plan

This thread is devoted to standardizing a treatment plan that gives someone starting with PSSD the crash-course in treatment options. It's based off of several years of theory that I've been working on and includes the work of Dr. Goldstein. I'll be editing this post and the thread to keep it clean, but I encourage anyone to give feedback on it. It uses the assumption that PSSD needs three factors to be initiated:

PSSD Risk Factors
1) Extreme Psychological Stress
2) Genetic Susceptibility
3) SSRI antidepressant


Side Notes:
a) PSSD is more common in males.
b) PSSD is more common in ages 15-25
c) PSSD is more common in previously hyper-sexual individuals
Omg, apart from the genetic component that I can not say, I fulfill all 5 points:
Had a lot of stress in 2017, it started after a drug that inhibits serotonin, I am male, was then 24 and previously always very sexual.
June 2015 - April 2016 Fluoxetine
April 2016 - March 2017 Fluvoxamine
December 2017 9 days Trazodone
After Trazodone PSSD: loss of libido & spontaneous/night/morning erections, prostate/pelvic pain, genital numbness, lower sperm count, Anhedonia
chemistry
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Re: Suggested Treatment Plan

Unread post by chemistry »

Excellent post, Ghost - I really appreciate you putting the time and effort in to compile this information. Interestingly enough, after having PSSD for years myself, It's almost as if I've been acting as if I had read this post 6 months ago. I agree with everything you wrote and it holds true in my particular case. One of my symptoms actually is that I find it very difficult to let go and relax, and this gets much much worse if i haven't enough sleep. I think this constant feeling of tension and stress for no particular reason is not helping my condition - particularly the anhedonia, since the only time I'm able to "tap into" some sort of profound emotion is during the few times i'm able to truly let go during my meditation (or whenever really). For instance i'll get flashbacks to Pre-SSRI periods in my life, usually when I was a kid since i took SSRIs at 14, where I had no worries and life was "good" and I'll sort of remember what that felt like and how good it felt. I'll actually feel it which never happens. As soon as I notice that I kind of lose it, but I hope which practice i'll be able to access those emotions more regularly and easily.

Moral of the story is I think to treat PSSD in 2019 we need to approach it at all angles - starting with the basics and moving from there.
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