New therapist, new theories

[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.

[arahant]

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.

[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.

[arahant]

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

[Thomas]

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.