420 replies to this topic

[FunkOdyssey]

Fair enough. So lacking access to pharmaceutical dopaminergics (except Wellbutrin but that is really more NE than DA and the NE makes me more pure O than I otherwise am) I decided to go the Uridine/DHA/CDP Choline route again, we'll see if it helps.

in my experience and opinion, if you are suffering from anything remotely related to depression/dysthymia, supplemental sources of choline are something to avoid. If CDP-choline is found to be helpful, it's likely in spite of the choline, not because of it (the CDP is doing the heavy lifting).

At the very least, test uridine/DHA both with and without cdp-choline so you can isolate its effects.

Edited by FunkOdyssey, 07 December 2012 - 05:54 PM.

[nupi]

Thanks, I was thinking about that (remembering that a lot of people claim supplemental Choline to be depressing them). I could never quite pin point whether Choline (either Alpha GPC, CDP Choline or even just ALCAR) makes me depressed or not, though (in fairness, dysthmia is probably a more accurate description of what I am generally experiencing, anyhow). They however never seemed to do anything at all which is why I eventually removed them from my stack.

As for the DHA, I have a slight overweight of EPA in my fish oil but there are numerous publications claiming EPA might fight depression on its own (not that I ever really noticed, either).

Edited by nupi, 07 December 2012 - 06:04 PM.

[Vieno]

For God's sake nupi, can't you stop offtopicing!!! xDD Please people, don't get into arguments on ethics. That would be the death of my attempts to keep this thread medical

Different people seem to complain about sexual anhedonia very differently. Can't be sure if it's because of different physiologies underlying individual anhedonic states or is it because of people generally relate to sex in so many ways. However sex hormone issues have nothing to do with consummatory anhedonia. All in all, I want to pinpoint one exact disorder of the brain and its causes and cures, not multiple semi-anhedonic problems and what can be done to them. It's important to be specific and accurate, that way we can effectively cure things.

Here's something that would help all of us: all people believing to suffer from anhedonia, try some opioid. It would be useful to see if the disease is all about opioid resistance.

[nupi]

Then have a mod change the topic. (besides if you think that was a diversion on ethics you aint seen nothing yet) SCNR

I like the opioid idea - would Codeine do or do we need something stronger?

Edited by nupi, 07 December 2012 - 06:29 PM.

[Vieno]

Then have a mod change the topic. (besides if you think that was a diversion on ethics you aint seen nothing yet) SCNR

I like the opioid idea - would Codeine do or do we need something stronger?

I hope I will never need to see a true dicersion on ethics in this thread

Codeine probably will do it, but for genetic reasons codeine works badly for about 5% of people, so it's a slightly unreliable testing agent. Codeine does not itself induce any effect but an enzyme called CYP2D6 metabolizes it into morphine, and how well that metabolization works depends on genetics. I think it was Ethiopians who almost all metabolize it lousily. Anyway, codeine is the easiest to obtain so it can be tried: if it works, it is informative, if it doesn't, then we need to go for better opioids. Codeine can be found in many prescription-free cough suppressants, 100mg should already give some slight euphoria. Just make sure you don't take dextromethorphan which is also found in couch suppressants. Obviously many kinds of opioids, especially hydrocodone and oxycodone, can be found in prescription painkillers. I guess morphine is only used in hospitals.

E: Buprenorphine should be avoided, because it is unique in its ability to _not_ induce euphoria.

E2: I'd be most interested in zrbarnes' experience with opioids, because it appears that he is physiologically closest to me and medievil in terms of anhedonia. But if it turns out that opioids do not have an effect on you nupi, then we could deduce that you have the same physiological dysfunction.

All in all, I'm drafting an overview of this disorder and I want it to be an exact physiological diseas, not any psychiatric syndrome. It is crucial to pinpoint the physiological mechanisms as accurately as possible.

Edited by Vieno, 07 December 2012 - 06:38 PM.

[gizmobrain]

E2: I'd be most interested in zrbarnes' experience with opioids, because it appears that he is physiologically closest to me and medievil in terms of anhedonia. But if it turns out that opioids do not have an effect on you nupi, then we could deduce that you have the same physiological dysfunction.

My experience with opioids is quite limited. I know that I had a blast coming out of anesthesia from getting my wisdom teeth removed (I do not know the type of anesthesia used), but the one time I took Hydrocodone for back pain, I did not see any results. At all.

Edited by zrbarnes, 07 December 2012 - 06:50 PM.

[Vieno]

know that I had a blast coming out of anesthesia from getting my wisdom teeth removed

Sorry, what does this mean? Unfamiliar expression to this non-native English speaker

the one time I took Hydrocodone for back pain, I did not see any results. At all.

Most importantly: were you already on amphetamine/your current stack? How much did you take? Did you notice any other effects either, such as euphoria or breathing suppression? Do you still have some pills or the prescription left so that you could test again?

[nupi]

Blast=really enjoyed it.

I will get a bottle of codeine drops tomorrow (from my last attempt to avoid DXM, I know they are available) and see what happens with a high dose. An interesting experiment in its own right

I never had any obvious issues with medications metabolized by CYP2D6 so I should be fine there.

Edited by nupi, 07 December 2012 - 07:12 PM.

[Vieno]

Yay, I know a new word

Btw, I mistakenly assumed that oxycodone and hydrocodone wouldn't be dependent on CYP2D6, they are... but anyway if it's ok for you then no problem.

Are you on some medications now that you're up to try codeine? And how much will you take? I got no effect from 200mg, except funny feelings in stomach thanks to the sorbitol..

Edited by Vieno, 07 December 2012 - 07:20 PM.

[gizmobrain]

Most importantly: were you already on amphetamine/your current stack? How much did you take? Did you notice any other effects either, such as euphoria or breathing suppression? Do you still have some pills or the prescription left so that you could test again?

No, this was about a year ago, before I started taking CILTEP, and after I had stopped taking Adderall. Unfortunately, I don't remember the dose, but it was probably 2.5 or 5mg. I only took it once, and I don't have it any more. When I say I saw no results, I mean that it felt like a placebo pill in all ways.

And yes "I had a blast" meaning, they put me to sleep and when I woke up, I was laughing and talking too much, and all over euphoric. But I don't know what they gave me, so that might have been a different mechanism of action.

Edited by zrbarnes, 07 December 2012 - 07:22 PM.

[nupi]

Are you on some medications now that you're up to try codeine? And how much will you take? I got no effect from 200mg, except funny feelings in stomach thanks to the sorbitol..

20mg Fluoxetine (i.e. Prozac). As for the dose, I will have to see how concentrated it is... I remember it helping to sleep but other than that I cant say if it did much

[Vieno]

No, this was about a year ago, before I started taking CILTEP, and after I had stopped taking Adderall. Unfortunately, I don't remember the dose, but it was probably 2.5 or 5mg. I only took it once, and I don't have it any more. When I say I saw no results, I mean that it felt like a placebo pill in all ways.

And yes "I had a blast" meaning, they put me to sleep and when I woke up, I was laughing and talking too much, and all over euphoric. But I don't know what they gave me, so that might have been a different mechanism of action.

Interesting. I did some googling and it appears that anesthetics are used for tooth removal, not analgesics. It was mentioned that in rare cases opioids may be administrid after the operation, if post-operational pain is too big, but I suppose this wasn't your case. Also, nitrous oxide can be used as a sedative which induces what you describe. This is one of the texts I examined: http://www.medicinen...eth/article.htm

Obviously I haven't done a thorough study on tooth removal, but it doesn't appear that opioids would be a common choice of medication for tooth removal.

Anyway, I forgot to ask something: when you had this operation done, were you already anhedonic? In fact, I need to ask that have you been anhedonic all your life? I started to "lack pleasure" about three years ago, and it gradually progressed (together with attention deficiency) so that six months ago I realized I have a disorder.

Edited by Vieno, 07 December 2012 - 07:35 PM.

[Dissolvedissolve]

I think it might be beneficial to have more discussion of whether people are experiencing consummatory or anticipatory anhedonia. It would be beneficial for people to talk specifically about deficits in anticipation or in consummatory pleasure. At least for me, I know I have experienced what seemed to be consummatory anhedonia, but which I gradually realized was primarily anticipatory once I forced myself to go out and engage in activities. Now that my anhedonic symptoms are not very substantial, it's relatively easy to see that I don't have any deficit in consummatory pleasure.

I would also like to mention, and I think most people are aware of this, but deficits in anticipatory pleasure are far more common in both schizophrenia and depression. Obviously, I'm not suggesting that everyone experiencing anhedonia is schizophrenic or depressed. I am also not suggesting that no one is experiencing a deficit in consummatory pleasure - that's perfectly possible.

I'm looking at the Temporal Experience of Pleasure Scale (TEPS). I skimmed through a paper to attempt to find it. It seems these are the items, but feel free to correct me. At least, they seem to be the items most correlated with consummatory and anticipatory pleasure.

Anticipatory factor
1. When something exciting is coming up in my life, I really look forward to it
3. When I think about eating my favorite food, I can almost taste how good it is
7. I don’t look forward to things like eating out at restaurants
11. When I’m on my way to an amusement park, I can hardly wait to ride the roller coasters
12. I get so excited the night before a major holiday I can hardly sleep
14. When I think of something tasty, like a chocolate chip cookie, I have to have one
15. Looking forward to a pleasurable experience is in itself pleasurable
16. I look forward to a lot of things in my life
17. When ordering something off the menu, I imagine how good it will taste
18. When I hear about a new movie starring my favorite actor, I can’t wait to see it


Consummatory factor
2. The sound of crackling wood in the fireplace is very relaxing
4. I love the sound of rain on the windows when I’m lying in my warm bed
5. The smell of freshly cut grass is enjoyable to me
6. I enjoy taking a deep breath of fresh air when I walk outside
8. A hot cup of coffee or tea on a cold morning is very satisfying to me
9. I love it when people play with my hair
10. I really enjoy the feeling of a good yawn
13. I appreciate the beauty of a fresh snowfall

→ source (external link)

For me, personally, I would respond in the positive sense to all the consummatory factors, other than perhaps number 9 for reasons of personal space (although I do love head scratchers).
For the anticipatory factors, I can't really say I respond to any of them to a large degree.

Edited by Dissolvedissolve, 07 December 2012 - 07:40 PM.

[Vieno]

Are you on some medications now that you're up to try codeine? And how much will you take? I got no effect from 200mg, except funny feelings in stomach thanks to the sorbitol..

20mg Fluoxetine (i.e. Prozac). As for the dose, I will have to see how concentrated it is... I remember it helping to sleep but other than that I cant say if it did much

But SSRIs are strong inhibitors of CYP2D6! Besides, SSRIs generally induce anhedonia (I assume it is consummatory, nobody STILL hasn't confirmed this!!!) so Prozac may hinder the induced euphoria.

[gizmobrain]

Anticipatory factor
1. When something exciting is coming up in my life, I really look forward to it
3. When I think about eating my favorite food, I can almost taste how good it is
7. I don’t look forward to things like eating out at restaurants
11. When I’m on my way to an amusement park, I can hardly wait to ride the roller coasters
12. I get so excited the night before a major holiday I can hardly sleep
14. When I think of something tasty, like a chocolate chip cookie, I have to have one
15. Looking forward to a pleasurable experience is in itself pleasurable
16. I look forward to a lot of things in my life
17. When ordering something off the menu, I imagine how good it will taste
18. When I hear about a new movie starring my favorite actor, I can’t wait to see it


Consummatory factor
2. The sound of crackling wood in the fireplace is very relaxing
4. I love the sound of rain on the windows when I’m lying in my warm bed
5. The smell of freshly cut grass is enjoyable to me
6. I enjoy taking a deep breath of fresh air when I walk outside
8. A hot cup of coffee or tea on a cold morning is very satisfying to me
9. I love it when people play with my hair
10. I really enjoy the feeling of a good yawn
13. I appreciate the beauty of a fresh snowfall

Interesting... I can relate to all of the Consummatory factors, and rarely, if ever, have any of the Anticipatory factors.

Edited by zrbarnes, 07 December 2012 - 07:43 PM.

[Dissolvedissolve]

But SSRIs are strong inhibitors of CYP2D6! Besides, SSRIs generally induce anhedonia (I assume it is consummatory, nobody STILL hasn't confirmed this!!!) so Prozac may hinder the induced euphoria.

SSRI-induced anhedonia is generally anticipatory in character, at least in my understanding. There is a certain feeling of apathy and lack of interest, often specifically with regard to sexual activity. I have noticed this effect from sustained increased levels of serotonin. Anhedonia is reduced when I remove serotonergics (bacopa, 5-htp).

[nupi]

Fair point about the CYP2D6 inhibition. As for inducing anhedonia, if anything, it has lightened it a little (I definitely enjoy music a lot more than without, but then again I get that with serotonergics in general).Overall, Prozac has some special effects on me. For starters, it is supposed to have really bad sexual side effects but in reality it increases my libido and has no really obvious side effects at all...

As for the list, I have

Anticipatory factor
1. When something exciting is coming up in my life, I really look forward to it (used to anyway, with depression things are kind of strange, with the SSRI there is some of that again)

Consummatory factor
4. I love the sound of rain on the windows when I’m lying in my warm bed (it has some calming effect in any case)
I enjoy taking a deep breath of fresh air when I walk outside (this happens mainly in summer or when returning from the tropics where I really missed that feeling)
9. I love it when people play with my hair (though I can think of parts of my body that I prefer, even outside the genitals :-)

Rest I rarely get or very weakly.

@D: SSRI make me lazy but not necessarily sexually disinterested - Prozac quite the opposite (but then again I maintain that Prozac is not a true SSRI)

Edited by nupi, 07 December 2012 - 07:49 PM.

[Vieno]

E: Wait a minute... I gotta digest what zrbarnes just said...

Edited by Vieno, 07 December 2012 - 07:49 PM.

[gizmobrain]

This thread just got interesting...

Pardon my ignorance on the difference between Consummatory and Anticipatory. I hope I didn't entirely derail this thread on that point alone.

Edited by zrbarnes, 07 December 2012 - 07:51 PM.

[Vieno]

Oh my fucking shit I can't believe this, I thought everyone realizes the difference between the two! Oh my, gotta tell a moderator to edit something about consummatory anhedonia to the original post with cat size letters. Oh my, oh my... at least medievil has consummatory issues. Fuck this shit.

But SSRIs are strong inhibitors of CYP2D6! Besides, SSRIs generally induce anhedonia (I assume it is consummatory, nobody STILL hasn't confirmed this!!!) so Prozac may hinder the induced euphoria.

SSRI-induced anhedonia is generally anticipatory in character, at least in my understanding. There is a certain feeling of apathy and lack of interest, often specifically with regard to sexual activity. I have noticed this effect from sustained increased levels of serotonin. Anhedonia is reduced when I remove serotonergics (bacopa, 5-htp).

Where have you gotten this impression from? I'd like to learn about this.

E: Dissolvedissolve, thank you so much for bringing up the differences between consummatory and anticipatory anhedonia. They were obvious to me and I already wrote a reply to your message saying this is obvious, but obviously it wasn't! Thanks, cleared many things. Though now I'm more lost than ever O.O

Edited by Vieno, 07 December 2012 - 07:52 PM.

[gizmobrain]

I will say this much though, as it might be related: Depression from the breakup, combined with my lifelong anticipatory anhedonia caused consummatory anhedonia and increased my lifelong anticipatory anhedonia.

When I recovered from depression, the consummatory anhedonia went away, but my anticipatory anhedonia remained (and slightly worse then before).

Edited by zrbarnes, 07 December 2012 - 07:52 PM.

[Dissolvedissolve]

The problem is this is called "The Anhedonia Thread." Perhaps it would be wise to split off discussion of anticipatory anhedonia? It seems to me that zrbarnes has experienced primarily anticipatory anhedonia. It seems medievil may experience primarily anticipatory anhedonia as well - I know he has mentioned motivational problems - but perhaps he has consummatory issues as well. It seems that amnesiagirl has also reported similar problems.

I know it may seem contradictory to refer to anticipatory anhedonia as such, but that is because the two versions of anhedonia were, until the past decade or so, not properly differentiated. Also, as someone who deals with and has dealt with anticipatory anhedonia, it can be very difficult to realize that activities will be enjoyable when fail to cause any excitement whatsoever. And at times I have thought that I do not enjoy activities, although I really can't be sure whether this was actually consummatory anhedonia or an incorrect perception derived from my anticipatory anhedonia.

Edited by Dissolvedissolve, 07 December 2012 - 07:55 PM.

[Vieno]

I will say this much though, as it might be related: Depression from the breakup, combined with my lifelong anticipatory anhedonia caused consummatory anhedonia and increased my lifelong anticipatory anhedonia.

When I recovered from depression, the consummatory anhedonia went away, but my anticipatory anhedonia remained (and slightly worse then before).

So you have something absolutely different to me.

The problem is this is called "The Anhedonia Thread." Perhaps it would be wise to split off discussion of anticipatory anhedonia? It seems to me that zrbarnes has experienced primarily anticipatory anhedonia. It seems medievil may experience primarily anticipatory anhedonia as well - I know he has mentioned motivational problems - but perhaps he has consummatory issues as well. It seems that amnesiagirl has also reported similar problems.

I know it may seem contradictory to refer to anticipatory anhedonia as such, but that is because the two versions of anhedonia were, until the past decade or so, not properly differentiated. Also, as someone who deals with and has dealt with anticipatory anhedonia, it can be very difficult to realize that activities will be enjoyable when fail to cause any excitement whatsoever.

It is my bad that I failed to understad the general misunderstanding. I'm a pro on semantics myself (no kidding) and these things have always been obvious to me - I assumed they were obvious to others too. To such extent, that I assumed the title of this thread to make it clear to everyone that this is about consummatory. If even medievil suffers mainly from motivational problems, then I'm so alone that I need to reconsider everything. Waiting for medievil to come and tell what's the truth about his condition!

[nupi]

Dissolvedissolve: Anticipatory anhedonia is however a very classic depression symptom. Many depressed patients say that something was more fun after the fact than they thought. In my case, it's often the opposite (in particular when it comes to romance and sex). And after a while, you stop bothering, knowing that it will end up being disappointing anyway. For the past couple of months (years?) my main motivation was anxiety but the SSRIs mostly removed that so now I am left with nothing - although since I switched to Prozac I get bouts of "I realllllllly want to do X" where X is usually a rather crazy idea..

Edit: Vieno, do you have any idea whether consummatory anhedonia will create anticipatory anhedonia after a while?

Edited by nupi, 07 December 2012 - 07:59 PM.

[Vieno]

Hey guys, I'll come back later today with a questionnaire that reveals what is everyone's individual issue, ok? I have studied consummatory anhedonia so much that I can make much better questions than those presented in dissolvedissolve's link.

[Dissolvedissolve]

Here's a quick reference. I don't doubt someone with more time could be more thorough.

the' class='bbc_url' title='External link' rel='nofollow external'>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989833/']the clinical feature of apathy or low motivation has been underscored in association with SSRI prescription
[...]
the presence of diminished motivation in an individual—a development that is not attributable to a reduced level of consciousness, cognitive impairment (e.g., dementia), or emotional distress (i.e., depression). Reinblatt and Riddle³ reinforce this definition of apathy by clarifying that the lack of motivation cannot be the result of sedation or depressive symptoms

→ source (external link)

This quote suggests apathy and low motivation. Those are two anticipatory, likely dopaminergic concepts.

[nupi]

D: SSRI definitely have that, especially pure bred ones like Escitalopram. It's kind of a like "cant be bothered, life is fine" type mood.

[gizmobrain]

Regarding Consummatory Anhedonia... I once took a DMAA capsule and a Galantamine together to see if they would help me wake up in the morning. I got back in bed, and fell asleep for a bit, and when I woke up, my entire body felt good. Like wanting to just roll around in my sheets because it felt so good.

Really weird, and I probably don't recommend it, but it's definitely always stuck with me as an interesting interaction.

Edited by zrbarnes, 07 December 2012 - 08:11 PM.

[Vieno]

Here we go with a prototype Consummatory Anhedonia questionnaire. Not all questions evaluate the consummatoriness of one's anhedonia with equal accuracy, but they all help with diagnostics. No is yes for consummatory.

• When listening to music of my choice intended to evoke beautiful feelings (such as pop, classical or soul) I get feelings that could be described as euphoria, albeit not necessarily as strong as "being high".
• When going out with a group of friends for a beer and light-hearted chat, I get absorbed in the interaction so intensely that good feelings just seem to be floating around.
• When eating sugary foods (with not much other ingredients such as fat) such as sugar, honey, sweets and some high-carb types of pastry, I enjoy the eating experience to a great extent even though I'm full from salty food that I ate previously.
• When having sex (with a partner or alone), I do not only experience gratification from fulfilling my physiological need of getting an orgasm but additional euphoric pleasure.
• When excercising for an extended period, I get rushes of euphoria and intense feelings of well-being build up.
• When I'm presented humour of my preference, I laugh spontaneously and feel ease and happiness at least for a moment.

Just list your answers.

Edit: Vieno, do you have any idea whether consummatory anhedonia will create anticipatory anhedonia after a while?

It is impossible to answer this as we have no definition for consummatory anhedonia. I do not know what kind of physiological changes follow chronic consummatory anhedonia. However, psychologically, it is wise to not pursue things that do not bring pleasure. Consummatory anhedonia however can also lead to psychological blue mood, which lessens motivation to unhealthy levels: this can, for example, be seen as lack of willingness to seek for treatment. So, consummatory anhedonia can induce psychological depression, which includes unhealthy lack of motivation.

Here's a quick reference. I don't doubt someone with more time could be more thorough.

the clinical feature of apathy or low motivation has been underscored in association with SSRI prescription
[...]
the presence of diminished motivation in an individual—a development that is not attributable to a reduced level of consciousness, cognitive impairment (e.g., dementia), or emotional distress (i.e., depression). Reinblatt and Riddle³ reinforce this definition of apathy by clarifying that the lack of motivation cannot be the result of sedation or depressive symptoms

→ source (external link)

This quote suggests apathy and low motivation. Those are two anticipatory, likely dopaminergic concepts.

Thank you, an useful link. Will study the topic more. Things are getting totally different in my head as it turns out SSRI-induced anhedonia may be of anticipatory nature.

[anon2042]

Wanting to reply but yeah, this thread is getting a bit confusing now going in a lot of directions.

Someone mentioned CDP-choline, I don't know the specifics and don't remember it being mentioned much here other than just general caution with choline/depression but I saw this on Wikipedia: "Citicoline has also been shown to elevate ACTH independently from CRH levels and to amplify the release of other HPA axis hormones such as LH, FSH, GH and TSH in response to hypothalamic releasing factors.[5] These effects on HPA hormone levels may be beneficial for some individuals but may have undesirable effects in those with medical conditions featuring ACTH or cortisol hypersecretion including, but not limited to, PCOS, type II diabetes and major depressive disorder.[6][7]"
In addition it was easier for me to get Alpha-GPC for some reason, I think I was looking for capsules to start with and there were no veg-friendly CDP-choline.

And nice try guys! I am not going to be the only woman on this thread discussing her sex life in front of a bunch of guys Haha, in all honesty though, I don't really know what to say on that one, due to my short memory (almost a year now with amnesia), I don't really know what's normal for me.

To keep my dopamine up, I have been screwing around with DHA+TAU for a couple of weeks with not much results that I can see. I've been very bad on choline supplementation though and I'm cautiously bring it back up. I am interested in CILTEP but a bit scared about all the purity that needs to be going on with the supplements/extracts. Also probably I've mentioned it before but I try to keep herbs to more of a minimum than extracts since there's less going on. Maybe longecity can market a CILTEP supplement down the road that's an all in one? I posted some questions about selegiline wondering if I should try that again from a different angle to keep the dopamine up, but I need some answers in that thread before I continue.

I did want to sympathize with the poster who mentioned rejection sensitivity - I too can get triggered when people will automatically say therapy is needed to fix a problem, especially when you're in a situation that creates a Catch-22. If you can't at least dull the symptoms from rejection sensitivity with something it's going to make therapy unbearable the second you misinterpret one tiny thing the therapist says.

I developed severe rejection sensitivity over the past year in both social and unfortunately professional (medical realms). I had about 5 intake sessions trying to find a new pdoc (for the ones who did get back to me at all after numerous calls or didn't ask me that I commit to paying them 30k over the course of a year) and was rudely and coldly refused treatment due to my extensive history. The final blow was being turned down help at the ER (which was actually illegal, but no one would listen to me), which is a long and extremely traumatic story. I don't know what the poster's history is with rejection sensitivity, but if it's in the professional realm and caused by pretty traumatic events like that maybe it's easier to see why seeking help with a therapist or doctor could be a huge hurdle to get over.

Sorry to pull this thread in yet another direction, but wanted to chime in.

Edited by amnesiagirl, 08 December 2012 - 04:24 AM.