56 replies to this topic

[magniloquentc0unt]

Hi everyone. I have been given fluoxetine (SSRI) to treat a case of Dysthymia 4 years ago,. The treatment lasted 8 months. During these 8 months i had 3-4 MDMA use episodes.
I then stopped taking fluoxetine because it pooped out, i think, and i tought i did not need it anymore. During the treatment the apathy was great and libido was absent.
I was left with lasting side effects: lack of energy, motivation, inability to focus and concentrate, broken train of tought, emotional blunting, general anhedonia, and as said, zero libido and "mechanical functionality" in that area.
I tought everything would fix itself given a bit of time. The libido did not come back for years, until i decided to go to a doc. Lots of hormones testing and blood drawing was done, everythings perfect. Was given Cialis and i took one fourth of a pill and im functional again, ever since, but a problem of delayed eyaculation persists. I am overall unmotivated and dont feel excited by anything. I still can not focus my toughts in the way i could before SSRI, or MDMA.
One of the two substances has ruined something. I must say that "giving it time" was a so-so decision: it did get better, but i believe much more could have been done. I still feel un motivated, unexcited, i dont enjoy anything and i cant feel emotions, its a bit of a weird situation. I would not say im not depressed, as i do not experience despair. Just everything is kinda flat.
Over the last year i tried a lot of adaptogens, (ginseng, gingko, rhodiola, jiaogulan, bacopa, schisandra, gotukola, reishi, lionsmane, the list goes on). A couple of them had some sort of beneficial effects (my top 3 is ginseng, rhodiola and bacopa), but not to the extent i desire.
I went to see a psychiatrist: unfortunately he never had a patient with such history as mine. From what ive been reading, a mainstream conclusion might be to treat it with stimulants, and we did.
first methylphenidate, went up to 60mg and did not feel any different, besides being slightly more chatty, maybe. Then we jumped to modafinil: 200mg again nothing happened. I dont feel more alert, more awake, more concentrated, nothing. I can literally go, lie down and id fall asleep within 5minutes on both substances. I have to add that coffee does not do much on the cognitive sphere either, besides giving me jiittery hands after the 6--7th cup.

I am going to list a couple of anectodes that come to my mind, maybe it can help some of the more experienced here:
-inability to take decisions: i feel everything is right and wrong at the same time, which can be good if you were the dalai lama, but in daily life makes people around you angry.
-absence of fight or flight response. i go straight to the freeze state.
-stimulants dont work
-i have the feeling of not being right here right now. not as described by depersonalization or derealization, but no importance is given to what happens around me. i have no idea how i would react if someone jumped in with a knife, id probably just stand still.
-my doc has troubles "believing" me. he says he sees an intelligent person that reacts properly, argues and seems interested, but i dont feel that way.
-toughts kinda happen on "autopilot" and while im speaking of something i tend to jump between topics. i feel it has a impatience factor to it, but i believe im a very patient person.

trying a DA/NE modulator / reuptake inhibitor sounded like a pretty straight forward decision, but it went nowhere.

Has anyone had or heard of a similar experience and can give me a hint?

Edited by magniloquentc0unt, 18 March 2013 - 03:54 PM.

[renfr]

SSRIs does that but only during withdrawal, MDMA also does it but damage is long lasting (several years) not to say permanent as to recover 100%.
I would say you ruined your serotonin transmission by using MDMA (1 shot is enough to cause permanent damage) and as a consequence you downregulated your dopamine receptors (hence the lack of libido, fight or flight reaction, inability to make a decision).
http://sideeffectsz....3/01/mdma-8.jpg
That's what happens to brain serotonin, your receptors are now strongly upregulated and you're insensitive to dopamine and therefore most of stimulants.
Your best bet would be to take serotonergics and to upregulate your dopamine receptors.
Cholinergics can help with that, sulbutiamine as well.

[magniloquentc0unt]

first of all thanks for your answer
did you really want to post that picture?

Edited by magniloquentc0unt, 19 March 2013 - 12:00 PM.

[magniloquentc0unt]

by the was, what kind of serotonergic would you suggest? SJW? Tianeptine?

[jonnyD]

by the was, what kind of serotonergic would you suggest? SJW? Tianeptine?

I would prefer SJW. I had good results with it after MDMA abuse.

[magniloquentc0unt]

by the was, what kind of serotonergic would you suggest? SJW? Tianeptine?

I would prefer SJW. I had good results with it after MDMA abuse.

thanks for the suggestion. althou i have to say i tried SJW at quite high concentrations (~600mg a day at common [i cant remember] extraction ratios) for quite a long time (3months) and it didnt do much, besides anaesthetizing and furtherdampening what was left of my emotions, i believe. The brand was good.. but again.. who knows.. from what i read there is a lot of people that suddenly respond to meds they havent been responding to for ages, and vice versa...

[protoject]

I also had no benefit from SJW. If anything caused more problems. I can say almost for sure, subjectively at least, that my dopaminergic/ noradrenergic response was significantly enhanced after taking citicoline for a couple months. [to the point that I'm even too sensitive to anything dopaminergic at times]
actually, coffee and modafinil used to do practically nothing to me, whereas now I have a fairly strong reaction to them ever since I did that citicoline.

(coming from a similar place of damage that you are w/mdma)

Edited by protoject, 20 March 2013 - 10:28 PM.

[magniloquentc0unt]

I also had no benefit from SJW. If anything caused more problems. I can say almost for sure, subjectively at least, that my dopaminergic/ noradrenergic response was significantly enhanced after taking citicoline for a couple months. [to the point that I'm even too sensitive to anything dopaminergic at times]
actually, coffee and modafinil used to do practically nothing to me, whereas now I have a fairly strong reaction to them ever since I did that citicoline.

(coming from a similar place of damage that you are w/mdma)

sounds promising, guess giving another supplement a go wouldnt hurt... any particular brand you would reccomend?

[magniloquentc0unt]

ive just found out that choline is transformed to uridine. which im already taking (with no particular benefit i believe...).. i must admit i have not being taking it methodically, and in conjunction with omega3 and choline... of which i have some left...

Edited by magniloquentc0unt, 21 March 2013 - 11:58 AM.

[anothermember]

I'm experiencing many of your symptoms. I think in your case fluoxetin is the culprit. It bored the hell out of me too. I was so fucking numb on it. Right from the start! Althoug I've recovered complete from the 2 weeks intake of fluoxetin, after beeing 8 weeks on Paxil (60mg) emotional, and sexual side effects never dissapered. I didn't take any other drugs while on it

I've taken lots of drugs including MDMA in my youth. Although I was not an heavy MDMA user, one night I took seven good XTCs pills. Never experiencend this kind of long-term emotional blunting from my drugs abuse although comedown depression was pretty standard.

Edited by anothermember, 21 March 2013 - 01:58 PM.

[Galaxyshock]

Sorry to hear, especially that it seems treatment-resistant.

Mucuna could be worth a try for boosting dopamine.
Liquorice has helped myself bringing back that fight-or-flight response unlike any other adaptogen.
Phenibut can really help with anhedonia but should be used carefully.

Another supplement if you want to experiment with a bit different stimulants:
Craze http://www.longecity...nootropic-damn/
Helps a ton with my apathy and numbness issues..

Hope you get some relief.

[magniloquentc0unt]

Sorry to hear, especially that it seems treatment-resistant.

Mucuna could be worth a try for boosting dopamine.
Liquorice has helped myself bringing back that fight-or-flight response unlike any other adaptogen.
Phenibut can really help with anhedonia but should be used carefully.

Another supplement if you want to experiment with a bit different stimulants:
Craze http://www.longecity...nootropic-damn/
Helps a ton with my apathy and numbness issues..

Hope you get some relief.

Thanks for your answer
unfortunately i've already tried Mucuna, to no avail. Liquorice and Phenibut i havent tried yet, but honestly the whole "adaptogen" and "plant" world seems nice words and placebo effect to me as of now...
That Craze supplement is quite "IN" at the moment it seems.. might think about it... i believe ill try subultiamine and aniracetam next, while waiting for a Tianeptine prescription: sounds like my best bet

[Tom_]

5HTP 100mg
tryptophan 1000mg
omega 3
sulbutramine 900mg
NAC 1500mg + 4000mg vit c
b vit complex
multi vit
DLPA 2500mg
melatonin 1mg at night
phenibut 200mg daily

you need screening for a sleeping disorder narcolepesy, some form of apnea etc...

behavioural activation is a must - google can tell you as much about it as you need to know. DONT KNOCK it in drug and depression treatment is very well evidence based. It might be your best option

It should include:
physical activity
social activity
'meaningful' activity (something you do or did find was worth while)

If you can't bring yourself to start out full blown start out as small as you have to. If that means going outside and inside again so be it..build up, just depends how bad the apathy is.

[Galaxyshock]

^ You are suggesting the same tryptophan and other crap for every issue / disorder people here have.

Edited by Galaxyshock, 26 March 2013 - 04:15 PM.

[Tom_]

Typically to treat the same problem: anhedonia, amotivation and somnolence.

On the odd occation you will see me suggest totally different ideas - in regards to problems like suspected personality disorder, psychotic disorders, bi-polar and PTSD. More often than not in fact you will even see me suggesting the use of pharms.

What I suggested in the main part also has this lovely thing called...CLINICAL EVIDENCE BASE.

Lets not turn this in to a flame war.

[magniloquentc0unt]

Im trying the greatly advertised Uridine + DHA + Choline and i believe theres something going on.. i just cant nail it yet... thinking of ordering aniracetam and sulbutiamine, melatonin im not sure i need because i have absoluztely no problem falling asleep. I must admit that i have never tried Serotonine precursors, as i was too much in my "dopamine-trip" set of beliefs, which proved false.

[Tom_]

Yes, but it improves sleep efficency and it would seem with your exessive anhendonia etc this could be a sign of hypersomnia. Melatonin doesn't cause extra sleepiness so its a perfect way to test this. If not one of the major theories of depression (substance induced depression is the only DSM criteia realistcally fit ) is abnormal circadian rythems and melatonin resets that. It might even be an idea to try: 0.3-0.5mg when it gets dark and 3mg an hour before bed. You may want to look into bright light therapy.

DHA is a "why not" although I'm not sure it crosses with BBB. Omega 3 might be better to take for this reason.

Choline in low-moderate doses can't go wrong.

Sertononin precursers could be (COULD) a hail mary pass, they would also be working on the whole sleep theory of mine (which I must stress is only one of the ways I'm looking at this). Increased sertononergic transmission tends upregulates dopamine - in the main.

I think the NAC might make an important part of the treatment response.

[magniloquentc0unt]

Yes, but it improves sleep efficency and it would seem with your exessive anhendonia etc this could be a sign of hypersomnia. Melatonin doesn't cause extra sleepiness so its a perfect way to test this. If not one of the major theories of depression (substance induced depression is the only DSM criteia realistcally fit ) is abnormal circadian rythems and melatonin resets that. It might even be an idea to try: 0.3-0.5mg when it gets dark and 3mg an hour before bed. You may want to look into bright light therapy.

DHA is a "why not" although I'm not sure it crosses with BBB. Omega 3 might be better to take for this reason.

Choline in low-moderate doses can't go wrong.

Sertononin precursers could be (COULD) a hail mary pass, they would also be working on the whole sleep theory of mine (which I must stress is only one of the ways I'm looking at this). Increased sertononergic transmission tends upregulates dopamine - in the main.

I think the NAC might make an important part of the treatment response.

you are right, i forgot to mention, hypersomnia is absolutely one of my simptoms. Its not like i have narcoleptic attacks of sleepiness i cant hold and then i fall on the ground, more like i never feel truly rested and awake. I never feel well. Not after 8h of sleep, not after 10 and not after 12. I go to bed at midnight and i could easily wake up at 12am on a daily basis.
Anyhow, i must admit i am a bit tired of trying out supplements: i literally have a couple of dozens half finished bottles resting around. But, on the other hand, It would be stupid to stop trying them out now, when so few routes are left: i appreciate methodical investigation when it comes to substances. Also the "unefficient sleep" hypotesis is something that i had in mind for quite a while now... Guess i will try these supplements while waiting my psichiatrist to prescribe Tianeptine

[Tom_]

Are you giving these substances long enough to work? In many cases well over a month is needed to see the effects up to three before something should be written off as a failure.

While the research for Tianeptine is mostly positive its rarely of very high quality and is quite thin. I'm not sure its something I would suggest as a firstline...although it does act opposite to an SSRI so the old matra if what you are doing doesn't work do the opposite might apply.

Do you overeat? Carbs in paticular?
Feel heavy in the limbs?
Perk up briefly?
Get bothered by social rejection (romantic or otherwise)?

^ Questions are fairly important.

I would seriously suggest you either speak to your psychiatrist about having a polysomnogram or a night breathing study at the very least - although if this was the problem/part of it I would expect a stim to wake you up somewhat. Worth a try.

[magniloquentc0unt]

Are you giving these substances long enough to work? In many cases well over a month is needed to see the effects up to three before something should be written off as a failure.

While the research for Tianeptine is mostly positive its rarely of very high quality and is quite thin. I'm not sure its something I would suggest as a firstline...although it does act opposite to an SSRI so the old matra if what you are doing doesn't work do the opposite might apply.

Do you overeat? Carbs in paticular?
Feel heavy in the limbs?
Perk up briefly?
Get bothered by social rejection (romantic or otherwise)?

^ Questions are fairly important.

I would seriously suggest you either speak to your psychiatrist about having a polysomnogram or a night breathing study at the very least - although if this was the problem/part of it I would expect a stim to wake you up somewhat. Worth a try.

Usually i do give them time: id say most of the things ive tried ive tried about 3 weeks each, with multiple dosing a day... with jiaogulan and gotu kola ive been a bit less precise thou.
Memory is one of my biggest issues, and tianeptine has shown promise on that field especially. From anectodes, it seems to work as a mood amplyfier: gives access to peaks of emotions, something that ive found SSRI to narrow, and flatten out.

now, to your questions:
-Overeating: ive put up around 10Kg in the last year: ive always been extremely skinny, so this is weird. Ive been off SSRI for the last 4 years. I believe is just my metabolism slowing down because of age, as ive always been one of these persons that hated eating. But yes, carbs is what i like the most, and sugars (and yes i know: cut them off and see, i just cant do it :/ )
-Heavy in the limbs: hell yeah. While on SSRI i felt my body was lighter, and when on MDMA my limbs felt UNBELIEVABLY lighter. I believe serotonin plays a role there.
-perk up briefly? Id say i rarely enjoy anything - i dont get the question
-absolutely, id say im pretty social avoidant and also dont feel at ease with people, besides close friends. i dont know if its because im """scared""" of them or because im bored of them

[Tom_]

3 weeks is not anywhere near long enough most need at least 2 months.

I wasn't going to say cut them, I was screening for atypical depression vs melachonic depression.

Sorry few more questions: Worse in the morning or evening? Feel guilty? I assume you don't move around much?

Strictly speaking you have already ruled out a diagnosis of atypical depression - you don't have mood reactivity - if something good happens you don't feel any better am I right?

Were as with melachonic depression the two cardinal symptoms are anhendonia and lack of mood reactivity.

However overeating, heavy limbs and social avoidance are screaming atypical depression.

The reason I am so bothered is because atypical depression might indicate the use of an MAOI while melachonic a TCA/more tempted to suggest Tianeptine.

Currently I am more for a trial of an MAOI monotherapy either moclobemide (not availble in the USA) or selegiline. These aren't the MAOI's where you risk cardiac problems if you eat a peice of cheese...these are the 'nice' ones with side effects no worse than most antidepressants and both have evidence in improving adhd like symptoms.

Edited by Tom_, 26 March 2013 - 07:37 PM.

[magniloquentc0unt]

3 weeks is not anywhere near long enough most need at least 2 months.

I wasn't going to say cut them, I was screening for atypical depression vs melachonic depression.

Sorry few more questions: Worse in the morning or evening? Feel guilty? I assume you don't move around much?

Strictly speaking you have already ruled out a diagnosis of atypical depression - you don't have mood reactivity - if something good happens you don't feel any better am I right?

Were as with melachonic depression the two cardinal symptoms are anhendonia and lack of mood reactivity.

However overeating, heavy limbs and social avoidance are screaming atypical depression.

The reason I am so bothered is because atypical depression might indicate the use of an MAOI while melachonic a TCA/more tempted to suggest Tianeptine.

Currently I am more for a trial of an MAOI monotherapy either moclobemide (not availble in the USA) or selegiline. These aren't the MAOI's where you risk cardiac problems if you eat a peice of cheese...these are the 'nice' ones with side effects no worse than most antidepressants and both have evidence in improving adhd like symptoms.

First of all, thanks a lot for the effort and dedication you're putting into answering this thread.
Id say i dont feel that guilty, when i look back to some behaviour i had years ago some time yes i do, but i believe its in the normal range: its not like a hunting tought.. Anyhow, yes, in the evening it gets better, i get more work done, and if i start doing something there is much greater chance that i might continue doing that thing for more than the usual 5-10minutes.
About mood reactivity, this is something i have difficulty explaining to everyone. I dont "feel feelings"; but i do experience them and people can read them on my face. It is just they dont affect me. Id say it falls in the dissociation spectrum, but the descriptions of depersonalization and derealization ive read dont apply for me.
Before SSRI my dysthimia was definitely more melanchonic. now because of the permanently numbed emotions, i couldnt say: maybe the sadness is there and i just cant feel it.

[Tom_]

I don't think we are gonna be able to place you on either the emotional flatness/dissacoiation/neurodevelopmental spectrums (its possible this is in part some atypical autistic spectrum - have you had life long problems?)

Depression wise - again too mixed a picture.

Few suggestions:

Follow STAR*D or TMAP algorithms for depression: assume you have already failed on the first SSRI.
Start an MAOI-A or B (ex: moclobemide): Most effective antidepressants out there really. Consider adding lithium after 3-4 weeks
Start a TCA consider adding lithium after 3-4 weeks
Start Tianeptine

I definatly err towards the first or second option.

The first has the benifit of being exeptionally well researched to the highest standards and very few people fail once they reach the last stage. The second loads of studies all consistantly showing efficacy in all types of depression.

[magniloquentc0unt]

Id say that before my^^any depression and im my youth i had my weird things... avoiding eye contact is one thing.. the other one is i believe i relate in a strange way with the people i like. I was extremely shy (i have to say, i believe MDMA has made this better, permanently). Also, on some particular tasks (drawing) Im sometime able of a thing i call hyperfocus, namely working in a sort of tunnel vision for 6-8 hours straight.. this happens very rarely nowadays, as i believe """the depression""" makes everything a bit "meh". (very strange: i think ive dreamed of this moment, deja-vu?)

[Tom_]

Ah, suggesting autistic taits then.

So far we have a diagnosis of:
Moderate depressive episode - history of severe
dysthemia or double depression
mixed neurodevelopmental disorder
possible primary hypersomnia

Doesn't change my suggestion: MAOI or follow depression algoritium alongside behavioual activation. Once in remission of depression you can focus on diagnostic uncertaity alongside improving other disorders.

[anothermember]

Its not like i have narcoleptic attacks of sleepiness i cant hold and then i fall on the ground, more like i never feel truly rested and awake. I never feel well. Not after 8h of sleep, not after 10 and not after 12. I go to bed at midnight and i could easily wake up at 12am on a daily basis.

I have this too and my limps feel heavy as well...

Do you experience unsensitiv skin? My skin feeling has changed. On the SSRIs my skin always felt anesthetized. I'm pretty shure this a SSRI aftermath too...

If you want to talk in Skype, you can PM me your skype name. I'm German.

Edited by anothermember, 26 March 2013 - 09:45 PM.

[magniloquentc0unt]

mhm no im not sure what you mean by unsensitive skin... I must say it does feel a bit anaesthetized in the genital area (sorry!) as i have become much more difficult to arouse... but aside from that, i do not feel anaesthetized skin...
about the libs heavyness its something ive got so used to, i probably dont notice it consciously anymore, i just label it "being tired"

[magniloquentc0unt]

by the way, i have to say that i did respond partially to SSRI: my mood got better and i started a project on my own that went well and i put a lot of effort and dedication in it.
The downside was the emotional level, where everything was "kinda ok, not a problem" general contentness kind of thing. And of course the absent libido. So mhm.

[Tom_]

Sertraline/Ecitlopram/agomelatine + Bupropion could be a winning combo.

[magniloquentc0unt]

I was very excited about Bupropion for a year or so, and did read quite some papers about it as a med for counter acting SSRIs permanent side effect: I have to say that most, if not all the enthusiastic papers ive found were founded by an unresstricted grant by GlaxoSmithKline... also, from anectodes, many many many people report problems with short and long term memory, even lasting ones. Id rather leave it as of now. I think agomelatine might be good, tho. I think the user Animal had a similar story, and had success with it