Surviving Anhedonia

Thought you might be interested in this summary of a new treatment that's currently in phase 2 trials showing promise for negative symptoms:

http://images.ubmmedica.com/psychiat...017_Miller.pdf

*Willow*

I'm not sure if anyone is still active on this thread but thought I would give a shout out and check in to see if anyone has found anything, anything to help alleviate their anhedonia. I am truly at the end of my rope with it and don't know how I can enter another year in this state. Not only am I unable to feel any emotions at all, but I've also lost the capacity to sleep or eat. I cannot feel any hunger at all, ever, and no do not feel satisfied/satiated after I eat. Nothing tastes good or is pleasurable. The worst thing is this unbearable feeling of blankness/numbness totally washing over my brain, drowning out my pleasure receptors. It feels like my head is filled with cotton wool and nothing penetrates it. It never shuts off, even to sleep, I just lie on my bed all night waiting for my brain to cycle down into sleep patterns and it never does. Out of desperation, I've tried several different sleep meds and none of them have done a thing.

I tried to be proactive this month by joining a gym, thinking that vigorous exercise might trigger some response. It has been excruciating. I go on the treadmill or elliptical and try to give it my all but I feel no reponse in my brain or body, I don't even feel like my muscles are working or contracting, I don't feel fatigued afterward. It's the strangest sensation. I also tried acupuncture again, and the practitioner has tried several different meridians with me and it has done nothing at all. Have tried various Chinese herbs and saw an Ayurvedic doctor last week who prescribed more herbs, but they haven't touched the anhedonia at all. I honestly do not know what to try next. My psychiatrist is no help, he doesn't seem to believe in anhedonia and claims it's all in my head and I just need more talk therapy. Talking to my therapist every week is an exercise in futility because all I can do is repeat my despair at not being able to feel anything, feeling my life pass me by, feeling more and more hopeless. DBT and CBT therapy are not helpful, because they are all about exercises to regulate your emotions and I don't have any emotions to regulate.

I saw an ad for the Fisher-Wallace stimulator and wondered if anyone has tried it. I'm also curious about TMS therapy -- if that would stimulate the parts of my brain that are so completely shut down?

Are there any supplements/drugs/treatments that have worked for you? Is there hope? How do you make it through the day with severe anhedonia?

Tiny bud,

I too have been having sleep problems, and have resorted to sleep aids that have stopped responding. I sympathize with everything your going through. I found that it's important to hang on to the things that use i use to feel pleasure with: writing, philosophy, literature. With surrounding myself by those things i once in a great while will have a break through moment that lasts briefly. I have also resorted to alcohol. It has helped me feel a few times, not strongly, but it's something.

My psychiatrist has recommended i try Electro Shock Therapy as a last resort. Meds that up the emotions like Wellbutrin, and Effexor did nothing. I've heard special K might help but that can induce psychosis, which im prone to, and isn't a long term answer.

I've heard that out of people's darkest depressions where they feel nothing, and ECT brings them back to life, where they can feel everything. It's gotten better over the years, but there's still risks, but i don't have the money to get it.

I've been suffering from it for 4 years probably now.

I best advice is to keep trying to surround yourself with things that elevate your mood with a passion, even though it wont work 99.999999% of the time. I've found that a passion project, even though there is no passion, helps me cope, with the aid of alcohol sadly... Entertaining art, and engaging in idealistic ideas really helps me. This may not sound like much, but for me, I still have my cognition. As a philosopher, I'm greatful that i do, because a lot of people with my condition struggle with their's. There are two sides to my nature, the cognitive and the affective. They're intimiately intertwined. I've had to double up on my cognitive side to make up for not having an emotional side.

I wish i had more answers for you. If you have any more questions feel free to ask.

((hugs))

Saw this---only an abstract no article available..

https://www.ncbi.nlm.nih.gov/pubmed/29293435

This thread sure has hit a lot of familiar notes and cords for this new member. I am living very similarly in sort of an opposite extreme regarding emotions. I am emotionally fragile and can't remember waking up happy and being happy for a period of time. I cry a lot and I have for some years. Started SSRI 15 yrs ago for Depression, dosage was doubled 7 yrs ago for PTSD. Klonopine & Remeron were added + SSRI doubled 5 yrs ago. Discontinued all pharmaceutical prescriptions Feb 5, 2017. I still feel like damaged goods. I am losing interest in food...and I love to cook and eat healthy-ish food. I can t seem to imagine a happy scenario from my current state. No desire for social interaction out of fear someone might ask me how I'm doing. Or worse how my family is. My brain feels numb. Music can and does still shift my moods and levels of sadness. Motivating to get physically moving is turning into a challeng. I got to the post office every day to check my mail, usually drive to river & try to throw out negativity. The past couple of weeks I've been making almost daily adventure to waterfowl refuge area to ponder the miracle of migration. It's a distraction till I get back to my reality check of being homeless....and feeling hopeless that my symptoms seem to be growing faster than I can eliminate the things that aren't working for my DNA. Pharmacogenomic testing is a technology advancement that I believe can help save and improve quality of life. I wish I'd had it done sooner. I've had sleep issues a long time, but PTSD seems to have exacerbated the ones I've had. I need to stop at library for stack of books on my way to the post office. I'm grateful I dropped in on this thread.

I didn't even feel like bringing up my anhedonia this meeting with my psychiatrist. Last time she brought it up she tried to refer me to get a second opinion. I asked her what's going on with my emotional decline and she tried to give me a generic answer on what schizophrenia is. I've had about 360 views on my anhedonia question on research gate but no answers, except for a woman that is going through the same thing as i am. To go through an entire day and not feel a shadow of a depressive or pleasurable moment wears on me. My friend who just broke up with his girlfriend after 11 months asked me if i can empathize, i had to break down that a lot of empathy is cognitive, like how Alan Turing had to get in the mind of the enemy when cracking ENIGMA, the "unbreakable" german code. It was a mental feat. But I couldn't help wonder if i missed something... did i not respond to something he said correctly? As time goes on I wonder if I'll stop cognizing how other's feel completely.

I know that everyone is bored of my obsession with words, but I keep coming back to the word 'anhedonia' and wondering if that's the best word to describe your experiences, DT? And that's not to dismiss your suffering at all; perhaps that was misunderstood last time? But I just think that anhedonia is means a lack of positive feelings, whereas you're talking about a lack of ALL feelings, both positive and negative; kind of like blunted/flat affect, but experiential on the inside as well as observable on the outside.

The reason that I feel it is important to consider what best to call it is because if you call it A and you research treatments for A and they don't help you, perhaps calling it B and treating for that might actually work?? But perhaps not as it'd still be a negative symptom and nothing we currently have really helps those...

Wrt ECT: I researched that as it was on my list of treatments for treatment resistant sz that failed to respond to clozapine and you're looking at a 50:50 shot of it working, which imo isn't great odds when you're risking cognitive damage, given how much you value your cognition, like I do.

Wrt poor sleep: my pdoc says it's a sz thing, especially sleep reversal. I've always been a night owl, but falling asleep got later and later and later until it's around 4-6am now and has been for years. Sleep meds don't work for me, so I've stopped fighting it. You will likely find that you will build a tolerance for Benadryl with time and it won't work anymore. I don't have any suggestions, unfortunately, except either learn to accept the tiredness (I manage on approx 3hrs sleep and have for a long time and you do sort of get used to it), or maybe you could find a job that starts later in the day, idk?

Your bit about empathy struck me too. Personally, I think cognitive empathy is more useful than emotional empathy anyway. E.g. I want you to understand that I'm upset and why, I don't want someone who cries because I'm upset because then I have to comfort them and they've made my feelings all about them!! But it also made me wonder if you are being too cerebral about this whole thing?? I ask because I definitely struggled with this, and still do a bit. With my anhedonia (and I could still feel negative emotions so it was different to your experience), I started really working on mindfulness and truly being in the moment. Not trying to analyse every tiny little thought and feeling. And I started to notice moments where I felt ok, good even. They may only have lasted a flash, but I could feel a positive feeling. I didn't analyse it to death, except to remind myself that it happened and to remember what I was doing when it happened. And so I did more of those things, which is why I think it's great that you keep doing the things that you used to feel passionate about. I think it's good for us even if we don't experience it the same way. And gradually the anhedonia lifted. I still find feelings confusing if I think too deeply about them, and so I don't (try not to) question and analyse things, but just to accept whatever I'm feeling in the moment and just go with the flow.

I can certainly understand your fears about never experiencing true emotions ever again, but I guess I try to remind myself that worrying won't improve things, but could make it worse, like a self-fulfilling prophecy. Acceptance of things I didn't like was the hardest thing for me because it's counterintuitive and I couldn't understand it cognitively, or work out how to do it, but emotionally it just happened and it really does help me. Idk, it's hard to explain, I guess because it's dialectical and so feels completely counterintuitive.

I don't know if any of this was useful to you? If it's not, just let me know and I'll stop going on about words and meanings etc. I won't be offended.

to everyone struggling with this

ETA: I forgot to say that I'm starting to really struggle with empathy and reading people and their emotions. It used to be my greatest skill, I was very good at it. Now it's hard work and I'm not as good. My pdoc says it's a sz thing (tbh he says EVERYTHING I tell him is a sz thing!), but I don't really get exactly how/why. It's upsetting as it was my greatest strength, but I try not to think about it because getting upset isn't going to bring it back/improve that ability and it's just going to make it harder to cope with. But obviously ymmv.

*Willow*

Everyone's responses are welcoming and informing. I always enjoy your responses Willow. I didn't know you suffered from it too though. About my using the term "anhedonia" i agree with your criticisms of my use, but i can feel --not depression--but anxiety and angst still. I can also still have a hardy laugh. So those are my three things i can still hang on to. Laughing is largely a cognitive surprise to me. I'm not sure how that works.

Empathizing use to be my strongest attribute too. The boy who felt too much now feels nothing at all mostly. As cognitive as empathy is, there is still an element of sympathy to it. Sympathy is like a magnet that helps the feeler attach/connect to an idea or a person, and i totally lack that ability now, which now makes music near useless. I can no longer love the same way as i did before.

It's strange. I sat in my recliner and my cat jumped on my chest and just laid down facing me. I felt attached to her, and i love her, but it isn't as rich as it use to be. I sat there admiring her beauty, and her stoic look as she calmly purred on my chest. It's the deepest connection to a living thing i have now. I feel myself even distancing from my sister. I feel like a stranger in a strange world. If my sleep gets worse then that means trouble for work, and that's my livelyhood.

Why am i so numb to pleasure, sadness, and sleepiness? I don't even get angry anymore. I usually feel either nothing, or anxiety and angst. I use to dwell on a relationship from the past and the loss of my college career, but i don't feel any emotion regarding them now.

I'm not optimistic anymore about getting my emotions back. Now that i know it's not surpressed by a med this time, it's not looking good. Not even sex makes me drowsy or gives me a shadow of euphoria. I've been off lamictal for over 6 months now, and that was the last of the mood affecting drugs. This is my life now.

I do wonder if my brain had an emergency shut off valve, if they do in general, if the brain can tell when things are going to be too much to bear so it turns off the switch to the emotions so that the feeler doesn't commit suicide. The brain is so complex, i wouldn't be surprised if it had defense systems to protect against emotional throws that might affect it's very existence.

What you wrote about an emergency shut off valve jumped out at me. The brain does actually have something like that. When the brain is absolutely overwhelmed, it dissociates. If you consider your numbness, which I think might be a more accurate description(?), as a sort of dissociation from your feelings, maybe like a depersonalisation so your feelings are so separated from your consciousness that they either are absent (numbness) or they surprise you (like with laughing).

The reason I keep going on about it is that there's not much we can do for negative symptoms, but there's things you could maybe do for something else. E.g. Numbness could be depression, anxiety, or extreme stress, which are all more treatable, in general, than negative symptoms. Even if you don't think that applies now, it could be that it applied before (psychosis is certainly stressful, for example) and your brain shut down your feelings, and it doesn't know how, or doesn't think it's 'safe' yet to re-access them, idk? But maybe therapy could help if that was the case??

You've been off lamotrigine for 6 months but, if it was that, it's possible it will take a bit more time, idk? Or maybe it's your AP?? APs reduce salience so we have less interest in everything, so maybe that's why your brain can't feel emotions because everything is so 'blah' that it's not worth getting excited/upset/etc about? But then I feel that way too sometimes not on an AP - I don't know if I'm actually interested in something or if I'm telling myself that I should be interested in something and so pretending to myself, but then other times I feel no interest and it surprises me because it should interest me - but I guess that brings us back to negative symptoms... :/

Idk...I really feel for you. I know it's not a great way to live I go through phases where I'm like it and times when it's not as bad/almost gone. I'm not sure I actually do much to influence that though. All I've figured out to do is to help myself to cope with the things that I experience; nothing I or anyone else does seems to make the experiences themselves better/disappear. So I guess that's where acceptance and mindfulness comes in for me.

And you are right about feeling being an important part of empathy. Sometimes I worry that I'm becoming a monster because I can't feel anything above a very superficial level of empathy for people that I'm very close to; not all of the time, but some of the time. It is so alien to me from where I used to be that it feels like nothing is real in that moment. Emotions bond us to other people. Having a cognitive affection for someone/something is a pale reflection of real love...but sometimes we have to work with what we've got and that's all we can do. It sucks, but

DT

*Willow*

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761908/

OK----its an antidepressant but a very special one, different mechanism of action called vortioxetine----I was reading about it because it helps cognitive dysfunction and actually treatment resistance......but it helps what they are calling negative symptoms in patient 3. From the sound of it however, it might have to be taken with latuda to get the effect though. Basically its a case study they don't know yet but people are doing really well on the combo.

Thanks SP.
Last time i talked to my doctor she suggested i try Latuda but it's not generic and would cost me about $1,180 a month. She thinks something newer like that would help with my negative symptoms but I'm not hopeful...

The vortioxetine is different, but it seems to work similarly to an SSRI and give sexual dyfunction. The flood of Serotonin to my brain when i was on SSRI's was too much to bear, i felt nothing. I don't think this will work for me...

I just googled when latuda will be generic and a result said in 2018 so that's good news. That's one med i woul actually try. Abilify im afraid will give me side effects i couldn't live with. I already have a lot of trouble falling asleep...

I wish i could find out what exactly is causing my anhedonia... Why i reacted to SSRI's the way i did.

The dysfunction is supposed to be lower than most ADs....and it directly activates some of the serotonin receptors which is supposed to kind of desensitize them and yet people come out happy anyway.

I’m thinking about asking for it for the cognitive and negative symptoms just not sure it will work with Abilify the way it works with latuda, it’s also a new more expensive drug but I’ve got gold level insurance right now.....why not.

Hi @daytripper, I was wondering if you've had any success getting your emotions back?

Mem32, I haven't had any success getting my emotions back. My doctor did all she could do, working with me, to try all sorts of drugs and even getting off some. Nothing has changed, even when I was just on just Geodon at a low dose, which was the ultimate test, because when I first was ill and was put on Geodon it allowed me to feel my full weight of emotions.

I believe either Lexapro or Lithium damaged my brain and that's why I can't feel emotions. Lexapro really did a number on me, I went full rapid cycle acute depression with acute rage. It was horrible.

So anhedonia is a form of depression, which i think it should be a different category. I had to fight tooth and nail to get my negative emotions back like stress, anxiety, and I can feel sad, but mostly just in my stomach and sometimes it represents itself as just that my head feels like it's being weighted down.

My doctor's final recommendation to try and bring my emotions back was to try ECT, Electric convulsant therapy. I don't have the insurance that could pay for that though, also I'm a little uneasy about trying it.

When i was on an academic site for scientists I got a response from someone who was also trying to get her emotions back. I think she was put on an SNRI and boom, they all came rushing back. So there is hope! She just needed a little experimentation to find the right drugs.

J. K. Rowling had anhedonia for a time too. She penned the Dementors after her episode, which she described as thought all the happiness in the world had gone away, and leaves you with only your worst memories. But she got out of it, so there's that. If you have any questions I'll try to answer then.

I posted here but I don't remember anything. Nothing. My short term memory is really good but my long term memory is so terrible. It's fried almost completely. All I remember is a few pictures of the past. I don't remember vacations. Only a few pictures in my head comes to mind. Idk if that's normal.. Maybe it is. I know my dad has a bad memory but that's probably from drinking so much. I think I am this way because I'm in a house most of the time? I need to go outside in nature on acid.

The anhedonia has gotten better but I notice from an outside perspective, I have a really flat affect. I don't participate in conversation like I do when I'm psychotic. Of course, when not properly medicated, I pause in the middle of a sentence for like 10-15 seconds if someone lets me but what I'm saying in those moments are profound enlightened well put together but not very articulated thoughts but it seems like so.

I don't think as much as I do anymore. My cognition feels like it is impaired. It could be because of the Invega.. I want to stop taking it.. But I'll just go psychotic? I think it's worth a try.. I'm willing to give up my disability if I don't get psychosis.. but ****.. I guess I have to be on a low dose of antipsychotic regardless.. But this is too much.. I sit around, feed off of information and then tire out within an hour. I'm surrounded by love and family and they get it.. everyone sees potential in me but I don't know how well I'm going to do starting my anthropology class tomorrow.. I feel scared of everything without confidence.

Idk what those panic attacks were about but I never want them again so it gives me relief that it can be much worse. I can cry when I listen to a good song.. kind of.. but I think too heavy about things as if I have to concentrate on emotion and jinx myself.. It's like I need to change my thinking pattern.. I get songs stuck in my head sometimes so hard that it drives me nuts.. like last night.. I went to bed because I kept looking at circles in everything in letters and the time on my watch, when I look in the mirror, I focus on my pupil from far away like I see my soul. That's when I know I'm going into some sort of psychosis or a panic attack so I took the seroquel and felt better.

I want to be more spiritual and feel good when I listen to music. I've come to the conclusion of just saying "**** it" and going with the flow. Let the pieces of my cognition and memory fall while I walk and don't look behind, just to keep going. At least my brain has developed a lot more since I was 12. But I still feel numb. Scared that there's little information in my outside reality. I need stimulation and creativity.. which the invega kills.. so I take dextroamphetamine.. I can focus on it but I think it kills my creativity even more..

MDMA I will try in the future (When it's legal of course @ mod) 140mg. I've felt the magic. I know what it is. People that do it too much don't feel the magic anymore... they become anhedonic...

So I mean in 2019 no one has payed attention to people with anhedonia because it's rare. Depression isn't rare. But I feel like it's also not just brain chemistry but a product of society... social media, bullying in children.. in the workplace, driving home exhausted from work.. not getting anywhere in life.. bad marriage causing divorce and leaving children confused and then a step-parent comes in and maybe abuses them.. People trying to find meaning in life when in the past it was just about survival.. people getting offended by minor things because it's so easy for the middle class to relax if they can.. idk .. idk .... idk....

So that's my update. Doing better. I think.. I can feel music so that's good.

Have you ever tried st john's wort?

It inhibits dopamine, serotonine, norepinephrine, GABA and glutamate reuptake and has a mild MAOI effect (so you have more of everything), lower inflammatory responses and regulates the cortisol axis. I have found myself more driven to do things while taking it, even if emotionally I don't feel well. It doesn't cause sexual dysfunction as far as I know, It's totally different from any synthetic antidepressant.

It interacts with a lot of meds so if you want to try it you need to ask a doctor first.

Also, there is tianeptine that regulates the glutamate neurotransmission and has some opioid-like activity, It is not approved in all countries.

SSRI and AP caused me severe anhedonia while I was a teen, it took me 3-4 years to recover some normal emotions. Now my depression is "normal" depression (negative emotions) instead of absolutely nothingness about everything (actually, I think it is also the reason why I was so schizoid-like and never had any kind of interest towards my peers, sexual or social interest). I think I haven't fully recovered yet, I don't know if it is even possible since the damage was done while I was a teen.

Crazy, inside and aside

"Outwardly: dumbly, I shamble about, a thing that could never have been known as human, a
thing whose shape is so alien a travesty that humanity becomes more obscene for the vague resemblance."
I have no mouth and I must scream -Harlan Ellison-

I'll ask my psychiatrist about St John's wort. Thanks brother.

I remember searching "Anhedonia" into Google and Google didn't know anything.. Now there's loads of results!

the prefrontal cortex, which is involved in planning and personality expression

the amygdala, which processes emotions and is involved in decision-making

the striatum, which is the area that houses the nucleus accumbens, implicated in the reward system

the insula, which is thought to be important in consciousness and self-awareness

The prefrontal cortex seems important in high-level processing of rewards, including cost-benefit analysis and decision-making. Its connections to the ventral striatum seem to be particularly important in motivation and therefore anhedonia.

GABA (an inhibitory neurotransmitter), glutamate (an excitatory neurotransmitter), serotonin, and opioids may also play their part.

Specifically, the study looked at treatment-resistant bipolar disorder. The authors concluded that "ketamine rapidly reduced the levels of anhedonia."

Ketamine blocks N-Methyl-D-aspartate receptors, thereby preventing them from being activated by glutamate. This infers that glutamate, an excitatory neurotransmitter, might play a role in anhedonia.

I tried 140mg since then but it gave me a panic attack so I took benzos and went to sleep. I woke up and the magic wasn't there.

Alcohol is the only thing that even comes close, and it takes a few tall one's to feel anything at all. I jjust.. gave up on this, the only reason I live is to write now. Nobody will finish my books if I don't.