Variance: anhedonia, emotional blunting and PSSD

[Variance]

Hi all,

 

I've lurked in the forum for a little while now but thought I'd finally introduce myself to give my bit to the community and hopefully track my progress too.

 

I took citalopram 20mg for 6 months in the first half of 2018 to try to help with symptoms of generalised anxiety. I tapered (in what I now know to be a rather quick fashion) over about 10 weeks and hence have been antidepressant-free since August 2018, one year ago.

 

Luckily, I never really suffered with many of the physical side-effects that many describe here, whilst on the drugs, tapering, and off the drugs. But the biggest thing for me by far has been the sense of blunted emotions, anhedonia and sexual dysfunction that has arisen. I noticed these increase gradually while I was on the meds, and then increase dramatically after coming off. Whilst on the meds and even tapering, my overall experience was mixed - whilst the dulled emotions and sex drive bothered me, my anxiety was definitely reduced and I did have more of a sense of resilience to difficulties.

 

The problems really started once off the meds. I assumed that these side effects would go away once I was off, but they actually got significantly worse. Combined, they have really led to a real sense of having lost who I was. The loss of libido has been particularly upsetting, having had quite a high sex drive previously and sex having played an important part in my life. Almost as bad is the loss of enjoyment in music, which I simply don't experience in quite the same way any more. A phrase that resonated with me a little was that of listening to an orchestra, but with the strings and percussion missing. You hear the music, but it just doesn't quite seem full or right. Emotionally I feel less empathy and love which impacted my relationship. The anxiety has still been numbed, the one small positive. But everything is numb.

 

With regards to my sex drive, it's not at 0%, and I do have windows where things seem better, but they feel so fleeting and hard to grasp onto. And often the more I chase these feelings (via porn, say) the further away they seem. Progress seems so painfully slow and there are definitely low periods where I feel like it's never going to recover. But there are times when I can be aroused somewhat by porn/sex and a few magical times where it seemed like everything was back to normal. Recreational drugs sometimes helped me feel something too, though clearly aren't any sort of long term solution.

 

I have found forums like this a mixed blessing. There is an awful lot of negativity around, from people sadly in a very bad place, who have been suffering for 3/5/7/10 years etc who are convinced that this is permanent, they'll never recover, life isn't worth living etc. In my bad times it can be very easy to follow this line of thinking, look at the timescales involved and fall into despair. Nevertheless the forums have been an invaluable source of information and sometimes inspiration - I tend to try to focus on the success stories and positives rather than wallowing in the tough bits. I can completely understand why most people wouldn't want to hang around here when they feel as if they've recovered - they move on with their lives - and I'm convinced that there is a lot of unreported recovery. People don't stay in the hospital when they are better, as the saying goes. Also however painful and slow, it would just seem very surprising to me if anything like this was really permanent. Brains just don't work like that and they are capable of remarkable healing, given enough time. 

 

I've recently been in quite a bad wave, brought on to a large extent by difficulties in a relationship which has now sadly ended in quite a difficult and messy way. Though I feel numbed, the end of the relationship has clearly impacted me and in a sense I guess is manifesting itself in this complete anhedonia (rather than high anxiety, which it might have done pre-meds.) Though I feel horrifically numb and flat at the moment, it's all still a bit recent and I know that I need to give myself some time and a chance to heal from the break-up.

 

Anyway - I'll try to pop back here to post any updates I have or answer any questions from fellow forum members.

 

Variance

[Altostrata]

Welcome, Variance.

 

How did you taper off citalopram? Did you have any withdrawal symptoms while tapering?

 

How has your symptom pattern changed in the last 6 months?

[Variance]

Thank you, Alto and thanks also for doing such a good job here!

 

My taper was relatively fast, over a period of about 10 weeks. I only split my tablets into quarters, so I initially reduced to 15mg every other day, then 15mg every day, then 10mg every other day, and so on - reducing every 1 or 2 weeks. (I thought this was slow at the time!)

 

I guess I was happy going at that pace because at the time, withdrawal symptoms didn’t really seem a major problem. Sure, I had some of the brain zaps and felt some anxiety creeping back, but assumed that this was fairly normal. Sex drive was weak, but I thought it would return.

 

But it was in the weeks after dropping to zero that the issues began. Sex drive went from weak to zero. My brain felt very foggy and sluggish, and I woke up exhausted every day. I struggled to find pleasure in music and hobbies. I was also recovering from a bout of mono a few months prior so initially thought that it was partly down to that, but reading around made me realise that this was very likely withdrawal.

 

In recent months, I’ve still been very flat most of the time. There are moments, sometimes even periods of a few days, where I almost feel back to normal, but they feel so fleeting and far between. But I do take them as encouragement that feeling better isn’t out of reach one day. Meanwhile, it’s just so incredibly frustrating how much joy this has sucked out of my life. Though often the apathy is so much that I don’t even care.

[Variance]

I've had a bit of a rough time recently.

 

Before taking meds, I could have been described as somewhat sexually compulsive. I had issues with porn and sexual addictions, which caused me a lot of concern over the years. The meds numbed a lot of the cravings by essentially killing my sex drive. But I had no idea how much I'd miss those cravings - the feelings of sexual desire!

 

Since the break up, I've been having trouble controlling those compulsions again. Now this might sound quite counter-intuitive - if my sex drive is very weak, how do I still have a sexual addiction? The key point is that though my sex drive is definitely weaker, it's not zero. I'm operating on say 20%. But this ends up frustrating the hell out of me, because I can't get the desire and release that I want and got in the past - and I end up seeking more quantity and more intensity. The more I chase it, the worse I end up feeling, and then the libido just goes back to zero. My ability to control myself is counter-intuitively a lot more diminished than it was before the citalopram, even though physiologically my excitement and arousal is much weaker.

 

The problem is one of acceptance. I'm finding it incredibly hard to accept my situation at the moment and just want everything to be like it was before I ever touched an antidepressant, and I want it now. But the more I think like this, the more I end up in this self-destructive sort of behaviour which only makes me feel worse.

 

I know what I need to do. These glimmers of libido that I'm getting and then acting on immediately - I should take as a sign of encouragement that things are gradually moving in the right direction. But I really, really need to take the pressure off myself by not trying to force myself to feel like I did before. The more I force it, the worse it gets. What I really need to do is just to take porn, dating etc completely off the table for a while. Just take a break from it all. I was thinking until the end of next year, but perhaps the end of this one is more realistic and a bit less scary. When you feel at rock bottom though, it's just hard to see what that path forwards looks like.

[Variance]

I think it's important to remember that most of us started taking antidepressants for a reason. It's easy to sit here and think how good my life might have been if I'd never started. Often there is something not right or not working in our lives, which leads us to take them. I used to suffer from quite sharp anxiety. One thing I can say is that this anxiety is definitely quite blunted now, to the point where I'd say that I don't really have an anxiety disorder any more. Sure, I do still struggle, but it does seem a lot more manageable. So in a sense, the drugs worked.

 

The problem is of course all the ancillary effects that went along with it - problems with fatigue, motivation, mental clarity, emotional response, sexual function. The anxiety is numbed, but so are all the positive feelings - all the joy, the excitement, the reasons to be alive. Or, in brief, just not feeling like myself. I'd take the anxiety back in an instant if I could have those good feelings again too.

 

Or would I? If I'm brutally honest, I'm also sure that even if I felt like I recovered from my current symptoms 100% tomorrow, within a few months I'd have quickly adjusted to the new normal and have a whole other slate of problems to deal with! All I can really do is just try to make the most of each moment and not agonise too much about feeling or not feeling in a certain way. The more I think like this, invariably the better I feel. The more I feel sorry for my predicament, the worse I feel.

 

I've taken a bit more care of myself and felt a little better since the weekend, and in general I do think I can sort of feel those positive feelings coming back. Painfully slowly. But it does give me hope. It can be difficult to read accounts of people struggling with no improvement 5 or 10 years down the line, but these must be a tiny minority of overall cases. I do think that it simply wouldn't make sense for this to be a permanent state for the brain - it's an incredibly plastic organ and it can and will fix itself, just in a gradual and very frustrating way. And being optimistic in that regard can only help, both in terms of speed of recovery and how good I feel along the way.

[Variance]

It's the exhaustion that's just killing me at the moment. I just feel so tired and foggy most of the time and never seem to wake up feeling refreshed at all. On the plus side I'm functional enough to get by in general life, and I even ran a marathon earlier in the year, so I guess I shouldn't feel too hard done by. But I do miss feeling myself.

[ChessieCat]

On 9/25/2019 at 4:10 AM, Variance said:

I think it's important to remember that most of us started taking antidepressants for a reason. It's easy to sit here and think how good my life might have been if I'd never started. Often there is something not right or not working in our lives, which leads us to take them.

 

I was thinking the same thing last night.  My depression was situational and might have been managed by counselling and learning skills to handle the situation/s.  However, when thinking about it I might not have managed to stay in my marriage which was very important to me because I wanted to keep the family together because was better for my daughters.  Perhaps the AD numbed me enough to get through it until the end.  (My husband started having health issues 2 years after we were married, and as additional health problems were added he changed.  We were married for 18 years.  I started an AD about 10-12 years into the marriage.) 

[Variance]

Thanks for commenting Chessie. Just something to bear in mind.

 

I've had a fairly rotten weekend. In one of those periods where I just feel very dysphoric. It's a horrible feeling, but it feels quite synthetic - not a real organic emotion. The way I could describe it is, it's quite similar to that feeling I might have got when I'd overdone some recreational drugs in the past, the high had worn off and an aggressive comedown was kicking in. Certainly an unpleasant emotion, but in that context you know what it is, why it's happened and that it will wear off in time, which sort of makes it manageable. Except this time there's no high, just the comedown, and it's just kept on coming back for a whole year, and there's no indication that it's going away any time soon.

 

Yet it's still a 'fake' sort of dysphoria - one that doesn't feel like it would have arisen due to natural emotions. This gives me a little hope - comedowns happen because you've messed with your brain chemistry and it's trying to revert to homeostasis. It's a necessary part of the process of the brain returning to normal. What goes up, must come down. However unpleasant this is, could it be a sign that my brain is trying to do the right thing and get back to normal? Can anyone relate to the above at all?

[Variance]

I'm still feeling particularly dysphoric at the moment and actually rather anxious. It's incredibly unpleasant, but it is a bit different from my baseline numbness over the past year. It's like I'm getting some feelings back, just all the bad ones at the moment. So I'm trying to take it as a positive that something is coming back, even if it's horrible now. Perhaps it's some version of the 10 month wave, a bit off schedule at 13 months?

 

But, I do think I'm feeding into my symptoms a little bit at the moment, as I'm being quite obsessive on this forum and beyond, and I think it's becoming part of the problem in a way. It can be tough to read about the bad cases when you're feeling low. So please don't take it the wrong way, but I'm going to try to take a bit of time off from here just to focus on recovery for a while. I'll try to check in in a couple of months.

[Variance]

Mixed bag at the moment. I feel worst when I let it get the better of me and get into a bad cycle. My response to feeling bad becomes part of the problem - I feel bad/numb and tired/lazy/foggy, so I don't work hard, wallow by myself a lot, don't exercise and hence feel even worse and more tired/foggy etc.

 

I do manage to break out of this cycle sometimes, and on my better days I actually feel alright, like I can live with the situation. It's actually surprising how quickly I can feel better sometimes when I do manage to break out of the cycle. I can be hopeless and pathetic one day, and a day or two later feel just fine. Sometimes it's a great night out with some old friends which snaps me out of it. Once it was a date which led to some casual sex (enjoyable sensation but the desire still rather missing). Other times it's strenuous exercise which helps to 'clear the mind' a bit. Or I just force myself to do the work I keep on putting off, however tiring and unpleasant it is, and I end up feeling much better for it.

 

It's still a struggle, mind. And alcohol is a real double edged sword. So much of my social life has historically revolved around alcohol that avoiding it completely is not only difficult but leaves me feeling a lot more alone. And it can be fun. But overdoing it is prone to leaving me worse off for several days, so it's a fine balance to strike.

[Variance]

Still a mixed bag. I had a pretty unpleasant run in December, which I put down to a probably ill-advised night out on recreational drugs. It wasn't terrible, but I just felt so down afterwards that I couldn't feel the joy, love and happiness that I would have used to. Music was a huge part of my life pre-medication, but now it just doesn't touch me in the same way any more, which is really depressing. I barely listen to it any more, when I used to every day. And while I didn't have a horrible time on that night, I felt like it was a huge reminder of how much I was missing those wonderful feelings I would have before (even though they would be tainted by anxiety.)

 

It's taken me a bit of time to recover from that, and I suffered from a nasty feverish sort of cold over Christmas, which left me feeling pretty despondent about my situation too. I've felt a bit more positive in the new year. I've been on a nofap regime for a few weeks, and there's definitely stirrings of some sort of arousal at times. It's nice to have a reminder that I'm not completely dead sexually, even if pre-meds I'd have been climbing up the walls at this stage.

 

But I'm feeling quite regretful again about my whole decision to start the meds, even if not trying to beat myself up about it. Pretty much every day I spend time thinking about the PSSD and wishing I'd never started. I feel just as obsessed as ever with sex, unhealthily so probably, but now I'm consumed by thinking about the lack of desire rather than being anxious about excessive desire. It's quite a hard headspace to live in happily, and I'm still not sure how to get out of it.

[Variance]

Becoming a bit obsessive on the forums again, which I don't think is helping. It's causing this secondary effect where the worrying about the symptoms becomes so consuming that it actually starts to cause/worsen them. Time to get out of the loop again!

 

It reminds me a bit of something my therapist talked to me about managing anxiety a few years back. Sometimes the fear of anxiety itself becomes the actual problem, more than the underlying anxiety itself. The thing to do, however hard, is to try to sit back and simply observe it, rather than buy into it and feed it. It breaks the vicious cycle.

 

I think although this is very different to the anxiety I used to have, the principle can still be applied here. The symptoms are bad enough on their own, without the constant obsessing and ruminating over them making them worse. It's so tough, but I just need to get on with life and try to forget about it for a while, let the healing happen, and allow myself to have an OK quality of life in the meantime. That's what's helped the most in the past months.

[Variance]

Popped back here as I feel a bit low, but it was kinda self inflicted.

 

In honesty, I have seen some signs of progress in the last month or two. Quitting the forums and focussing on life was helpful. Sex wise, while libido remains weak a lot of the time, I've noticed the return of more random erections at times, in the morning and throughout the day, which seems encouraging. Have been dating more - I went on a date where I was actually getting decent erections from touching and kissing, which was nice. I still get frustrated by the lack of desire sometimes but the more I try to force it, the worse it gets. The dating hasn't really worked out in the end, which led to a mini porn binge chasing after that old libido, which definitely wasn't helpful.

 

I'm still tired and foggy an awful lot of the time, lack drive, feel a bit emotionless, and feel quite lonely sometimes. But there are also more times where I actually feel quite content and almost glad for the experience I've been through. So still quite a way to go I feel, but perhaps small steps in the right direction (albeit with those setbacks).

[Rozon1]

hey @Variance hows your over all quality of life? you doing okay?

[Variance]

I was at my grandmother's funeral yesterday. It was a really weird and pretty disheartening experience, and I'm now left in a wave as big as I can remember.  I was sad, yes, but somehow the grief felt very shallow, like I wasn't feeling it fully. The emotional anaesthesia felt so profound. I just wanted more than anything in the world just to feel the grief and sadness fully like I know I would have before.

 

After the event, on my way home, I broke down crying for about an hour about everything. Feeling sad about my grandma, but also feeling guilty that I couldn't feel properly sad. Feeling hopeless about my state and feeling like I'd never be the same again. Feeling like I'm wasting so much of the best years of my life. The crying didn't give me much emotional relief, so I found it hard to stop.

 

I have to keep some perspective, as I know that just a few days ago I wrote that I thought I was making a bit of progress, but that small window definitely slammed shut for now. Today's been one of the worst days for a while - I've been exhausted, demotivated, flat, irritable, overwhelmed, everything. It's hard to know who to turn to as no one really understands.

[Shar244]

On 3/4/2020 at 9:29 PM, Variance said:

I was at my grandmother's funeral yesterday. It was a really weird and pretty disheartening experience, and I'm now left in a wave as big as I can remember.  I was sad, yes, but somehow the grief felt very shallow, like I wasn't feeling it fully. The emotional anaesthesia felt so profound. I just wanted more than anything in the world just to feel the grief and sadness fully like I know I would have before.

 

After the event, on my way home, I broke down crying for about an hour about everything. Feeling sad about my grandma, but also feeling guilty that I couldn't feel properly sad. Feeling hopeless about my state and feeling like I'd never be the same again. Feeling like I'm wasting so much of the best years of my life. The crying didn't give me much emotional relief, so I found it hard to stop.

 

I have to keep some perspective, as I know that just a few days ago I wrote that I thought I was making a bit of progress, but that small window definitely slammed shut for now. Today's been one of the worst days for a while - I've been exhausted, demotivated, flat, irritable, overwhelmed, everything. It's hard to know who to turn to as no one really understands.

Hope you’re feeling better now? Some days are a lot worse than others in general then with the added stress of what we’re going through can be unbearable - I understand. Sorry about your Grandmother

 

xx

[Variance]

Has been a little while since I posted and I wanted to come back with a more positive update. It's so true that the online forums are the places many turn to when they are doing badly. No one is here voluntarily, everyone here would prefer to have never needed this forum in the first place. When you're doing better, you just want to... get on with life I suppose, not lurk online whinging about how miserable you are. SA tries to maintain a positive outlook at least, but there still can be an awful lot of negativity here! Far worse are the other PSSD boards, reddit etc, where it can be so toxic it's unbelievable. It's like a competition for who's the worst case. So hopefully this can provide a little more balance and these posts can more accurately reflect the better, and worse, periods, rather than just the bad.

 

Lockdown was pretty rough for me to start out, as I was isolated and didn't cope with it too well. I was living unhealthily, chasing the old (unachievable) porn highs again and generally not treating myself well. I hit a bit of a low point but managed to escape to my parents' house, where I've been doing a lot better recently - to the point where I felt quite content living like this. I've picked up some old hobbies, been playing lots of chess and golf, keeping quite fit and eating well, sleeping well, and feeling an awful lot better for it. In many ways, this state is better than I was pre-meds. I have low anxiety, I don't catastrophise about things, my outlook is neutral to positive, I feel quite normal. On good days, which there have been more of, I don't feel super tired or brain foggy, I feel mildly motivated to do things, I can feel some whispers of old emotions.

 

On the downside, the sexual symptoms have not really changed, but I've found a little more peace with this for now. I even feel a little more positive that it will return in some way, at some time. I've at least accepted that, for now, sex is just not going to play as big a part in my life as I thought it would have. But there is more to life. I do however feel a little sad that any sort of relationship seems a long way off at the moment. Mood wise I will still have days where I feel pretty down/numbed/low but they are easier to deal with when you're coming off the back of a better period. I don't have quite the same excitement, rushes or euphoria from music (and other activities), but I can enjoy it. In some ways it's a healthier balance than the highs and lows of before, but damn I still really miss those highs.

 

My plan for now is to just keep on going, keep up with my hobbies, keep fit, stay connected. This lockdown period, living with parents and working from home, does feel like a bit of an escape from reality, so I do slightly worry about my transition back to working in London and living on my own again, and how I'll handle that. But the more better days I can get under my belt, the more confidence I have that I can live like this in some contentment, and just get on and enjoy life again. Sex will still be there for me when I want it again.

 

 

On 5/26/2020 at 9:54 AM, Shar244 said:

Hope you’re feeling better now? Some days are a lot worse than others in general then with the added stress of what we’re going through can be unbearable - I understand. Sorry about your Grandmother

 

xx

 

 

Thanks and hope you're doing alright too!

[Altostrata]

Thanks for coming back with that good news.

 

How has your withdrawal symptom pattern changed in the last 6 months?

[Altostrata]

Hello, @Variance, how are you doing?

[Sofa]

@Variance

How are you feeling? Did you ever return to your old self?