zenzeno Seeking Advice On Severe Citalopram (Celexa) Withdrawal

[zenzeno]

Greetings All,

 

I'm trying not to panic as my doctors are seemingly clueless. Hopefully someone here can shed some light on this. You see, from 8/1/12 to 10/22/12 I was taking 10mg of Citalopram (generic Celexa). On 10/23/12 I stupidly took 40mg Citalopram. Even more stupid, on 10/24/12 I took 60mg of Citalopram. On 10/25/12 I quit cold turkey out of shear terror. Well after 33 days of withdrawal hell, today on 11/26/12 I reinstated by taking 10mg of Citalopram. I am scared to death that I will be stuck with PSSD for life now since I altered doses and then quit cold turkey and reinstatement will be too little too late. The side affect that bothers me most is ejaculatory anhedonia. The wiki entry for Citalopram states the following on adverse effects: Sexual dysfunction is often a side effect with SSRIs. Specifically, common side effects include difficulty becoming aroused, lack of interest in sex, and anorgasmia (trouble achieving orgasm). Genital anesthesia, loss of or decreased response to sexual stimuli, and ejaculatory anhedonia are also possible. Although usually reversible, in some people these sexual side effects become permanent after the drug has been completely withdrawn. This is known as Post SSRI Sexual Dysfunction. So yeah I reinstated today in a desperate and tardy attempt to curb ejaculatory anhedonia. I fear it is too late because I had quit cold turkey and abrupt cessation hit me hard bringing on SSRI discontinuation syndrome. Any help is greatly appreciated because my doctors are zero help. I just don't know what to do and if anything can be done to reverse my anhedonia.

[Nadia]

Hi Zenzeno... you are not too late to reinstate, and you were on Celexa for a short time, so don't panic just yet! Moderators familiar with reinstating and tapering will surely be along to give you some good advice. But I just wanted to say it doesn't sound to me like you have too much to worry about. In all likelihood you will recover just fine.

[Altostrata]

Welcome, zenzeno. I moved your first post here to start your Intro topic. You can put updates and questions here and be able to track your progress all in one place.

 

You did the right thing by reinstating 10mg Celexa. How are you feeling now?

 

Cold turkey upset your nervous system. It will take a while for it to calm down. Hopefully, your symptoms will change for the better.

 

Yes, sexual dysfunction is a very common side effect of SSRIs. Not everyone gets PSSD once they're finally off the drug, and if they do, it can go away. It's not always permanent.

[zenzeno]

Thank you so much for any and all assistance. Today is the fourth day I will be taking 10mg citalopram (celexa) after 33 days of cold turkey hell. Unfortunately I still suffer from ejaculatory anhedonia. I am just so paranoid that quitting so abruptly has damaged me irreversibly. And again, I quit cold turkey because after a relatively stable 3 months at 10mgs I screwed up big time by taking 40mgs one day and then 60mgs the next with horrible results. I can only assume that such a radical shift in dosage introduced severe side effects including a brain zapping session coupled with 5 weeks cold turkey, ravaging my system badly enough so that my ejaculatory anhedonia is permanent and that my brain is somehow rewired to block and mute pleasure. And that once side effects occur from higher doses, there is no turning back. I'm also concerned that I should cease sexual activity because it may reinforce the anhedonia. As an aside, I read somewhere that citalopram (celexa) is sometimes used to destroy the sexual appetites of sex offenders. I see countless horror stories online about this offensive drug causing PSSD. Needless to say, my anxiety over all of this is excruciatingly exhausting. I have a cousin who is a doctor in psychology, she tries to comfort and reassure me that everything will be fine. She said I should continue taking the (offending drug) 10mg citalopram until I can visit my psychiatrist and request a switch either to prozac or wellbutrin. I'm not sure which one would be better and at what dosage, I just know that I simply do not want to live with ejaculatory anhedonia and scorn the day I ever touched an SSRI. If I switch to wellbutrin I'm scared that I'll get hit with SSRI withdrawal and that my PSSD will even worsen. Again thank you so much for your consideration and guidance.

[s1335]

I have also quit Citalopram in a probably too abrupt fashion and haven't experienced the sexual side effects, but certainly the brain fog anxious depressive social anxiety. I had the brain zaps and tried to reinstate smaller doses (5mg) to counteract them and started taking the dosage every other day. I understand this is a grave error on my part, but I have just started taking the Citalopram 20mg ( I used to be on 40mg on and off for around 4 years.). I am probably in the hole for sure the way I have treated my brain!

 

Not sure what to do next..

[Altostrata]

zenzeno, many people have experienced the sexual side effects and recovered. Please discard this belief.

 

While you recover, don't try to force yourself to do things you would ordinarily do. Treat yourself gently. Don't berate yourself for not feeling normal.

 

Recovery teaches us all patience.

 

Switching to another drug may do more harm than good. The results of doing this are unpredictable.

[Jemima]

Thank you so much for any and all assistance. Today is the fourth day I will be taking 10mg citalopram (celexa) after 33 days of cold turkey hell.

 

Give it more time. Antidepressants can take several weeks to have an effect.

 

Unfortunately I still suffer from ejaculatory anhedonia. I am just so paranoid that quitting so abruptly has damaged me irreversibly. And again, I quit cold turkey because after a relatively stable 3 months at 10mgs I screwed up big time by taking 40mgs one day and then 60mgs the next with horrible results. I can only assume that such a radical shift in dosage introduced severe side effects including a brain zapping session coupled with 5 weeks cold turkey, ravaging my system badly enough so that my ejaculatory anhedonia is permanent and that my brain is somehow rewired to block and mute pleasure. And that once side effects occur from higher doses, there is no turning back.

 

Assume nothing. This kind of catastrophic thinking is typical of early withdrawal. Anhedonia, sexual or not, does happen in withdrawal and it is one of the last symptoms to go away. But it does go away.

 

I'm also concerned that I should cease sexual activity because it may reinforce the anhedonia. As an aside, I read somewhere that citalopram (celexa) is sometimes used to destroy the sexual appetites of sex offenders. I see countless horror stories online about this offensive drug causing PSSD. Needless to say, my anxiety over all of this is excruciatingly exhausting. I have a cousin who is a doctor in psychology, she tries to comfort and reassure me that everything will be fine. She said I should continue taking the (offending drug) 10mg citalopram until I can visit my psychiatrist and request a switch either to prozac or wellbutrin. I'm not sure which one would be better and at what dosage, I just know that I simply do not want to live with ejaculatory anhedonia and scorn the day I ever touched an SSRI. If I switch to wellbutrin I'm scared that I'll get hit with SSRI withdrawal and that my PSSD will even worsen. Again thank you so much for your consideration and guidance.

 

While I agree with your cousin that you will likely be fine in the long run, switching drugs is probably not a good idea right now. Give your nervous system time to adapt to the reinstatement of Celexa, a month or more, and then decide what to do.

 

It takes an enormous amount of patience to get through withdrawal successfully, but it is do-able.

 

NOTE: Please forgive the overlap with Alto's post. Apparently I was typing while she was posting.

[zenzeno]

No real progress yet to report. I'll report back when I have any real updates. I just wanted to share a link I ran across that is keeping me up at night:

 

http://psurvivors.livejournal.com/34153.html

 

The neurology of post-SSRI sexual dysfunction (PSSD)

It has long been known that SSRIs sometimes cause permanent neurological damage to the pathway of physical sexual pleasure. It has not been understood exactly why this happens, except that it likely involves chronic depletion of serotonin from certain serotoninergic neurons, and consequent damage to said neurons. Ultimately, that must somehow reduce the binding of dopamine to D1 receptors (which is what causes pleasure). Due to PSSD's relation to serotonin depletion, the people that are most prone to PSSD are those that have genetic alleles that cause weak serotoninergic function.

 

The striatum is rich in dopamine and D1 receptors, is adjacent to the nucleus accumbens (the primary pleasure center), and is involved in movement control (and is therefore lacking dopamine in the case of Parkinson's disease).

 

I have learned that the striatum is also largely responsible for sexual pleasure. Furthermore, it's sex-related function is dependent upon input from serotoninergic neurons. I therefore conclude that PSSD is the result of damage to these serotoninergic neurons in the striatum, and consequent lack of dopamine release to the sex-related neurons of the striatum, and in turn, the lack of sex-related pleasure in the nucleus accumbens. The fact that there is a direct effect upon the striatum, and only an indirect effect upon the nucleus accumbens, also explains why sexual pleasure is effected by PSSD, whereas other types of pleasure (such as that of food) remain intact.

 

That lack of dopamine release in the striatum need not cause any Parkinsons-like symptoms, nor are such symptoms reported, because Parkinsons-like dystonia could only result from depleting dopamine from the striatum beyond it's basal level that is required for movement control. Unless a person could somehow tap this basal dopamine and use it for the sexual system, Parkinsons-like symptoms should not occur.

[compsports]

Hi Zenzeno,

 

Your fears are understandable but it is best not to focus on something that may not even happen. Heck, you're still adjusting to reinstating the drug and haven't even started withdrawal.

 

Personally, I would stay away from sites like this. It is just not helpful in my opinion.

 

Anyway, welcome to this great forum.

 

Compsports

 

No real progress yet to report. I'll report back when I have any real updates. I just wanted to share a link I ran across that is keeping me up at night:

 

http://psurvivors.livejournal.com/34153.html

 

The neurology of post-SSRI sexual dysfunction (PSSD)

It has long been known that SSRIs sometimes cause permanent neurological damage to the pathway of physical sexual pleasure. It has not been understood exactly why this happens, except that it likely involves chronic depletion of serotonin from certain serotoninergic neurons, and consequent damage to said neurons. Ultimately, that must somehow reduce the binding of dopamine to D1 receptors (which is what causes pleasure). Due to PSSD's relation to serotonin depletion, the people that are most prone to PSSD are those that have genetic alleles that cause weak serotoninergic function.

 

The striatum is rich in dopamine and D1 receptors, is adjacent to the nucleus accumbens (the primary pleasure center), and is involved in movement control (and is therefore lacking dopamine in the case of Parkinson's disease).

 

I have learned that the striatum is also largely responsible for sexual pleasure. Furthermore, it's sex-related function is dependent upon input from serotoninergic neurons. I therefore conclude that PSSD is the result of damage to these serotoninergic neurons in the striatum, and consequent lack of dopamine release to the sex-related neurons of the striatum, and in turn, the lack of sex-related pleasure in the nucleus accumbens. The fact that there is a direct effect upon the striatum, and only an indirect effect upon the nucleus accumbens, also explains why sexual pleasure is effected by PSSD, whereas other types of pleasure (such as that of food) remain intact.

 

That lack of dopamine release in the striatum need not cause any Parkinsons-like symptoms, nor are such symptoms reported, because Parkinsons-like dystonia could only result from depleting dopamine from the striatum beyond it's basal level that is required for movement control. Unless a person could somehow tap this basal dopamine and use it for the sexual system, Parkinsons-like symptoms should not occur.

 

[mindbend]

Hi Zenzeno,

 

Take it from me that if you want to find opinions supporting how things are going to be screwed up permanently, it won't be hard to do. That's what I have been doing for the past couple of months to no avail. It has only been making me feel more miserable.

 

You should find comfort whenever you read 'the reasons for something happening is not fully understood' and not focus on the 'it can cause permanent damage' part. The irony is that our brains are truly complex mechanisms which we still only understand so little of and they are not static, new pathways are being formed all the time so no one would be able to tell you reliably how your recovery is going to be.

 

I have been experiencing anhedonia related to absolutely everything. It has become really tiresome but 4 months in to my discontinuation I am experiencing brief moments of some sort of pleasure. I have used an SSRI for almost 7 years and had days where I also occasionally took more than intended by mistake. It is very easy to despair that the damage is permanent, the worry can be especially intense during the first phase of withdrawal. I can only tell you it will be tougher on you if you keep looking into all the possibilities without giving your mind some time to recover. Let it surprise you!

 

I hope you feel much better soon!

[Altostrata]

zenzeno, I don't believe that person's view of the neurology is correct.

 

There is a great deal of misinformation on the Web about long-term adverse effects of psychiatric drugs.

[Iggy131313]

I *think* that that piece was written by David Healy, the fact is that PSSD sorts itself out, it can take a long time but it goes away, Zen, you may want to read the success stories thread, look for a post called ''great success story'' the guy talks about PSSD which he had a REALLY hard time with.

[Altostrata]

Why do you think that, Iggy? I hope Dr. Healy wouldn't write anything as simplistic as "it must ultimately reduce the binding of dopamine to D1 receptors (which is what causes pleasure)."

 

This is someone who thinks each neurotransmitter has a defined job to do.

[Jemima]

The post you linked sounds scientific, but we don't know the credentials of the person who posted. He or she doesn't cite any references supporting these opinions, which is all that they are: opinions. In addition, the post is five years old.

 

A lot of new information is coming to light regarding the plasticity of the nervous system and brain, once thought to be utterly unchangeable. Well, it turns out that the best scientific minds were wrong. What a surprise. The CNS can not only heal, neurons once thought to be exclusive to one sense, such as hearing, can be retrained to improve vision or anything else where there is a need. Everyday activities, such as reading, exercising, and meditating change the structure of the brain.

 

Here's a recent post where we were discussing this:

 

http://survivingantidepressants.org/index.php?/topic/3599-plasticity-interesting-stuff/

 

Personally, I think there's every reason to expect that normal functioning will return as we recover from psychiatric drugs and withdrawal from them. And I agree with other posters that if you want to find some terrifying information - about anything - you can sooner or later find it on the Internet.

[Iggy131313]

Why do you think that, Iggy? I hope Dr. Healy wouldn't write anything as simplistic as "it must ultimately reduce the binding of dopamine to D1 receptors (which is what causes pleasure)."

 

This is someone who thinks each neurotransmitter has a defined job to do.

 

My mistake, zenzo posted it on another forum, and someone replied saying this is from David Healy,m but on further investigation, that statement preceded a quote from Dr Healy, so forget I said it, NOT from Dr Healy!

[zenzeno]

I suppose there are a several reasons why I continually ruminate over the possibility of permanent ruin. For instance, I remember just how violently ill I became after taking too many pills over a 48 hour span (40mgs one day followed by 60mgs the next. Quite a rapid ascent from just 10mgs a day.) I especially remember tremendously disturbing brain zaps, pulsating static electric charges, like a power surge overloading and frying a circuit board, as if my brain was somehow being electrocuted. I was suddenly made aware of parts of my brain that I have never before or ever since detected. It felt as if fireworks were going off inside my head. Unfortunately I resisted the urge to vomit, thinking I could ride it out. The next day, after the storm finally passed, I decided to jump off the ride and quit cold turkey. I somehow managed to free fall for 33 days enduring the ever increasing, extreme turbulence of withdrawal. Fearing total collapse, I finally reinstated out of sheer desperation.

 

At present, the headaches and anhedonia continue to persist. I have run across reports that indicate taking just one pill can cause irreversible damage. It might be worth noting that I am a 36 year old man. And oddly enough, my neighbor living across the street just so happens to be my terribly unhelpful psychiatrist who can't be bothered to return my calls. When I finally managed to see her by appointment, all she said to me with a vacant glance was: "It's out of your system." (I think I'll be skipping our next block party lol.)

 

Ive heard that SSRI withdrawal can be even more brutal than heroin withdrawal. Anyhow, I'm not sure if this relates because I found it on a blog dealing with addiction but I found this passage somehow fitting: “I just need to go to detox and get these chemicals out of my system”), but this is not the case. Much of the latest research shows it takes about 90-days for the brain to jump-start the healing process. Depending on the length of time in active-addiction, the brain may not return to “normal” functioning for a period of 6-months to several years. Even then, a person can experience a return of cravings (which may feel like a return of withdrawal symptoms) for the substance for the rest of their life. Source: http://dopaminedialogue.wordpress.com/withdrawal-2/

 

TL;DR: If you rocket sky high into a thundercloud only to free fall without a parachute, you're gonna have a bad time.

[Altostrata]

The detox model for addictive drugs is not appropriate for tapering off psychiatric drugs.

 

With psychiatric drugs, the goal is to get the drug out of your system in a way that's so gradual your nervous system won't notice it.

 

With addictive drugs, the goal is to get the drugs out of the addict and the addict away from drugs as soon as possible. I personally think there's a punitive aspect to it, making the addict suffer for his or her sins with withdrawal symptoms.

 

There are the additional detoxification purification rituals which are nonsensical if your goal is to minimize stress on the nervous system, but make sense in a morality play.

[zenzeno]

Apologies for being crudely blunt, but I have got to state the obvious here: porn no longer excites or interests me in the slightest. I find it to be about as rewarding and appealing as watching paint dry. I find this realization to be exceedingly alarming and disturbing given the extent of brain damage this implies. Not that I can't do without it, but even more disturbing is the fact that sexual activity with my partner is severely handicapped. I'm lucky if I feel anything at all when I'm intimate with her. And on the rare occasion that I do sense any degree of pleasure, it's a muted and localized sensation. My brain is essentially MIA. I'm concerned that the frequency of our almost daily encounters only further exacerbate and somehow reinforce my anhedonia, thus rapidly sealing my fate. Although I suspect that having quit cold turkey for over a month is mostly to blame for enflaming such harsh and increasingly pronounced side effects seemingly consistent with PSSD. Unsatisfied with the inadequate services rendered to me by supposed health professionals, I've resorted to sleuthing the interwebz. Granted there is no shortage of disinformation online, however, I feel obligated to share this article, the title alone strikes a major chord: "Brain Differences Play Role in Sexual Side Effects to Anti-Depressants" (http://scopeweb.mit.edu/?p=1660). No offense ladies, but this study suggests an inherently male affliction.

 

It should go without saying just how greatly I appreciate everyone's feedback from these forums; especially considering how maddeningly unhelpful and seemingly clueless all the doctors surrounding me happen to be. The doctors I have consulted within my family range from psychologists to orthopedists to neurologists; not to mention my neighborhood psychiatrist and pharmacists. I find it rather appalling that not one of them can provide me with any helpful guidance or concrete answers whatsoever. One of the only remotely comforting pieces of advice begrudgingly imparted to me was the utterly paradoxical and hastily dismissive response: "Believe in a higher power". Evidently when it comes to medical consultation, you get what you pay for. Perhaps only the aid of a godly priest can save me now. Conspiratorially speaking, I can't help but wonder if all these doctors have signed some kind of secret confidentiality agreement with Pig Pharma. It's more likely just a combination of arrogance, greed and ignorance that seems to run rampant throughout the medical establishment in the USA. Ours is a culture of profit before people, after all. If only I had been born Canadian *le sigh*. /end rant.

[Altostrata]

Believe me, PSSD is not an exclusively male phenomenon.

 

I know this tries your patience, but it does tend to go away over time.

 

Having sex everyday may be exhausting and frustrating to you, but I can't see that it would make recovery more difficult. Perhaps you should slow down, though, and get some emotional nurturing instead.

[Rhiannon]

Aha! A Redditor! (referencing the TL;DR above, although I suppose that's used other places besides Reddit).

 

You don't really need to obsess over why you're obsessing. Obsessiveness and painful, unstoppable rumination are normal withdrawal slash AD side-effect symptoms. In fact everything you're describing sounds like a fairly normal withdrawal slash AD weirdness symptom.

 

Believe it or not, your girlfriend might be okay with taking some time off from the daily sex. Taking time off from porn is also not an unhealthy thing to do. It might be a good time to focus on other forms of self-care and self-love. There are tons of suggestions on this website. You need to give your CNS the kind of regulating, stable environment it needs to rebalance itself.

 

Please believe me when I tell you that the weird mental states and fear and obsessiveness that you are experiencing are absolutely normal for someone with your history with the AD use, CT, and at this stage in the reinstatement process. It's going to take some time yet to stabilize and have any clue at all what your new normal is. And then once you're stable, and you do a proper taper, normal will continue to change. (It may end up changed forever, but in a good way.)

 

Also, I can tell you right now that you will NEVER be sorry if you get your hands on a copy of Anatomy of an Epidemic by Robert Whitaker. It answers a lot of your questions about how things got this way and why doctors are so brainwashed about psych meds. It won't make you any less pissed off (you are correct it's all about money being more important than people), but it will make things make a lot more sense. Plus it's a good read, even/especially for someone with your brainsiness.

 

TL;DR: Relax. You're actually okay. Seriously. And read Anatomy of an Epidemic by Robert Whitaker.

[zenzeno]

Thanks again for everyone’s invaluable consideration regarding my perplexing affliction. I am at a complete and total loss as to what to do next.

 

Just to quickly review my circumstances: after 3 months on 10mg Citalopram I took 100mg over a 2-day span and quit cold turkey. After enduring an agonizing month of withdrawal, including ejaculatory anhedonia and anorgasmia, I reinstated 10mg of Citalopram so as to withdraw more cautiously.

 

I tapered off slowly over the next two months. SSRI free Since February 1st, I have been hammered by just about every Citalopram side effect listed on Google including a red skin rash on my left arm.

 

Throughout the past month and a half of withdrawal I have been taking many supplements and vitamins. Please allow me to indulge by listing them for your reference: Multivitamin ACE+Selenium+Zinc, B Complex, Beta Carotene, DGL - Deglycyrrhizinated Licorice, Ginkgo Biloba, Melatonin, Omega-3, Stress-J, Valerian and Vitamin D.

 

I am considering taking Bee Pollen, Folic Acid and Calcium Magnesium. I abandoned Valerian in favor of Melatonin.

 

Now here comes the kicker: I think I may have unwittingly slammed the door shut on any possibility of healing my sexual anhedonia by taking Melatonin. I am not certain if my worsening condition is due to a failed attempt to reinstate and taper but I am pretty sure that Melatonin has played a major role in further decimating what little sexual sensation I had left. Around the beginning of March I began recklessly taking Melatonin with abandon. NutraSpray Melatonin by Source Naturals from Whole Foods to be precise. Without careful consideration, desperate to counter insomnia, I took roughly 4.5mg a day for a couple of weeks.

 

I would estimate I burned through about half the bottle in that time somewhere around 60mgs. Over these past two weeks of using Melatonin, I noticed my withdrawal symptoms become even more untenable, not just the diminishing, until completely muted, null and void orgasms, but some of the most intense head and stomach pains to date along with worsening depression, anxiety and emotional detachment. So I finally decided to flush the remaining half of the melatonin spray bottle.

 

And after the fact, to my horror, I discover online that Melatonin should be avoided when taking an SSRI and may even conflict with Valerian and Vitamin C.

 

And because of the sheer volume I consumed, I now have Melatonin side effects to contend with in addition to the laundry list of Citalopram side effects that are still in play. I feel as though the Melatonin was fuel on the fire and has rapidly burned up any chance I had of sexual healing.

 

So at this stage of the game I am utterly gutted and shell–shocked. Perhaps I’m suffering from a plethora of health complications as a result of my haphazard self-medicating. Maybe I should just cut my losses and accept that nothing can be done and that I am only making matters worse by my futile attempts at coping with every increasingly dreadful and exasperating day. Hindsight being 20/20, I still struggle to see the forest for the trees and somehow keep making wrong turns. I wish I could just kill the engine and toss the keys away and go into hibernation until it all passes.

 

P.S. I am indeed a redditor and I have gotten some limited feedback from there. Surprisingly there is very little I have managed to glean from Reddit related to SSRI withdrawal.

 

P.P.S. Here is a purely anecdotal and somewhat amusing video from Dr. Oz explaining melatonin production in the body, how it regulates your sleep patterns -- and how too much of it can have a negative effect on your libido: Sleep Aid: Melatonin | The Dr. Oz Show

Edited March 19, 2013 by Altostrata
added paragraph breaks for readibility

[Altostrata]

zenzeno, in my opinion you did indeed overdo it on the melatonin. More is not better with supplements!

 

However, this probably did not "shut the door" on any of your healing, sexual or otherwise. Your nervous system needs time and gentle support to heal.

 

It looks like you tried to throw the kitchen sink at your symptoms. What you might do now is cut back on everything and very carefully see what reduces your symptoms by trying things one by one.

 

Are you taking fish oil and magnesium? These seem to help most people. See the topics in our Symptoms and Self-care forum.

 

PS Please add 2 returns after your paragraphs for readability.

[zenzeno]

Well it’s been about 3 months since I discontinued Citalopram use entirely. The intensely agonizing and treacherous withdrawal I have endured these past few months have left me completely bankrupt physiologically.

 

It’s hard to put this into words so as to aptly describe it, but what I find most disturbing throughout my withdrawal process is the fact that I could actually feel my brain gradually disconnecting from and shutting down my pleasure zone. A sequence of wires loosening and unplugging, thus reducing pleasurable sensations into dwindling static traces before completely fading out.

 

This harrowing ordeal directly contradicts some of the measured medical advice that I received from a doctor stating that negative side effects would wear off as the drug wears off. For me the opposite has transpired. Coming off the drug has left me in ruin.

 

I am seriously contemplating taking Wellbutrin and would like to know your opinions on whether or not I should. Perhaps it is too little too late, but I simply have nothing left to lose.

 

I don’t know how long I can tolerate a potential lifetime void of pleasure, sexual and otherwise. Even my dopamine driven love affair with music has astonishingly evaporated as well.

[Altostrata]

Wellbutrin is not a good idea. It is stimulating and will make some symptoms worse. You can't treat withdrawal syndrome as though it was depression.

 

If I were you, I'd try reinstating maybe 2mg citalopram. See this topic for titration tips http://survivingantidepressants.org/index.php?/topic/2023-tips-for-tapering-off-celexa-citalopram/

[btdt]

No real progress yet to report. I'll report back when I have any real updates. I just wanted to share a link I ran across that is keeping me up at night: http://psurvivors.livejournal.com/34153.html The neurology of post-SSRI sexual dysfunction (PSSD) It has long been known that SSRIs sometimes cause permanent neurological damage to the pathway of physical sexual pleasure. It has not been understood exactly why this happens, except that it likely involves chronic depletion of serotonin from certain serotoninergic neurons, and consequent damage to said neurons. Ultimately, that must somehow reduce the binding of dopamine to D1 receptors (which is what causes pleasure). Due to PSSD's relation to serotonin depletion, the people that are most prone to PSSD are those that have genetic alleles that cause weak serotoninergic function. The striatum is rich in dopamine and D1 receptors, is adjacent to the nucleus accumbens (the primary pleasure center), and is involved in movement control (and is therefore lacking dopamine in the case of Parkinson's disease). I have learned that the striatum is also largely responsible for sexual pleasure. Furthermore, it's sex-related function is dependent upon input from serotoninergic neurons. I therefore conclude that PSSD is the result of damage to these serotoninergic neurons in the striatum, and consequent lack of dopamine release to the sex-related neurons of the striatum, and in turn, the lack of sex-related pleasure in the nucleus accumbens. The fact that there is a direct effect upon the striatum, and only an indirect effect upon the nucleus accumbens, also explains why sexual pleasure is effected by PSSD, whereas other types of pleasure (such as that of food) remain intact. That lack of dopamine release in the striatum need not cause any Parkinsons-like symptoms, nor are such symptoms reported, because Parkinsons-like dystonia could only result from depleting dopamine from the striatum beyond it's basal level that is required for movement control. Unless a person could somehow tap this basal dopamine and use it for the sexual system, Parkinsons-like symptoms should not occur.

By the time I quit my celexa and effexor combination...( I quit celexa a year before getting off effexor) I had both sexual dysfunction and movement problems. It has been a long time there has been some improvement in the sexual area.  I did have complete numbness in all sexual areas like the dentist causes with a lidocaine shot. This is gone.  There have been some odd things between then and now.  The occasional sexual urge unrelated to reality like while at the grocer ect.  or a flood of sexual feeling while driving happened one time then was gone for ever.  I think this is an attempt to get the system back online but so far it has not regulated.  The rare times I even think of it now and persist there is a headache known by the name of orgasm headache according to my research it is severe and would stop a train.  So far there have been changes but not the complete sort that would cause a person to pursue any sort of sexual gratification as it is not expected.  The other odd thing if your thinking of suggesting the act of sex without orgasm is the other odd thing is the lead up to the orgasmic state is without pleasure unlike the way it is in my memory.  It has been so long perhaps my memory is faulty.  It is hard to say there have been changes but not healing is how I see it.

Not sure if that is at all helpful but maybe your understanding of this process will be helped with this input I don't understand the workings of the brain you post but it does interest me perhaps you will have some advice from you understanding that escapes me.

I wish you peace. 

[Rhiannon]

Altostrata is the Dumbledore of SSRI withdrawal. I am generally slow to trust others but I would take Alto's advice about SSRIs even before my own (and I'm no slouch either). 

 

Sometimes things that are free really are worth more than things that cost a lot of money. This is definitely one of those cases. If Alto says try a 2-3 mg reinstatement on citalopram, I'd do it.

[Altostrata]

Please, no pedestals.

 

(zenzeno's last post in this topic was a year ago.)