Hi all, I have a slightly long story to tell, so please bear with me.
Anyway, I unknowingly suffered from depression for a few years and finally decided enough was enough last year. I decided to take Zoloft again (took it 6 years prior for horrible social anxiety and it worked wonders). When I was first on it I stupidly stopped taking it because I was drinking alcohol every night, and it was then that I first experienced what I later learned were sensations called brain zaps. Anyway, I weaned off it, deciding I was cured (dumb af), and after a few months IIRC I started taking it again. It didn't have an appreciable effect this time so I weaned off yet again. At the time I wasn't a medical professional and I was clueless about everything, including side effects (otherwise I would've obsessed over them as I suffer from OCD, and hypochondria is also often part of clinical depression). But in retrospection, I'm pretty sure I wasn't suffering from depression at the time. Anyway, over the next following years I succumbed to the insidious disease. I also had major problems with social anxiety.
These years were characterized by horrible errors in reasoning and judgment and a complete lack of insight on my part (which is, notably, another major component of major depression). So last year I decided I'm going to do something about it. I had read so many horror stories about the so-called PSSD online and started obsessing, as usual. However, I dismissed the claims. So I start taking Zoloft because it worked so well for me in the past. 3 weeks go by, nothing much happens. 6 weeks go by, nothing extraordinary happens. 8 weeks go by and I notice my melancholic thoughts are gone. I also notice the infamous SSRI-induced indifference creeping up on me as well. I notice my once strong sex drive is now literally non-existent. I notice what I surmise can't possibly be nocebo - near anorgasmia. Deciding after three months the drug has failed to produce a favorable benefit-to-harm ratio (by a wide margin), I halve the dose (from 50 to 25 mgs). After a few days the withdrawals hit me like a truck (flu-like symptoms - horrible malaise, sweating, fever etc.). I go back to 50 and they disappear after a few days. So I did a slower taper and successfully weaned off. The zaps lasted for full 2.5 months this time. I was going crazy. At the time I still had poor insight and my maladaptive reasoning was getting the better of me. The drug seemed to have lost its potency because of prior discontinuation? I haven't found anything on this and it's still a mystery to me.
I would also like to point out that I was zombie-like for months after coming off it. I remember how I was impervious to depressive thinking and feeling, but also to all the highs in life. My libido was still gone but at least I wasn't suicidal. So I decided to do labs thinking my hormones might be out of whack. Btw, by this time I had dismissed the PSSD claims as nonsense and concluded the sufferers simply relapsed into major depression, which I still believe strongly to this day, and have found evidence to support my assertion. Anyway, the labs came back and they did show abnormalities but nothing an endocrinologist would deem worthy of intervention. My SHBG was pretty high, my estradiol was low, LH and FSH high normal, total T high normal, free T quite low. I considered starting TRT but didn't in the end. At this time my unprofessional, gut feeling was that this last stint with sertraline changed me somehow. I lost interest in music, gym, sex. I was a different person than I had been before. Depression came back, lack of sex drive and anhedonia remained.
So I start taking Remeron over 2 months ago. The drug banished suicidal ideation, lifted psychomotor retardation, awakened my appetite (I had been anorexic for years) and brought back pleasure of eating. But I still have zero interest in music and absolutely no sex drive. I am suffering from appetitive anhedonia, whereas before I only had a degree of consummatory anhedonia. This new state was probably brought on by a hard relapse and worsening of depression after Zoloft, which did squat. My question is - how do I treat this?! I know this is unremitted depression with residual symptoms. Anhedonia is a core component of depression, but I have no idea how to battle it. More antidepressants? What do I add to Remeron that doesn't worsen it? I'm at 30 mgs now, 15 was inadequate (though 30 is as well obviously). I'm looking into behavioral therapy now.
Anyway, PubMed has failed me, there are countless studies elucidating the obscure pathophysiology of this state but none offering solutions. If I read another study I will implode in frustration and anger. Does anyone have an answer? Or a similar experience to share? Thank you, and thanks for reading.
Some info on these anhedonic aspects: https://www.ncbi.nlm...525714/#S4title
Edited by Mental_Divergence, 08 May 2017 - 04:28 PM.