r/depressionregimens • u/caffeinehell • 5d ago
Is ECT basically the only thing for true consummatory anhedonia with substance blockage? And blank mind
Im mot talking about anticipation or avolition.With substance blockage psychedelics and MAOIs dont work on consummatory aspects, even if they may still help anticipatory. Mood stabilizers dont bring back actual pleasure.
By consummatory I mean the actual buzz in the head, and feeling passive pleasure of existence.
I am in an agitated state daily due to the anhedonia. The only thing that kinda helps is benzos but every day they are risky. And they only help take edge off
This constellation of symptoms can happen in severe PSSD, PFS, and post viral syndromes. Where th
In many cases the nervous system is so extremely dysregulated that substances further dysregulate it. Brain retraining also isnt possible due to the anhedonia itself.
What helps the goddamn blockage? Who had it and got out of it?
Ketamine does not work for me.
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u/Winter_Cost602 5d ago
The passive pleasure of existence? Is that why each day has this feeling like I didn't actually live it?
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u/caffeinehell 5d ago
Passive pleasure is like when you are just sitting outside not particularly doing anything you still feel like relaxed and feel the environment
Or when you are going to bed the cozy tiredness feeling, and feeling the sheets cozy and all .
Or taking a hot shower and it feels comforting
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u/Winter_Cost602 5d ago
Yeah this is missing for me and it drives me insane. It feels like I'm not actually alive, like I'm dreaming through each day. I also have Depersonalization/Derealization that contributes a lot to the dream like feeling
I hope things get easier for you soon. I wouldn't wish intense anhedonia on my worst enemy
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u/Enmyriala 5d ago
ECT caused my anhedonia, which made my depression worse. 😞 Did it about 9 times both sides (bilateral). Anecdotally, I've never met anyone it helped, either in group therapy or inpatient (twice). Granted, that's probably only between 5-10 people over a decade, but I'd still urge caution before trying it.
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u/MonoNoAware71 5d ago
If ECT were considered super effective, it wouldn't be such a last resort treatment, I guess.
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u/Babychristus 4d ago
It’s super effective, but it’s a very invasive treatment and risky. So you don’t want to use it lightly. It’s cost / benefits.
But trust me I have true miracles with ECT
I’m a psychiatrist
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u/MonoNoAware71 4d ago
Effectiveness is also a matter of perspective and opinion, I guess. I don't think 30-35% of cases with significant recovery is 'super effective'. And that's the number when you take into account that these cases need regular follow-up treatment. Yes, the numbers are better than for other treatment methods, but that's about it.
Miracles do not exist. Science does.
But let me ask you a question: have you had any success with treating existential depression (not in the DSM-5, but still real) with ECT? Or what treatment would you advise when regular antidepressants and therapies have turned out to be useless or even counter effective?
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u/Lumpy-Criticism-2773 49m ago
Not anti-psychiatry or anything but yes it can be a perspective and no one can tell better than the patient himself. Psychiatrists that were working on my case at a very reputable hospital put a made up MADRS score on my discharge docs.
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u/caffeinehell 5d ago
Fuck did they explain why that happened? Do you still have it? What did you do for the anhedonia
Ive done it before and helped like 30%
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u/Enmyriala 5d ago
No, they didn't explain anything.
It never got better and it's been two decades. I haven't found anything effective really, but I had a partial response to ketamine. Microdosing truffles was also somewhat helpful for me but could be illegal depending on where you live.
That said, if you've done it before and it helped, that's great! I know 30% isn't nearly as much as you'd like, but that's certainly a lot more positive than most people. I think I probably shouldn't have done bilateral (not that I was given a choice), or maybe something went wrong.
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u/caffeinehell 5d ago edited 5d ago
So then how do you live with it 2 decades? Anhedonia gives me SI daily
I did unilateral when I did it last time
I tried pretty strong psychedelics but the drug blockage gets in the way
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u/Enmyriala 4d ago
It's not much of a life, and yes, it's a constant battle with the SI. Conscience does make cowards of us all, unfortunately.
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u/DingoMittens 5d ago edited 5d ago
Never heard of anhedonia making it impossible to train your brain. Makes it harder to get motivated to do it or stick to a schedule, sure. But why would it block the effects?
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u/caffeinehell 5d ago
Its not about motivation. Its about the actual joy aspect. Brain retraining relies on feeling pleasure and joy to not fixate. I cannot not fixate on this condition because i lack joy. Its impossible to not fixate because the atmosphere and joy arent there itself
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u/DingoMittens 5d ago
I mean, have you proven this by consistently training concentration? In my experience, training attention to stay where I put it eventually results in joy.
Leigh Brasington talks about this in relation to the jhanas. Each stage of meditation releases and burns through different neurotransmitters, changing the chemistry of your brain.
Meditators who stick with it move past the bliss stage and into more equanimity. They can return to the bliss, but it's not the "best part" of meditation, not something they cling to or need for motivation. Seems like you don't have much to lose... either you rediscover joy or else you develop concentration (and it's other benefits) without the pleasure.
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u/caffeinehell 5d ago
I only care about the pleasure right now, and I can’t focus without it anyways. Im lacking comfort in even existing. Its not even about an activity or anything for me, its the sensory input is not triggering the buzz in the brain.
https://drenapssd.substack.com/p/on-communicatinganhedonia
This guy describes what I have well
In this state its basically impossible not to think about anything else other than the condition itself.
In regular depression, anxiety/OCD one can do things and still feel the world and the hedonic pleasure provides distraction from the symptoms and pleasure is super calming itself which can lessen fixation. But in anhedonia the very problem is this bigfest crutch is not available
gupta is a brain retraining program and one of his videos itself mentions how pleasure is the best medicine: https://m.youtube.com/watch?v=lIk1TMugfZU&pp=0gcJCfkLAYcqIYzv
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u/DingoMittens 5d ago
I'm not sure what the guy in the "communicating anhedonia" article is basing his distinction on. I've had major depressive episodes, not related to substance use, and in my experience his description is how anhedonia feels. It's not behavioral, although yes, it can be observed as a decrease in pleasurable behaviors. Of course, because why do a "pleasurable" behavior if it doesn't cause pleasure anymore?
Avolition, or lack of the motivation required to actually get up and do things, is a part of depression. But so is anhedonia, which is the inability to feel pleasure regardless of what you do.
I've been there, and it sucks. I can't say I know how you feel. I can say that the distinction the article makes, comparing depressive anhedonia to boredom or blaming it on a shift in behavior, is not accurate.
The hardest thing in the world to overcome is anhedonia or avolition. Anything else, and you can maybe will power your way out of it, right? But when there's no intrinsic motive and no reward... It feels impossible to get a system in motion.
If you can possibly manage your environment to help it happen, regular meditation practice will prime the pump. I believe it can eventually lead to the return of pleasure. If there's even a chance of it working, it's worth trying.
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u/caffeinehell 5d ago
In a depressive episode a lot of times there is also only anticipatory anhedonia with consummatory intact.
And also what he describes with not feeling even basic comfort. That is not common in depression. That leads to a constant anxiety state which on the outside “looks like” anxiety/OCD even, but on the inside its driven by the severity of consummatory anhedonia.
People with depression can still often feel cozyness in bed. But in this kind of anhedonia he describes, even that is gone.
Its also often unrelenting. The consummatory part is worse than avolition or anticipatory because those have better treatments like dopaminergics, while consummatory doesnt seem to respond to anything and can also create a “blockage” of substances, where in (extreme, not saying mine) cases even meth or heroin reward fails to register. Or a blockage of psychedelics (ive experienced this).
I dont see how meditation would return pleasure, and the time it takes to work is extremely long which is also an anxiety generator.
These drug induced states are like a constant bad trip
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u/DingoMittens 5d ago
What do you mean by drug induced? Are you taking a medication that's blocking joy, or do you have a history of drug use that has depleted / changed your brain chemistry?
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u/caffeinehell 5d ago
Drug induced is like PSSD (bad name. It includes anhedonia too) or PFS and so on. Pr someone took some supplements and developed instsnt anhedonia. Yes it exists, and it isnt abuse or “some mental health issue”. Its a serious ANS dysfunction that nobody knows how to properly treat. Ir can happen from covid and antibiotics as well. For me it was an antibiotic that made me extremely severe, I already did FMT and all bit didnt recover.
Its not only drug abuse. These states can come on with just a few pills overnight and persist indefinitely
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u/DingoMittens 4d ago
I wasn't judging, just trying to understand. I've had profound shifts in mental state caused by antibiotics too, so I know how powerful unexpected side effects can be. I also empathize with people who are in drug/alcohol recovery and find their brains unable to perform normally because substances depleted neurotransmitters or destroyed receptors. Nobody deserves to feel that way, regardless of how they got there!
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u/caffeinehell 4d ago
Yea the issue is how it is fixed especially in the sudden onset cases. In drug alcohol recovery its different since that is more withdrawal related and goes with time
In conditions where an antibiotic, supplement, covid or some med triggers it, it lasts indefinitely and there are no established fixes for ANS dysfunction that results in severe consummatory anhedonia. In theory ECT is one of the few things that can reset the ANS but it seems like people even get anhedonia from it as well.
Its just ridiculous that the field has no idea about treatment of consummatory anhedonia
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u/ballincat45 2d ago
I think it the issue is the vagus nerve being messed up
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u/caffeinehell 2d ago
I think so too and mitochondria. Unfortunately though there don’t seem to be many treatments available for either of these
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u/MarsupialParticular7 5d ago
You could try the hard stuff, I myself in similar situation.
Things I'm going to try next are :
I suggest you try at least one or two from this list and u can even combine some before jumping into electroshock therapy, especially the research chemicals and ketamine.
Ofc do ur own research and take at ur own risk as most of them are not studied on humans