Treatments for Anhedonia/Blunting

[electrify]

What treatments are good for anhedonia and blunting?

I've been on TRT for many years, since around 2016-2017 to now. I got on it for anxiety and low mood issues and it did eventually help and I completely recovered. I did not have anhedonia then. I also take HCG and Preg occasionally. And my preg levels were fine at around 130-150, TRT did not suppress preg for me past the first year or so.

Well fast forward to 2022 August. One month after COVID, drinking too much alcohol completely messed me up. I woke up the next day with a nasty hangover that involved anhedonia which alcohol has never done. That week I was recovering itself, but then caffeine of all things set me back and crashed me while my CNS was sensitive.

In the beginning, my pregnenolone levels tanked to 30. I also found out I had SIBO (and still do). Doing rifaximin (along with TUDCA, OX bile, motility activator) restored my pregnenolone from 30 to 130 and finally brought my low cholesterol from 100 to 140. SIBO must have led to a lot of sensitivities for me.

I had some improvement but not consistently. Rifaximin does lead to improvements when I do it but they don't last. My HPA axis on tests looks ok, did the DUTCH test and my cortisol curves are totally fine but I still have anhedonia/blunting. So I don't suspect my problems are hormonally related (and generally, fluctuations in hormones don't seem to affect me either way--I can skip my T dose and still feel the same, I can take more and still feel the same anhedonia wise)

I tried Ketamine treatment but felt more numb for a week so that's not an option unforunately. I also don't react well to stims.

Something that did help me was the peptide MIF-1 which inhibits melanocortin and is a dopamine PAM, but it didn't last after cessation. I was doing better in May and after the 3rd Rifaximin course in April some of my sensitivities to caffeine or foods went down but I crashed suddenly last month.

It seems like I have developed some form of PSSD/PFS like symptoms (my sexual function has gone to 0 since this started too) without actually having taken SSRI/Fin.

Pregabalin at 200 mg also helped my anhedonia quite a bit and has an afterglow but is not sustainable. And now its started to create rebounds even though I only used it every 3-4 days. I actually suspect this may have crashed me the last time I used it.

I'm considering trialing MAOIs as anecdotally Nardil or Parnate seem to get people out of anhedonia anecdotally. Definitely do not want to touch SSRI/SNRI as they are known to induce my symptoms and even Wellbutrin can as its stim-like (and some people have gotten numb on it too).

Otherwise not sure. I hate this state. My mood itself is totally fine, I sleep fine, but I am feeling so blunted. It affects me socially dramatically as ever since this began my social skills have also plummeted due to not feeling that enthusiasm. I used to be a highly emotional person before this (I loved having high E2 for the emotionality, but now it doesn't seem to do anything) and pleasure/emotions are the #1 important thing to me. I exercise but it doesn't really do anything for my anhedonia. It helps anxiety or mood (which are not my issues) but not the actual emotionality/pleasure response.

I'm currently taking LDN 1.5 mg which slightly helps, and also Methylene Blue 30 mg which also somewhat helps but the latter seem to be getting tolerance to. Nothing was as good as MIF-1 but that also developed tolerance.

I don't have any other depression symptoms besides anhedonia/blunting and sexual dysfunction (genital numbing lack of sensitivity to be specific). Mood itself is fine. I have some anxiety but its anxiety over my current anhedonia state itself as I'm constantly worried about how long its guna be like this and whether my life is over due to anhedonia. Emotional blunting/Anhedonia is the worst thing ive experienced. Far far worse than low mood.

I think my problems are GABA and Dopamine. But so many things that increase dopamine increase NE too which activates fight/flight and makes me more numb.

Also I tried Allopregnanolone drops and the first time I tried them my symptoms significantly improved for the day. It only worked that first time though. Same with Etifoxine, a nootropic (French med) which can increase alloP. Now it doesn't do anything due to instant tolerance I got, or at most it is very subtle.

 

[sammmy]

First I would stop the unnecessary stuff that has not helped you: HCG, Pregnenolone, Allopregnanolone. Stopping them eliminates them from the puzzle. Testing should be done one by one to find out what works or doesn't, not taking 10 drugs at the same time.

Pregabalin is an anticonvulsant i.e. it alters the nerve function and can easily cause genital numbness. Gabapentin is the same.

I would stop LDN and Methylene Blue - they are acting like stimulants. If you want to try a natural stimulant - try Guarana powder.

The main problem that stands out to me is your digestion - your sensitivities to foods. There is a saying that "everything starts in the gut" - it modulates the immune and nervous systems. Try to clear the SIBO infection, get tested if you have enough digestive enzymes (stool elastase test). Get on strong live probiotic that can pass through the stomach acid. Not having enough digestive enzymes leads to undigested food entering the small intestine and bacterial overgrowth there. Digesting food well is the foundation of life and if you don't have that, you can't expect to have libido or overfill with joy.

The digestive tract is often neglected in diagnostics by traditional medicine, which leads to years of taking drugs that only cover up symptoms but don't resolve the root problem.

 

[electrify]

First I would stop the unnecessary stuff that has not helped you: HCG, Pregnenolone, Allopregnanolone. Stopping them eliminates them from the puzzle. Testing should be done one by one to find out what works or doesn't, not taking 10 drugs at the same time.

Pregabalin is an anticonvulsant i.e. it alters the nerve function and can easily cause genital numbness. Gabapentin is the same.

I would stop LDN and Methylene Blue - they are acting like stimulants. If you want to try a natural stimulant - try Guarana powder.

The main problem that stands out to me is your digestion - your sensitivities to foods. There is a saying that "everything starts in the gut" - it modulates the immune and nervous systems. Try to clear the SIBO infection, get tested if you have enough digestive enzymes (stool elastase test). Get on strong live probiotic that can pass through the stomach acid. Not having enough digestive enzymes leads to undigested food entering the small intestine and bacterial overgrowth there. Digesting food well is the foundation of life and if you don't have that, you can't expect to have libido or overfill with joy.

The digestive tract is often neglected in diagnostics by traditional medicine, which leads to years of taking drugs that only cover up symptoms but don't resolve the root problem.

I don't take allopregnanolone anymore, only used a few times many months ago. Had genital numbness before I ever took pregabalin.

LDN is one of the things that helps me a little and actually reduces gut inflammation + increases motility which is supposed to help SIBO actually. Its not a stimulant, but instead should be working on opiod system. The methylene blue is also an antimicrobial (in addition to a mild-moderate MAOI) which I am using as an alternative for antibiotics for SIBO too (I've done 3 rifaximin courses but can't do any more).

What I noticed is when the SIBO is being treated, my reaction to stimulants gets "more normal". And when it flares up I start reacting badly to stimulants. I think methylene blue because it's also antimicrobial hitting the SIBO in a way prevents its own side effects.

The weird thing is I don't have any GI symptoms. Just the mental symptoms. But yea the gut is critical for the brain.

My elastase was actually high and sIgA high (on Doctors Data):

 

[sammmy]

How were you diagnosed with SIBO if you don't have digestive symptoms?

Your intestinal secretory IgA is slightly elevated - it could be reacting to an infection, bacterial dysbiosis (lack of "good" bacteria), or reaction to food (like gluten allergy).

Have you tried taking probiotics and do you eat enough yogurt? This is mandatory after antibiotic courses.

 

[electrify]

Just a lactulose breath test from Genova. I had hydrogen levels off the chart at like 130+ initially. Now they are like around 65.

I don't eat yogurt but I take the probiotics MegaSporeBiotic, Akkermansia, and L reuteri from biogaia.

 

[sammmy]

You should eat natural fermented foods like yogurt, if you can, because the strains in them were tested for thousands of years, unlike the ones "discovered" in the last few years based on sketchy "research". If you have to add a probiotic, choose one with many diverse types and strains in it imitating natural fermented foods, not isolated overpriced strains with fantastic claims like Akkermansia and Reuteri. The type of probiotic affects your mood more than you can imagine so you may want to try a different combination. Read the negative reviews before buying - they usually spill the beans.

MegaSporeBiotic has questionable safety and a self-contradictory sales pitch - quite a few negative reviews on Amazon claiming side effects; the description claims that it "recolonizes" the gut with the spores but if that was the case, you wouldn't need to take it every day. So, safety and efficacy is under question.

Have you done testing for food allergies?

 

[Nelson Vergel]

@electrify

Have you taken a vacation recently to a new place ? You may be dopamine depleted and it would be a great idea to find ways to increase it naturally by seeking activities that make you excited about the near future.

You also did not talk about your current living situation, relationship, job, etc.

We men tend to focus on hormones and pills for lack of motivation or excitement.

You may want to read these posts

Pharmacotherapy for Anhedonia

Pharmacological Treatments for Anhedonia (2022) Matthew E. Klein, Ariela Buxbaum Grice, Sahil Sheth, Megan Go, and James W. Murrough Abstract Anhedonia – the reduced ability to experience or respond to pleasure – is an important symptom domain for many psychiatric disorders. It is...

www.excelmale.com

dopamine excelmale.com - Google Search

 

[electrify]

You should eat natural fermented foods like yogurt, if you can, because the strains in them were tested for thousands of years, unlike the ones "discovered" in the last few years based on sketchy "research". If you have to add a probiotic, choose one with many diverse types and strains in it imitating natural fermented foods, not isolated overpriced strains with fantastic claims like Akkermansia and Reuteri. The type of probiotic affects your mood more than you can imagine so you may want to try a different combination. Read the negative reviews before buying - they usually spill the beans.

MegaSporeBiotic has questionable safety and a self-contradictory sales pitch - quite a few negative reviews on Amazon claiming side effects; the description claims that it "recolonizes" the gut with the spores but if that was the case, you wouldn't need to take it every day. So, safety and efficacy is under question.

Have you done testing for food allergies?

I did not know that about MegaSporeBiotic. Haven't noticed anything negative myself though. It was just recommended by my functional doc. Akkermansia I was somewhat low in on my microbiome test which is why I take it, and L.Reuteri is supposed to increase oxytocin which is involved in emotion and also was recommended in the "Super Gut" book for SIBO. I never liked yogurt much but do you know any recommended ones?

Have not tested for food allergies. I sometimes just follow the generic low FODMAP. Although since that can lower diversity I cycle on and off that diet.

 

[electrify]

@electrify

Have you taken a vacation recently to a new place ? You may be dopamine depleted and it would be a great idea to find ways to increase it naturally by seeking activities that make you excited about the near future.

You also did not talk about your current living situation, relationship, job, etc.

We men tend to focus on hormones and pills for lack of motivation or excitement.

You may want to read these posts

Pharmacotherapy for Anhedonia

Pharmacological Treatments for Anhedonia (2022) Matthew E. Klein, Ariela Buxbaum Grice, Sahil Sheth, Megan Go, and James W. Murrough Abstract Anhedonia – the reduced ability to experience or respond to pleasure – is an important symptom domain for many psychiatric disorders. It is...

www.excelmale.com

dopamine excelmale.com - Google Search

No major vacation recently, although I've gone on like 1 road trip. I can't really feel the excitement so I don't think I would enjoy a vacation. Don't have a relationship and I don't think I can even pursue one like this as my social skills as well as sexual function are affected. The emotional blunting kills my social skills so I have not done as much socializing other than sometimes with close friends. Otherwise social interaction feels awkward since im not feeling the usual emotions to be able to engage in the way I used to. I never had social anxiety but I am not able to come up with conversation topics well ever since the blunting.

Currently not working, I was in a PhD program 1 year in but had to quit a few months ago.

I was living on my own until this began overnight after the hangover a month post-covid. I suspect covid completely changed something in me biologically (SIBO being one of the things at least but probably more) that made me react so extreme. Then after a couple weeks when it wasn't getting better (or rather it was but then the caffeine suddenly re-induced it while my brain/body were sensitive) I had to come back home to my hometown/parents place.

It does seem like a dopamine issue though. MIF-1 while I was taking it I was doing better and I actually did do more since I had some more emotion, but too bad it didn't last. Mucuna Prueins L dopa slightly helps too and is more potentiated by the Methylene Blue im trying out.

Last few days since upping Methylene Blue I do feel somewhat better maybe 50% but idk how long it will last. That thread looks really interesting I will check it out.

 

[sammmy]

Any whole-milk plain yogurt that contains only milk and the typical live bacteria cultures will do:

No product found

www.fooducate.com

Do not get "low fat", flavored, types that are thickened with pectin or other artificial ingredients.

 

[bixt]

drinking too much alcohol completely messed me up. I woke up the next day with a nasty hangover that involved anhedonia which alcohol has never done

but then caffeine of all things set me back and crashed me while my CNS was sensitive.

I tried Ketamine treatment but felt more numb for a week so that's not an option unforunately. I also don't react well to stims.

Pregabalin at 200 mg also helped my anhedonia quite a bit and has an afterglow but is not sustainable. And now its started to create rebounds even though I only used it every 3-4 days. I actually suspect this may have crashed me the last time I used it.

I'm currently taking LDN 1.5 mg which slightly helps, and also Methylene Blue 30 mg

Also I tried Allopregnanolone drops and the first time I tried them my symptoms significantly improved for the day

Same with Etifoxine, a nootropic

You sir have a drug problem and need rehab (or at least a 2-month break from any and all substances). These substances may not be coke or meth but they all have the same thing in common as you have correctly identified:

I think my problems are GABA and Dopamine.

Benzos make you feel nice too too? (You mention GABA).

 

[electrify]

I don't see how this is a "drug-problem". I don't abuse anything. This happened after a 1 time use of alcohol a month or so post-covid. In the beginning first month I didn't take anything but I wasn't getting better.

I'm taking stuff therapeutically like LDN and MB. And a course of the peptide MIF-1 Although the effects didn't fully last for the MIF, partially did maybe 10% but it also made LDN work better afterwards it seems. These things are helping me.

I know something is off neurochemically but I can't just sit and wait when I'm dealing with "PSSD/PFS-like" symptoms of blunted/anhedonia/SD. I'm trying to get back to normalcy as fast as possible so I can live my life again. A lot of people with anhedonia in those pssd/pfs communities also try stuff.

Haven't actually tried a benzo, they are too addictive which is why my doc gave me pregabalin to use as needed but I stopped taking it last month once I started getting bad rebounds after although it would help the day of and the day after in the afterglow. The rebounds happened despite only using it every 3-4 days, I think its from a kindling effect.

I'm not sure why I didn't feel good afterwards with Ketamine when I tried it in January. It's really hyped up but I felt more numb that week then got to baseline.

Outside of substances though I also did try regular TMS in Oct/Nov 2022 but it didn't do anything.

 

[Willyt]

I feel for you having myself experienced bouts of flatness over the past several years. The only thing I can say with certainty is that age and excessive T make it worse. It certainly seems related to dopamine, but tough to tell for sure.

Like @sammmy and @bixt have said, you need to cut back on the number of variables to try to isolate what helps and what exacerbates the blunting. You got a lot going on...

 

[electrify]

I feel for you having myself experienced bouts of flatness over the past several years. The only thing I can say with certainty is that age and excessive T make it worse. It certainly seems related to dopamine, but tough to tell for sure.

Like @sammmy and @bixt have said, you need to cut back on the number of variables to try to isolate what helps and what exacerbates the blunting. You got a lot going on...

That's the first I've heard of T making it worse. I myself never experienced anything like this with T. Do you mean to say TRT caused flatness directly, or that some other stuff created flatness and more T made it worse?

I have already been on TRT for years before I ever got this from the alcohol incident post covid. Myself have not noticed any correlation with hormonal levels, been as low as 500 ng/dL and as high as 1000 with no difference in blunting/hedonic tone. It does affect general mood or motivation though a bit.

I don't plan on trying it but I've actually read cases of people (usually PFS/PSSD) doing supraphysiological T which broke through the flatness sometimes temporarily. One of the theories I've seen around is that high E2 helps emotionality. E2 is itself an MAOI and it's interesting that MAOIs seem to be the best anecdotal meds for anhedonia.

 

[t_spacemonkey]

maybe your symptoms are due to the covid you had?
I had a bad long lasting cold lately, and suffer from symptoms similar to yours. overall mood is ok but energy somewhat low and motivation low too.
i would definitely stay away from GABA'ertic drugs, like pregabalin, as the withdrawals are rough. I don't suspect GABA is a problem for you if you sleep fine and have no anxiety.
but dopamine quite likely. you could try the following
nac+glycine at night to boost Glutathione production
acetyl-l-tyrosine+alcar to help with dopamine/brain energy
NMN 2g/daily
and definitely stay away from ssri's and other pharma stuff this will create imbalances where you most likely had none

 

[Willyt]

That's the first I've heard of T making it worse. I myself never experienced anything like this with T. Do you mean to say TRT caused flatness directly, or that some other stuff created flatness and more T made it worse?

I have already been on TRT for years before I ever got this from the alcohol incident post covid. Myself have not noticed any correlation with hormonal levels, been as low as 500 ng/dL and as high as 1000 with no difference in blunting/hedonic tone. It does affect general mood or motivation though a bit.

I don't plan on trying it but I've actually read cases of people (usually PFS/PSSD) doing supraphysiological T which broke through the flatness sometimes temporarily. One of the theories I've seen around is that high E2 helps emotionality. E2 is itself an MAOI and it's interesting that MAOIs seem to be the best anecdotal meds for anhedonia.

Not TRT itself, but excessive amount of T can exacerbate it in my experience. I've read quite a few anecdotes on this forum about guys feeling flat after going supra-physiological. This is certainly what happened to me when I hit top of range or over.

Dose changes (increase OR decrease) can break though the flatness, but as you say that is temporary at best. We explored the idea in thread below.

Using protocol change to spike dopamine?

I have kept a crude TRT journal over the last several years, adding notes every week or so. On occasion, I will review the journal to spot any patterns or conclusions that I can draw with a reasonably high degree of certainty. This is how I often find myself repeating the same mistakes over...

www.excelmale.com

The body and mind love novelty! But that hunt for newness is impossible to keep up over time.

 

[electrify]

Not TRT itself, but excessive amount of T can exacerbate it in my experience. I've read quite a few anecdotes on this forum about guys feeling flat after going supra-physiological. This is certainly what happened to me when I hit top of range or over.

Dose changes (increase OR decrease) can break though the flatness, but as you say that is temporary at best. We explored the idea in thread below.

Using protocol change to spike dopamine?

I have kept a crude TRT journal over the last several years, adding notes every week or so. On occasion, I will review the journal to spot any patterns or conclusions that I can draw with a reasonably high degree of certainty. This is how I often find myself repeating the same mistakes over...

www.excelmale.com

The body and mind love novelty! But that hunt for newness is impossible to keep up over time.

That is really interesting. I wonder what mechanism leads to that. I always had a feeling keeping things too stable isn't great.

I see that low dose Selegiline an MAOI is also mentioned in that thread which is something I was considering to get me out of this episode as well. But right now 30 mg MB + 1.5 mg LDN are having benefits so im sticking to those. But Selegiline only inhibits MAO-B at low doses whereas I think MB inhibits MAO-A which I also think the latter is more needed.

maybe your symptoms are due to the covid you had?
I had a bad long lasting cold lately, and suffer from symptoms similar to yours. overall mood is ok but energy somewhat low and motivation low too.
i would definitely stay away from GABA'ertic drugs, like pregabalin, as the withdrawals are rough. I don't suspect GABA is a problem for you if you sleep fine and have no anxiety.
but dopamine quite likely. you could try the following
nac+glycine at night to boost Glutathione production
acetyl-l-tyrosine+alcar to help with dopamine/brain energy
NMN 2g/daily
and definitely stay away from ssri's and other pharma stuff this will create imbalances where you most likely had none

They might be yea. I've seen some other reports of people having bad reactions to stuff post-covid. I dug out some 23andme gene results recently from years ago and it turns out both my MAO-A and MAO-B activity is high, and COMT high too so there is a good chance my dopamine is easily lowered or hard to recover.

I mentioned GABA because even though anxiety isn't an issue, stuff like Chamomile tea (has Apigenin which is GABAergic) very slightly helps too. And my initial response to Allopreg or Etifoxine. They are actually coming up with Zuranolone an allopreg analog soon for MDD, so I suspect the GABA system is involved in more than just anxiety/sleep. I hope it gets approved, we find out in about 2 weeks

 

[Abonicex]

I'm in a similar situation.

Worst thing that has probably happened me in my life.

To me the answer is the destruction of my testicles that provoked me low t

I do not know what to do.

I've tried so many things.

 

[electrify]

Been a while since I updated here. Its been very up and down for me in general. Windows and crashes from various things.

Helpful still are GABAergics. I am on Gabapentin 600 mg which helps my anhedonia, and Armodafinil 75 mg. These are just bandaids. Same with cycling MIF-1 monthly. Ipamorelin has a positive effect slightly as well, probably from NPY GABAergic activity and ghrelin stimulating motility/gastric emptying.

I had a horrific reaction to Betaine HCL, just 1 pill created insane overmethylation issues that crashed me and required NAD+ IVs to demethylate. NAD IVs are actually really helpful for my anhedonia, they also make other things work better. They are a temporary lift. NAD+ is also a demethylator.

Ever since the Betaine HCL, I stopped reacting to LDN as well and had a horrid endorphin blockage crash, with such bad consummatory anhedonia that I even was considering ECT. Rifaximin which pulled me out of crashes before I reacted badly to as well, probably from overuse.

My microbiome is completely shot:

Anyways guess what saved me fucking miraculously? A clinic I went to ran a ton of blood tests and I had a whopping 28 vials of blood drawn. The most ever. And after that, I felt lightheaded, dizzy but and as I walked back. to my car it was like a light switch- endorphins magically turned on again. It was insane. I experienced like a big big window for a few weeks before it regressed again although i was still better than before.


This clinic deals with neuroimmune issues. My bloodwork showed very high IgE (5x the range), low IgM as well. They think I may have reactivated viruses too like HHV6, myco plasma pneu, etc tho for EBV/CMV i was negative. ANyways, one of their treatments they offered was plasmapheresis.

After the 2nd session, I experienced well being, more emotion and finally my sexual function also was starting to come back. Arousal, pre cum again! Was still blunted but it was more manageable. I felt nostalgia, sadness again too like grief about all the time lost. This lasted a week though and then regressed until 3rd session it lasted a few days. But all medications work better-Gabapentin is stronger, Armoda is stronger. My ferritin got depleted to 29 which was an issue so I needed 2 Iron IVs to replete it and that helped. And I am better than before the plasmapheresis.

But now I am coming closer to a potential solution. Some PSSD/PFS people also have experienced windows with plasmapheresis. And my symptoms are similar although not from the same substance. It seems like this is some sort of gut-brain-immune axis perturbation.

Next up I am going to do FMT. There is a PSSD case that recently has nearly recovered from FMT+plasmapheresis. I did it in the reverse order but I think because my gut is totally messed up, a lot of sensitivities to subtances got created and also some things that do help don't fully last. Once I address the gut I hope then the things I do will help.

Recovering the gut naturally is basically extremely hard with how bad mine is. And with all the ridiculous sensitivties leading to crashes I get are probably related. So FMT it is. I found a good clinic that can do it.

Will update how that goes. But its been quite an insane ride phew. Its clear that psychiatric medication or nootropic bandaids are not going to fix my problems, and in 2024 im basically trying completely different approaches.