Ability to experience any pleasure / anhedonia / ejaculatory anhedonia / PSSD / Post-Antipsychotic / Post-Abilify

[mtkhalid]

I have a few questions in this post. Before I begin, I wanted to mention this:

I have enduring sexual dysfunction symptoms (loss of libido, sexual anhedonia, genital anesthesia, erectyle dysfunction) thanks to Abilify 15 mg. Abilify is an antipsychotic, not an SSRI drug.

I know I have the same PSSD symptoms for sexual dysfunction as with someone who had taken an SSRI drug, but I had taken Abilify, an antipsychotic. (So I'm not even sure if I have classic PSSD, or simply enduring sexual dysfunction thanks to an antipsychotic drug).

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*Unable to ever experience pleasure in anything?*

I know that I suffer from ejaculatory anhedonia (sexual anhedonia); I can't experience any pleasure after orgasm or ejaculation.

I just wanted to know: Does this mean that I can no longer experience any form of pleasure, in anything, ranging from exercise to general life enjoyment?

Has Abilify 15 mg essentially caused a permanent, global, general anhedonia, in addition to causing ejaculatory anhedonia?

I'm not sure if you would consider my situation to be PSSD or Post-Antipsychotic (Post-Abilify) syndrome, but do folks with PSSD also, and always, experience permanent, general, global anhedonia, in addition to sexual (ejaculatory) anhedonia?

I'm hoping this is not the case, as it would be sheer cruelty to never experience pleasure in anything again.

In addition, has Abilify / PSSD permanently impacted or damaged the brain's reward/pleasure/dopamine system? Damaged/impacted the brain's pleasure centre?

I keep talking to psychiatrists, and they keep telling me these drugs (ie antipsychotics, etc) don't cause any permanent damage; then why are we seeing permanent symptoms associated with PSSD?

Lastly, with regards to exercise, I find that I don't achieve any pleasure from exercise anymore. I think this is likely because I'm not exerting enough effort in exercise, as you have to exercise moderately intensely enough to experience the endorphin rush.

Which brings me to another question.

I know Abilify impacts dopamine levels, but has Abilify permanently impacted my endorphins levels as well, and impacted the brain's ability to release endorphins after physical activity and exercise?

Can PSSD impact endorphins levels as well?

I just want to end this off by saying that I hope this is not the case. Sexual anhedonia is something I can live with; but anhedonia in anything is something I can't live with. To have your exercise levels be impacted by a blockage of endorphins would also be sheer cruelty.

Lastly, as I mentioned, my case is not classic PSSD as I wasn't taking an SSRI. All of my sexual dysfunction effects are the same as those with PSSD, except they were caused by an antipsychotic Abilify. So since I don't have classic PSSD, but rather, a variant, I'm not sure whether I'm doomed to experience permanent anhedonia as well, or a permanent blocking / damage of my pleasure centre or endorphins release system.

Thanks!

Lastly, as I'll mention in another post, I consulted with Dr. Irwin Goldstein of San Diego Sexual Medicine, and he prescribed some treatment (some drugs) for the treatment of ejaculatory anhedonia. If his treatment were to work, and resolve / cure sexual anhedonia, is it possible it could cure my general, global anhedonia, if in fact I'm suffering from global anhedonia?

[anacleta]

Do you suffer from alexithymia? Do you not understand your own emotions?
why do you ask if abilify has taken away all your pleasures instead of seeing it from your feelings?
I have pssd from citalopram but have been taking abilify for many years, I have pssd with sexual symptoms, but I have my emotions and can feel pleasure, enthusiasm and passion in other things. I realise this without anyone having suggested it to me

[mtkhalid]

anacieta - I'm just wondering whether having ejaculatory anhedonia means that I'm 100% necessarily doomed to general, global, anhedonia. I have definitely been able to feel my emotions, even after discontinuing Abilify, and they were very strong emotions (sorrow, sadness, despair, anger, joy, happiness, mild giddiness).

In addition, I have been able to connect with music, and experience music in a wholesome way, even after Abilify. I was able to drown myself in the music, and be absorbed by it, and be emotionally connected to the sadness/sorrow in the music, and the pop, etc. So I have been able to experience music.

I was just really scared that I've lost the ability to experience pleasure in exercise and physical activity as well (ie has Abilify impacted endorphins release as well, long-term).

Thanks for giving me hope! It's nice to see that you were only struck by sexual symptoms, and were able to experience pleasure in other things.

[Meso]

anacieta - I'm just wondering whether having ejaculatory anhedonia means that I'm 100% necessarily doomed to general, global, anhedonia. I have definitely been able to feel my emotions, even after discontinuing Abilify, and they were very strong emotions (sorrow, sadness, despair, anger, joy, happiness, mild giddiness).

In addition, I have been able to connect with music, and experience music in a wholesome way, even after Abilify. I was able to drown myself in the music, and be absorbed by it, and be emotionally connected to the sadness/sorrow in the music, and the pop, etc. So I have been able to experience music.

I was just really scared that I've lost the ability to experience pleasure in exercise and physical activity as well (ie has Abilify impacted endorphins release as well, long-term).

Thanks for giving me hope! It's nice to see that you were only struck by sexual symptoms, and were able to experience pleasure in other things.

You never mentioned how long ago did you stop taking Aripiprazole. How long were you on it before quitting the med?

Sexual anhedonia has different neural pathways than general anhedonia. For instance, libido and orgasms require and arise from the hypothalamus before the signal travels to the mesolimbic system and finally ends at the nucleus accumbens. While experiencing emotions require the prefrontal cortex, etc.

So, yes, you can have sexual anhedonia without ever having generalized anhedonia. As for the loss of pleasure from exercising, it could simply be high serotonin from post-Aripiprazole.

[mtkhalid]

Meso - I was on Abilify from roughly March/April 2014, to roughly December 2015. Here's the timeline:

> March/April 2014: Initially started at a low (5 mg?) dose
> Dose increased to 15 mg, sometime, around June-ish 2014 (best estimate)
> Taken off 15 mg, a month or two later
> On 10 mg of Abilify from roughly September 2014 to December 2015
> Stopped Abilify completely - Dec 2015 to January 2016

From December 2015 to present (Feb 2021), it's been 5+ years since I've been off Abilify

[mtkhalid]

A followup to this:

Is general anhedonia a defining trait of PSSD? I thought the defining trait of PSSD was just the sexual dysfunction symptoms. Or, is it more that the anhedonia just happens to occur along with PSSD?

If anhedonia is a defining trait of PSSD, how does that make sense? Aren't SSRI antidepressants used to treat Anhedonia in depression?

As well, I read about HT1A receptors, and Berberine, which can re-sensitize those HT1A receptors. Is Anhedonia related to those HT1A receptors? Does PSSD Permanently desensitize them? A Quora post recommended Berberine for anhedonia.

Lastly, is my case even considered classic PSSD? I have all of the sexual dysfunction symptoms of PSSD, but my issues were caused by the antipsychotic Abilify, not an SSRI. Does that mean I simply have enduring sexual dysfunction, as opposed to full-blown-PSSD? No doctor has officially diagnosed me with PSSD, but Dr. Irwin Goldstein (San Diego Sexual Medicine) gave a "pseudo-PSSD" diagnosis (ie not confirmed) based on the sexual dysfunction symptoms.

[Meso]

A followup to this:

Is general anhedonia a defining trait of PSSD? I thought the defining trait of PSSD was just the sexual dysfunction symptoms. Or, is it more that the anhedonia just happens to occur along with PSSD?

Mild PSSD has sexual dysfunction (only) as the defining trait. As PSSD gets more severe, there is generalized anhedonia, apathy, and blunted affect as well as depression.

If anhedonia is a defining trait of PSSD, how does that make sense? Aren't SSRI antidepressants used to treat Anhedonia in depression?

Because we are not reacting normally to SSRI. We are not normal people; we most likely have genetic vulnerability that made us get PSSD while millions of people take SSRIs without ever getting PSSD.

As well, I read about HT1A receptors, and Berberine, which can re-sensitize those HT1A receptors. Is Anhedonia related to those HT1A receptors? Does PSSD Permanently desensitize them? A Quora post recommended Berberine for anhedonia.

Yes, excessive desensitization of those autoreceptors can leads to excessive serotonin flooding the brain, leading to suppressed dopamine and other NTs. In PSSD, there is scholarly evidence that SSRIs downregulate SERT expression and this can lead to flooding of the brain with serotonin as well.

Lastly, is my case even considered classic PSSD? I have all of the sexual dysfunction symptoms of PSSD, but my issues were caused by the antipsychotic Abilify, not an SSRI. Does that mean I simply have enduring sexual dysfunction, as opposed to full-blown-PSSD? No doctor has officially diagnosed me with PSSD, but Dr. Irwin Goldstein (San Diego Sexual Medicine) gave a "pseudo-PSSD" diagnosis (ie not confirmed) based on the sexual dysfunction symptoms.

No, your case is not PSSD. It's post-antipsychotic syndrome and it's not the first time I've seen such a reaction. Aripiprazole desensitizes 5HT1A receptors, so maybe this happened in your case? Berberine and Evodiamine upregulate SERT expression.

[mtkhalid]

Thank you Meso! So can Berberine help me with my situation (post-Antipsychotic syndrome)?

I find it strange though, that the sexual dysfunction symptoms I have with post-antipsychotic-syndrome are 100% identical to the sexual dysfunction symptoms in PSSD (namely, loss of libido, ejaculatory anhedonia, genital anesthesia, erectyle dysfunction). Thoughts?

[mtkhalid]

Hi Meso -

So I'm suffering from Post-Antipsychotic Syndrome, and not PSSD?

The sexual dysfunction symptoms I have with post-antipsychotic-syndrome are 100% identical to the sexual dysfunction symptoms in PSSD (namely, loss of libido, ejaculatory anhedonia, genital anesthesia, erectyle dysfunction).

Do I have to worry about anything else (ie general anhedonia) with Post-Antipsychotic Syndrome? Or do I only have to worry exclusively about the sexual dysfunction problems with Post-Antipsychotic Syndrome?

[Meso]

I know I have the same PSSD symptoms for sexual dysfunction as with someone who had taken an SSRI drug, but I had taken Abilify, an antipsychotic. (So I'm not even sure if I have classic PSSD, or simply enduring sexual dysfunction thanks to an antipsychotic drug).

By definition, you are not suffering from PSSD.