Ghost: regarding PSSD subtypes

This is for hypothesis and even educated speculation.
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Meso
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Ghost: regarding PSSD subtypes

Unread post by Meso »

Note: This post is merely to help people report me their symptoms quicker. This is not a scientific post, and shouldn't be regarded as such. Take these subtypes with a grain of salt.

Subtypes:

1- Pure PSSD: Pure sexual dysfunction without other symptoms. Symptoms include ED, premature ejaculation or delayed orgasm, genital numbness, etc. These are manifestations of nitric oxide pathway dysfunction, TRPC and TRPV channel dysfunction, sex hormone dysregulation and sex hormone receptor insensitivity, with a possible thyroid involvement.

2- Cognitive PSSD: Sexual symptoms + cognitive dysfunction, but without anhedonia or blunted affect. In this subtype, there's a clear cortical dysfunction (cholinergic and/or glutamatergic, and DA/NErgic) leading to brain fog, reduced intelligence, poor memory, and poor concentration.

3- Excito-inhibitory PSSD: Sexual symptoms + cognitive symptoms + either intense anxiety/obsessions or complete loss of the anxiety response. Either severe insomnia or excessive daytime sleepiness. Symptoms don't include anhedonia and blunted affect, or any mesolimbic-cortical pathway dysfunction. This subtype is due to GABA-glutamate dysregulation. Low glutamate PLUS either low GABA (insomnia, anxiety, OCD, panic, paranoia etc) or high GABA (excessive drowsiness, complete loss of anxiety). This type is related to dysfunction of neurosteroids and allopregnanolone, as well as changes of expression of 3α-HSD and 3b-HSD enzymes and blunting of the HPA axis (GR upregulation).

4- Mesolimbic PSSD: Sexual symptoms + GABA-glutamate dysfunction + mesolimbic pathway dysfunction but without cognitive dysfunction. This subtype most likely involves presynaptic 5HT1A supersensitivity or postsynaptic 5HT1A receptors desensitization, or both, plus phasic (not tonic only) dopamine release dysfunction, and reduced oxytocin and beta endorphin release.

5- Complex PSSD: Sexual symptoms + cognitive symptoms + GABA-glutamate dysfunction + mesolimbic-cortical pathway dysfunction. All previous symptoms PLUS severe anhedonia and blunted/flattened affect. There's a clear central dysfunction involving multiple brain areas, with autonomic nervous system dysfunction on top. This severe subtype most likely involves presynaptic 5HT1A supersensitivity or postsynaptic 5HT1A receptors desensitization, or both. Along with all the previous dysfunctions. There's a cholinergic, dopaminergic, DA/NErgic, GABAeric, glutamatergic, and serotonergic involvement + sex hormone and NO pathway dysfunction on top.
Last edited by Meso on Thu May 16, 2019 1:47 pm, edited 5 times in total.
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Timm Thaler
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Re: Ghost: regarding PSSD subtypes

Unread post by Timm Thaler »

Could there be a 5th subtype?

I have:
- sexual dysfunction
- severe anhedonia and blunted/flattened affect
- loss of anxiety response

- NO!!! cognitive symptoms
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Meso
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Re: Ghost: regarding PSSD subtypes

Unread post by Meso »

Timm Thaler wrote:Could there be a 5th subtype?

I have:
- sexual dysfunction
- severe anhedonia and blunted/flattened affect
- loss of anxiety response

- NO!!! cognitive symptoms
Yeah, no cholinergic involvement but with mesolimbic involvement. We should name this type "Mesolimbic PSSD". I'll add it to OP.
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Re: Ghost: regarding PSSD subtypes

Unread post by naiverat »

Unsure if I'm suffering from pure PSSD or Mesolimbic PSSD. On my page, I've posted my symptoms more clearly and what treatments have given the best windows, if that's any clue. It would be great if you could review that and potentially help me develop a plan to treat this from multiple angles! Thanks.
Fluoxetine Jan. '16 - Aug. 16'. Low libido, weak erections, CNS dysfunction, anhedonia

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Luigi
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Re: Ghost: regarding PSSD subtypes

Unread post by Luigi »

Oh dear, in my case it seems to be complex PSSD, which really doesn’t fill me with confidence already being in a bad place.
Imtrying34
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Re: Ghost: regarding PSSD subtypes

Unread post by Imtrying34 »

Y issues see. To be numbness ahhedonia cognition etc going to try parnate or somethingi deal with all the sptpma not sure where to start o miss orgasms
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Re: Ghost: regarding PSSD subtypes

Unread post by Ghost »

I really like this.

Some things I'd like to work in at some point:

Role of gut health in different PSSD sub-types
Role of pelvic floor in PSSD (several subtypes)
Role of depression or depressive anhedonia - chicken or egg here, sometimes hard to say if Anhedonia started PSSD symptoms or PSSD started anhedonia symptoms.

Maybe you could shed a little light on which types would likely be from short or long-term use.

For me there are a lot of things going on a once - depression for a while, OCD, anxiety, fatigue, I had more brain fog at the beginning, but now it's a lot better. Depersonalization and derealization at the beginning too - but it's hard to say what level of these were due to mental illness. But in this categorization we'd probably call me "Pure PSSD" - My sexuality has been the most impacted thing, but it's not the full story. I seem to have lost the feeling of total relaxation and feeling fresh each morning. For a while I think my sleep was really fucked up too. I'll have to dig through my logs at some point.

Meso you might find the success stories section of my site to be helpful in parsing out presenting symptoms and what eventually led to recovery.

https://pssdlab.wordpress.com/success-stories/

once we work this out more I'd love to start categorizing this like you would any other broad condition with a diagnostic code for each type. Ex: PSSD1 v PSSD2 etc etc.

Will be even better if/when we get some treatment ideas for each type and give some info on recovery expectations for each.
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Re: Ghost: regarding PSSD subtypes

Unread post by PittieLady »

Which was I? Mesolimbic?
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Meso
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Re: Ghost: regarding PSSD subtypes

Unread post by Meso »

Ghost wrote:I really like this.

Some things I'd like to work in at some point:

Role of gut health in different PSSD sub-types
Role of pelvic floor in PSSD (several subtypes)
Role of depression or depressive anhedonia - chicken or egg here, sometimes hard to say if Anhedonia started PSSD symptoms or PSSD started anhedonia symptoms.

Maybe you could shed a little light on which types would likely be from short or long-term use.

For me there are a lot of things going on a once - depression for a while, OCD, anxiety, fatigue, I had more brain fog at the beginning, but now it's a lot better. Depersonalization and derealization at the beginning too - but it's hard to say what level of these were due to mental illness. But in this categorization we'd probably call me "Pure PSSD" - My sexuality has been the most impacted thing, but it's not the full story. I seem to have lost the feeling of total relaxation and feeling fresh each morning. For a while I think my sleep was really fucked up too. I'll have to dig through my logs at some point.

Meso you might find the success stories section of my site to be helpful in parsing out presenting symptoms and what eventually led to recovery.

https://pssdlab.wordpress.com/success-stories/

once we work this out more I'd love to start categorizing this like you would any other broad condition with a diagnostic code for each type. Ex: PSSD1 v PSSD2 etc etc.

Will be even better if/when we get some treatment ideas for each type and give some info on recovery expectations for each.
All good points. It's work-in-progress, but those are my initial findings. I'd like you to contribute, too.

One cannot put themselves in a category if there are gradual improvements over time with no intervention. Those categories I've written are the "final state" that don't change. Also, one can progress from a subtype to a more severe subtype after trying a drug and getting permanently worse.

Your PSSD is of the pure type, with moderate GABA-glutamate imbalance that was probably present pre-PSSD and was just exacerbated after PSSD. So, there's a gray area where you fit, type 1 with elements of type 3 due to pre-PSSD neurochemistry.
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Gth27
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Re: Ghost: regarding PSSD subtypes

Unread post by Gth27 »

I seem to have complex pssd with severe memory problems,no emotions and no sense off time at all.
My other symptoms are visual snow,after images,floaters,no libido,ED,extreme fatigue,sounds hurts
and a lot off other symptoms.
The anhedonia and blank mind are the worse. And the fact that nobody believes me.
Im about to lose everything. Mirtazapine caused this. When I was on it I never experienced sexual side effects. Only in withdrawal and every week its getting worse.
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