Taarn Intro - PSSD story and proposed recovery plan

[taarn]

This topic is about my planned PSSD recovery regimen but I haven't written an introduction yet so it also serves as an introduction.
I was suffering from depression and anxiety for at least 5 years since I was 22-23. (now I'm 28) My first encounter with sexual dysfunction was when I took isotretinoin (better known as Accutane) for acne which wasn't that severe that I needed it. It made me have less sensitivity and blunted orgasms. Thankfully I quit after a few months and my sexual function mostly recovered but I think isotretinoin was the thing that really kickstarted my aforementioned depression.
Almost a year and half ago I started taking drugs, mostly MDMA, sometimes Amphetamine or occasional weed but I never liked that. These helped with my depression and anhedonia, amphetamine was very helpful for work and studying. The problem was that my sexual function started to deteroriate and my anxiety started getting out of control, I also started to use benzos and zolpidem for sleep more and more frequently. That's why last summer I went to a psychiatrist first time in my life, he prescribed my Escitalopram but later I refused to take fearing of sexual side effects so it and landed in my trash bin. I took some blood tests and I had elevated estradiol and especially prolaction. I got bromocriptine and cabergoline for that and my sexual function has improved but I still had severe anxiety and sleep issues that's why I went to another psychiatrist who prescribed me Mirtazapine. I accepted to take it because after some reading it didn't seem to dangerous. I took only 5 pills but while taking it I felt totally dissociated from the world and it totally turned off my emotions, positives and negatives as well. At least it also totally erased my anxiety. I felt like I'm in a bubble it was really odd, I was afraid I'll stay that way so I stopped after the 5th pill, it was at the beginning of last december.
MDMA and weed almost always worsened my sexual function a lot, numb genitals, low libido, worse erections. But this has always gradually improved after I take those.

Now after taking Mirtazapine the case is different. A little more than 3 months has passed since I took it and except a prominent 3 day window in January and 1-2 days partial improvement in February I have basically zero sexual function. Low to no libido, no sexual thoughts, somewhat numbed and totally pleasureless genital area and orgasms which have improved from 0% to ~1-3% of my old baseline. The dissociation and anhedonia mostly disappeared, emotionally I'm acceptable. I took CDP-Choline, ALCAR, and BPC-157 which helped a lot with anhedonia and the constant brain fog which I got from Mirtazapine. Brain fog mostly disappeared thanks to them. I'm also taking vitamins and minerals, working out and trying to live a healthy lifestyle excluding the events when I get a bit more drunk than I should.
I've also got Wellbutrin prescribed and it seemed to help but after the last pills of Mirtazapine it didn't seem to work, maybe taking it in the long term could be possibly helpful.

I've spent countless hours and read tons of material since I started experiencing sexual problems, it was easy cause I'm also interested in that kind of stuff. So with my knowledge to date I came up with the following to do something about my PSSD:
1) I will optimize all my hormone levels. For some unknown reason I still have very low DHT although I have good testo. Seems like decreased 5-ar activity.
2) I think I'll need some kind of antiserotonergic agent to counteract malfunctioning serotonergic neurotransmission. I've already ordered Metergoline and also thinking about Cyproheptadine, mayble it will help with my sleep (now I'm taking agomelatine occasionally or I drink some wine)
I ordered WAY-100635, cause it's the best 5-ht1a antagonist out there and after some reading it looks like it can help to resensitize or restore 5-HT1A function. I already have Fenclonine which is able to deplete serotonin, that can be helpful but I'm still in a debate using it and about it's usefulness.
3) I always had windows after taking some kind of dopaminergic drug so I seem to react to them well. Because of this and because why I think that my PSSD symptoms at least in part are because of decreased/malfunctioing dopaminergic neurotransmission in subcortical brain areas related to reward and pleasure I will try to take some kind of dopaminergic agent. Maybe metergoline will be enough or possibly I'll add Amantidine, maybe Pramipexole or Rasagilne.
4) I don't want to cause DA receptor downregulation/desensitization so I'll try to cycle dopaminergics. I'm thiking on Memantine and I'll also take Forskolin which was show to upregulate some DA receptors. I have some Naltrexone so I'm also thining using that to improve dopaminergic activity through the opiate system. Bromantane is also an option.
3) Sarcosine + NAC to increase NMDA activity and to upregulate tyrosine hydroxylase. I'm in a debate because I don't know if I have overactive or underactive NMDA/glutamatergic system.
4) Cholinergics seemed to help a lot with brain fog. After some reading it seems they can help with sexual issues as well so I will try Donezepil or Galantamine.
5) Black Maca seems to be pro sexual so I'll take that as well.

I'm looking for your thoughts and ideas about this regimen and about PSSD recovery in general!

EDIT: I consider this recovery plan a bit outdated now.

[AdvencedResearchPL]

the best I can see here is WAY-100635. I used masteron, clomifen, tamoxifen,exemestan to open the HPA axis. This is a wrong way. Pramipexole or Rasagilne can help you if you are responsive. Bromantane and naltrexon are also a bad path. Generally, I would not take as many drugs at one time. Try WAY-100635 one at a time. And then if you want to mix others, I'd prefer to test up to two or three drugs at a time(
for example, a strong drug and a weak supplement). Of course, everything depends on you.

[taarn]

the best I can see here is WAY-100635. I used masteron, clomifen, tamoxifen,exemestan to open the HPA axis. This is a wrong way. Pramipexole or Rasagilne can help you if you are responsive. Bromantane and naltrexon are also a bad path. Generally, I would not take as many drugs at one time. Try WAY-100635 one at a time. And then if you want to mix others, I'd prefer to test up to two or three drugs at a time(
for example, a strong drug and a weak supplement). Of course, everything depends on you.

Using medications on your HPA axis without a concrete reason is not any good sure. But I had hormonal imbalance that had to be fixed. I still can't get over my very low DHT blood levels, especially because my testosterone is normal - high.

To be clear I don't want to take all these meds I listed at the same time or I'll have a liver failure or something lol. But different issues behind PSSD should be handled concurrently.

So it makes sense to take something anti-serotonergic while I'm blocking my 5-HT1A, the eventual more serotonin at 5-HT2 receptors wouldn't help I guess.
And something that stimulates DA receptors could possibly help to kickstart my libido initially. And having the optimal hormonal environment will help to positively modulate sexuality related neurotransmission.

[voyteck]

@taarn If you try WAY-100635, please let us know the effects.

[taarn]

Sure, I will share my experiences. I will start a new log thread soon.

[taarn]

So I'm typing the info in the format suggested by @Mesolimbo. A good idea to "standardize" this, I hope we'll be able to discover some patterns.

1- What is your gender?
Male

2- Why did you take antidepressants in the first place? and for how long were you on them? which med?
I took mirtazapine mainly for severe sleep issues (sleep PTSD), I could have tolerated the others without an AD. I had issues with anxiety and mild OCD and I also had episodes of depression. I took only 6-7 pills of 15mg.
I also have to add that I had a previous yearr of drug abuse, some weed, some amphetamine, mainly MDMA (somewhere between 10-20 pills), that caused me to have sexual issues like lower libido, occasional genital numbness but I always recovered. Sexual function became noticeably worse after started supplementing with 5-HTP so I stopped with it.

3- How was your sexual and emotional function before antidepressant intake?
Hypersexual, very emotional but tried to show to opposite to the public.

4- What are your symptoms exactly and when did they start? sexual dyfunction alone, or cognitive/emotional/hedonistic as well? which symptom is bothering you the most?
Full-blown PSSD started with the beginning of december 2018. Basically with the first 1-2 pills. While I was taking mirtazapine I felt totally dissociated/derealized, reality lost colors and felt more like a dream. I couldn't feel anxiety, basically all of my feelings were turned off. I felt like I was in a bubble and nothing really can interact with me. When looking in the mirror I had the weird feeling that I'm looking at life from some other person's view.
After I stopped taking it the derealization part mostly disappeard but anhedonia and emotional blunting remained. It had the most prominent effects on my sexual function which basically got killed. I also had constant brain fog and some cognitive issues and fatigue.
As I pointed out in some other threads fortunately I was able to get rid of cognitive issues, and mostly from anhedonia and emotional blunting.

Now I have total lack of pleasure in genital area, and pleasureless orgasms, like it went offline. Still able to feel pressure and pain. Basically no libido, close to being asexual but I still find girls beautiful and close interactions can elicit some 'mental arousal' and even erections, although those are 'lifeless', feel weird and missing pleasure. The subconscious part of libido and the physical urge like random erections and tingling/feeling/warmness in genital area is totally missing.
I have strong night-time erections and most of the time morning erections, they are missing pleasure. I also lost some degree of control over my pelvic muscles, that whole area feels weird, like my penis was detached from my brain.

Only good thing is that my sleep-PTSD just vanished. In the beginning I couldn't feel anxiety and OCD disappeared totally, now these are slowly crawling back. I take occasional clonazepam/zolpidem.

My current state:
Genital sensitivity/pleasure: 0%
Orgasms: 0-5%
Libido: 0-10%
Anhedonia: 80%
Blunted affect/emotions: 80%
Cognition: 100%

5- What meds/suppplements have you tried so far?
I've tried many supplements and even meds, chemicals. Most of them didn't have any effect on my symptoms so I only list those that I remember had some impact.

BPC-157: Very beneficial. Completely got rid of my brain fog, helped a lot with tiredness and also helped with emotions and anhedonia.
Ipamorelin + Mod-GRF (1-29): I've done some blood tests and my GH was surprisingly low. I read good things about Ipamorelin's effect on sleep so I tried. Helped a lot with sleep and got rid of my remaining tiredness.
CDP-Choline: Helped with brain fog and anhedonia.
Forskolin: Feels like it gives me more energy. (taking this to upregulate DA receptors and enhance SERT)
NAC 600mg / night: Probably helped with the anxiety that is slowly crawling back but I'm not sure. (I was taking this to upregulate tyrosine hydroxylase but I'm afraid of the glutamate transporter upregulation)
Sarcosine: I think it helped with anhedonia.
L-glycine: It caused me tiredness and very bad anhedonia.
Cistanche tubulosa: Probably increased T a bit, I'm still waiting for the new DHT results.
Grape seed extract: I don't know but it's a good antioxidant.
Inositol (1-2g daily): Not sure, probably it helped with sleep but it also felt like it made sexual symptoms even worse so I stopped taking it. Interestingly my most prominent window happened after I took it for 2 weeks before that night I drank some wine and took 1.25mg Bromocriptine.
Wellbutrin (Bupropion): Initially caused increased libido and some return of pleasure but stopped working after a few days. Gave me good energy and made me a bit more nervous, and also made me more emotional - this is somewhat similar to how I was pre-PSSD. Retained emotional improvements after stopped with it.
Agomelatine: Good for sleep but makes me groggy the next day.
Dopamine agonists: When pre-PSSD I took them to lower prolactin they restored my dimnished libido and also increased genital sensitivity and pleasure. After getting PSSD these seem to be useless when used alone. More interesting is that if combined with alcohol, the next day there is some chance for sexual improvements which are short-lived.
Naltrexone: LDN caused minor grogginess and mild anhedonia the next day. But I felt better overall after the course of LDN. I'm taking 25mg for 2 days now, no grogginess but causes very bad anhedonia and somewhat blunted emotions.
Exemestane and tamoxifen: They worked like they should on hormones but no effect on sexuality.
Proviron (mesterolone): I took 50mg /day for 2 weeks and a few days. Probably I had some increase in libido and definitely some healthy agressiveness, but only in the end of that period - overall I felt better but no improvements on lack of pleasure, and libido increase was only mental.
Low dose amphetamine: Helped a lot with anhedonia and emotions, but elevated anxiety and caused me to act more compulsively.

I'm on the ketogenic and trying to eat healthy. Working out 4-5 days a week. Also taking minerals and vitamins.

6- Do you have access to meds without prescription (buy online), or would strictly require a prescription for meds to try?
Yes I can get most of them online, but I can also get prescriptions.

7- Can you tolerate galicky foods? what about proteins?
No problem at all.

8- Have you done any blood testing? what were the results?
I've done many extensive blood tests. I tested hormones and levels of different minerals.
Everything came back normal except the following:

-High estradiol (which is now managed with exemestane)
-Low DHT (below range)
-T was ~700 before PSSD, now it's around 500 so it has lowered since getting PSSD
-Before mirtazapine when I abused MDMA I had high prolactin issues, but DA agonists helped. Now prolactin is normal without taking anything
-Zinc was well above range, but I managed to make it lower
-Cortisol was on the high end before PSSD: now it's low-normal.
-ACTH is now on the low end, don't know about pre-PSSD

[taarn]

I almost forgot to add that now I lack any feeling of hunger and craving for food. Anyone else with this symptom?

[voyteck]

Me! Sometimes it's due to stomach pains, bloating, constipation etc. But even when those are that severe, I rarely feel real hunger (maybe one meal per 2 days lately).
I am eating only because I know I should and I know I don't want to look even worse (already underweight for 1 year). Unfortunately I cannot eat enough kCal even when try (and drink special drinks).
I had cravings for foods a few months ago (sugary and salty one after another) but they were rare and are completely gone.

[taarn]

Me! Sometimes it's due to stomach pains, bloating, constipation etc. But even when those are that severe, I rarely feel real hunger (maybe one meal per 2 days lately).
I am eating only because I know I should and I know I don't want to look even worse (already underweight for 1 year). Unfortunately I cannot eat enough kCal even when try (and drink special drinks).
I had cravings for foods a few months ago (sugary and salty one after another) but they were rare and are completely gone.

That would happen to me as well, but I force down food.. it can be really tiresome.

[Meso]

Taarn, Mirtazapine is a partial kappa receptor agonist, which is responsible for the dissociation/derealization and the dysphoria it can induce in some people. It's common.

Do you experience inflammation? i.e. joint inflammation or muscle pain that's not exercise related?