PSSD like experiance (PAPSD?) and FND.

[6-Eggs!]

Hi All,

New here but figured I would share my very unique experience regarding PSSD and FND symptoms from ceasing a new type of anti-psychotic.

It's a long story staring about 2014 when I suddenly became very weak, fatigued and shortly after developed severe sexual dysfunction out of the blue. I was not taking anything at the time but though it was a relapse of my original Hypopituitarism where I was not making any testosterone from about 6 years prior to that.

I was unable to ejaculate (no volume) and had no sex drive and nearly impossible to get erections.

I saw my endocrinologist from years back again and had a full screening and everything was normal. I was very distressed and fatigued all the time and was eventually diagnosed with depression and chronic fatigue (not the classical CFS though, more 2ndary to the depression). I was unable to get out of bed for days at a time and slept 13+ hours without being able to wake up in the morning.
I was given some type of SSRI that I can't recall and it made me sick as a dog, euphoric, weird memory loss (lost all my card pins and passwords permanently) but had normal working and long term memory. Visual trails. Didn't help me sexually or feel better, just severe side effects.

This sort of thing went on for about 2 years of trialing 20 different types of SSRIs and SNRIs but all made me very unwell and nothing helped me sexually. Fed up at this point and my doctors agreed I was intolerant of SSRIs and SNRIs and anything that targeted serotonin selectively.

At this point I did my own research and found an MAOI called moclobimide. This worked pretty well about 60% and no side effects that I really noticed. I struggled for a few years not quite getting over the fatigue but my mood was better, not awesome though and my sexual function slowly started to come back. No where near pre depression/fatigue days.

in 2018 I lost my job due to my health not improving enough to function (mainly the fatigue) and I was already seeing a psychiatrist at that point. Had already tried lithium, sodium valporate, one other drug I can't recall. So when she heard I wasn't doing well enough and lost my job she said lets try Rexulti, a new 3rd gen antipsychotic. I said I don't want anything that will make my sexual dysfunction go backwards like the SSRIs did and she insisted there was no sexual side effects. So I agreed. This was December 2018.
I started on 1mg for a few weeks and then went to 2mg. I felt no side effects and within 6 weeks I felt much better. I felt improvements over the next 12 months and my sex drive improved a lot and sexual function was almost normal and I was happy.

So this is where things stated to turn. She just did 15 min check ups over the phone every few months but never considered taking me off the Rexulti. Mid 2020 so about 18 months in I had a sudden lost of sex drive and dysfunction. Again I got screened for hormonal problems, in fact my testosterone was the highest since I was in my mid 20s, now in my mid 30s. So a year of investigation and after seeing a sex therapist it was stating to point to the Rexulti as I never had an issue with the moclobimide. My doctor agreed to let me reduce the dose.

In August 2021 I started tapering down to 1mg. I felt like death, severe bouts of spontaneous anxiety, fear and irritability. There was severe restless legs and dizzy spells that came and went all the time. I felt agitated and withdrawn. But slowly it got better and my sex drive stated to improve in a windowed fashion. It had been about 5 or 6 weeks of the lower dose. So thinking 1mg was already pretty low I stopped toward the end of September 2021 completely, same round of withdrawal symptoms but within 3 days of stopping I got an uncomfortable warm/burning feeling in my perineal area (between anus and scrotum), but it felt like it was deep inside me in that area.


Over the new 4-6 weeks most of the worse withdrawals faded away but the weird feeling in my bits persisted until the 6 week mark where it went away finally. my sex drive after stopping the Rexulti improved a lot and it was proof that was the casue of the issue. I felt great finally and was finally able to translate desire to arousal again since 2017-2018.

At the 8 week mark, so mid November 2021 that burning feeling in my bits came back. I finally saw my doc about it. Was ordered a urine test to check for STIs. But then the follwing week. 21st of November my right foot went hot and numb and I just thought it was a pinched nerve in my ankle as it felt familiar like carpel tunnel I had 15 years before. The next day this moved up to my right knee to include my whole lower leg and it was painful too. I went home and while sitting at my desk I felt the feeling move up my entire right leg, then down my left and then I felt both legs numb and also my forward saddle area and penis and scrotum right up to my belly button go numb. I was scared and thought what on earth was going on!

My doc sent me straight to the hospital the next day as he thought I had some spinal injury.

So the hospital checked all my reflexes but couldn't see the casue. I was sent home.
The next few weeks it got much worse, burning pain like you wouldn't belive down my legs.

I was starting to have issues going to the toilet. Every time I crouched down my groin and penis and under the belly button went even more numb and I had urine retention for about an hour every time I crouched. Again to the hospital. Relflex fine. Conclusion, bulged disk pressing my my spine but was told in a few weeks it will get better.

My doc orders MRIs from head to pelvis as he wanted to rule out MS and things like that. MRIs showed nothing out of the ordinary but mentioned a bulged disk. I couldn't even get a private neurologist appointment until this month (30th of March 2022). So I saw Melbourne's one of top neurosurgeons to interpret the images for me.

The images were fine, the bulge was tiny and nothing at all was pressing my nerves or spinal cord.

3 weeks after the onset of lower body numbness my hands and face started to feel funny. Then a day later my hands and face went numb and started to burn. Another few days I started to get faint and shallow breathing on the way to the hospital again. I got a full blow panic atack but with an absolutely excruciating electric buzzing/shocking sensation in my face, hands and forearms and sternum. My partner was taking me and stopped and called the ambulance. I was in such pain that I would describe it like having 415V 3 phase electricity wired to my face and hands. This lasted for about 15 min and the ambos arrived and took me to the hospital.

Every single touch to my upper body was like electricity. I went to a different hospital this time as the main one wasn't that helpful. But this other hospital was just as useless and had no ideal. There was all kinds of ideals like GBS, CIDP maybe triggered by the covid vaccine as I also took that in late September. Again. nothing normal and the doctors said my symptoms were too all over the place to be any one thing.

But about early Jan this year it was so bad, I couldn't walk or hold things with my hands, bad tremors, difficultly swallowing and breathing, numbness and funny plastic like sensations to 70% of my body. Narcolepsy like partial fainting episodes when driving or being driven, crying, super anxious, unable to sweat in the hands since December, pain,, weird erectile dysfunction (excellent shaft erection but flaccid head), weird bowl movements and feelings, weird paranoid feelings about my own thoughts, unable to interpret sounds correctly, visual hallucinations when waking up. I kid you not, this is only a handful of the weird and severe symptoms I experienced in the last few months.

The last and final vistit to the main hospital I finally saw an neurologist and he was 95% certain I had functional neurological disorder (FND) which was probably caused by the withdrawal of the Rexulti.

The odd thing about my sexual dysfunction is mainly physical, numbness of the head of the penis and flaccid head. All other aspects mainly have improved dramatically. Sex drive is very good 90% of the time and ejaculation volume is the highest it's ever been in my life, exceeds pre depression days and even my teens.

My doc agreed with the diagnosis and got me to restart the Rexulti on a very low dose to break the downward spiral that is FND and it has a psychosomatic component. This worked pretty well. I am on 0.25mg from the 2mg I was on and within days my anxiety went down and I could start to sleep again.


That was 11th of Jan this year. Since then improvement has been windowed from minute to hours to sometimes a week at a time. It's been up and down a lot. Some new symptoms came out since like hissing/ringing in my ears from about mid Feb and have persisted since but slowly improved with some days no ringing/hissing at all.

Since about mid feb I got a sudden improvement in numbness in my saddle and penis, went from totally numb head to a max of 10% feeling to about 50% on average with some days being 40-70%. My head is stating to erect again but is windowed from minutes to days at most. My sex drive is great most days. I have sex daily, some days up to 3 times a day.

I have regained most days 100% feeling in most of my body.

The problems I still have is obviously some numbness in my penis head, windowed flaccid head but had massively improved. New symptoms of my lower legs don't sweat and dry out but is windowed usually on min-hour basis. Still got some ringing that comes and goes. Bad sleep. Sleep paralysis, jumpy sleep wake transition. Plasticy weird sort of numbness like feeling in face/hands and sometimes feet. The dizzy spells and the narcolepsy like faint feeling episodes when driving or being driven.

Slowly slowly there has been great improvement, physically, mentally and sexually but I feel like it will take quite a while. Months at least, probably longer.


Mid year my doc plans to have me drop my dose to 0.125mg and keep halving every 4-6 months thereafter. The reintroduction of the med was to break the downward spiral of mental health but allow a low enough dose that the rest of the unoccupied receptors in the brain to rest and return back to baseline. Kind of like starting the taper process again but at a much lower level so it's not just square one again.


When I learned that the Rexulti was likely what causes all these issues, I researched it a lot and found that unlike a traditional anti-psychotic it's pharmacology primarily works on serotonin. No wonder I became so unwell on it and withdrawing from it.


I hope that gives people some insight into wider issues that are not just PSSD specific and other classes of drugs that can do the same or similar things as PSSD

Any questions please feel free to ask.

[Kostakonkordia]

Hey,
I read youre story and that you originally had hypopituiarism. I looked it up and it could be that you are mercury toxic. This could greatly contribute to youre ED and all that. Do you have amalgams?

[tonyareias]

Amalgams still safe and used but some people can be more sensitive to minimal mercury levels.

How to detox from mercury?

[6-Eggs!]

I never had amalgam fillings in my life. Also I had full toxicology screenings done in my late teens for the hypopituiarism, when I got the fatigue/depression and recently when I got FND. All were clear.

The hypopituiarism was suspected viral origin as the anterior of the pituitary was stunned for some reason, which it is not protected by the blood brain barrier, low TSH and no FSH or LSH, but that cleared up in a few years and I was complete back to normal. That had nothing to do with my illness many years later.

I have had about 20 blood tests in the last 3 months and nothing abnormal. MRIs past and present are completely normal.

The pharmacological profile of Rexulti is as follows and can in therory explain the functional and sensory issues tardively developed after withdrawal. It does mess around with serotonin systems strongly as well as the other 2 transmitter systems.

It has strongest affinity for serotonin and norepinephrine, more so than dopamine which is the target for APs.

It blocks 5-HT2B and 5-HT2A and supposedly is more of a full agonist for 5-HT1A even though it's called partial according to info that I could find.

5-HT1A 0.12 Partial agonist
5-HT1B 32 ND
5-HT2A 0.47 Antagonist
5-HT2B 1.9 Antagonist
5-HT2C 12–34 Partial agonist
5-HT5A 140 ND
5-HT6 58 Antagonist
5-HT7 3.7 Antagonist
D1 160 ND
D2L 0.30 Partial agonist
D3 1.1 Partial agonist
D4 6.3 ND
D5 ND ND ND
α1A 3.8 Antagonist
α1B 0.17 Antagonist
α1D 2.6 Antagonist
α2A 15 Antagonist
α2B 17 Antagonist
α2C 0.59 Antagonist
β1 59 Antagonist
β2 67 Antagonist
β3 >10,000 ND
H1 19 Antagonist
H2 >10,000 ND
H3 >10,000 ND
mACh 52% at 10 μM ND
M1 67% at 10 μM ND
M2 >10,000 ND
σ 96% at 10 μM ND
SERT 65% at 10 μM Blocker
NET 0% at 10 μM Blocker
DAT 90% at 10 μM Blocker


That said 5-HT1A and SERT doesn't have much if any occupancy according to a study using a PET scan.

Quote

"An open label trial in subjects with schizophrenia was conducted to assess receptor occupancy
in patients treated with different doses of brexpiprazole (Study 331-09-219). 3 cohorts of
subjects were evaluated: Cohorts 1 and 3 received high doses of brexpiprazole (4 mg, up to 6
subjects each), and Cohort 2 received low doses of brexpiprazole (1 mg, up to 6 subjects). In
Cohort 1, the binding of brexpiprazole to the D 2/D3 (ligand: 11C-PHNO) and 5-HT1A (ligand:
11C-CUMI) receptors was assessed by comparing the binding potential from the baseline scan to
that of after 10 days treatment. In Cohort 2, the binding of brexpiprazole to the D2/D3 and 5-
HT2A (ligand: 11C-MDL100907) receptors was assessed by comparing the binding potential from
the baseline scan to that after 10 days of treatment. In Cohort 3, the binding of brexpiprazole to
the 5-HT 2A receptor and SERT (ligand: 11C-DASB) was assessed by obtaining a positron emission
tomography (PET) scan at Baseline and comparing it to the scan obtained on Day 10. Mean ± SD
occupancy for D 2 receptors following 4 mg/day brexpiprazole treatment for 10 days was 59 ±
5% (using 6 region model) or 67 ± 15% (using 8 region model); D3 receptor occupancy was 13 ±
10% (using 6 region model) and 31 ± 8% using (using 8 region model). Mean ± SD occupancy
for 5-HT 2A receptor following 4 mg/day brexpiprazole administration was 45 ± 7%. Clear dose
and exposure occupancy relationships were observed at each of these targets, with lower
occupancy observed following 1 mg/day treatment. Negligible occupancy (< 5%) was detected
at serotonin 5-HT 1A receptors and SERT following multiple daily doses (10 day) of
brexpiprazole administration of 4 mg/day for 10 days. An analysis of EC 50 values showed that
brexpiprazole was moderately D2 preferring, with the ratio of EC 50 (D3)/EC 50 (D2) equalling
approximately 4.56 when an 8 region regression model was used to separate D2 and D3 receptor
occupancies. Occupancy at 5-HT2A receptors was minimally lower than at D2 receptors. The ratio
of EC 50 (5-HT2A)/EC 50 (D2) was approximately 1.4 when an 8 region regression model was used
to separate 5-HT2A and D2 receptor occupancies."


My "PSSD" seems to be 2ndary to a widespread functional and sensory disruption caused by this medication. The ED is an odd one and not typical. I can get different types of ED in the span of 5 min and often even in the way I think about my erections. I seem to have somewhat decent amount of control between the shaft and head independently which is odd in itself as both should work together without conscious intervention (in my observation, shaft seems more automatic and the head seems more psychological). But this has come about in the last month or so with my improvements so I feel it is definitely getting better. It's getting easier to get a good solid erection including the head now, even the sensation of the head has improved a lot.

I woke up last night (not sure what time) with a very good erection, both head and shaft and the head I would say had 70% or maybe 80% full sensation. I woke up again at 6am and it was still like that and I feel very aroused so I had sex with my partner. We were both very satisfied. My libido doesn't have much if any issues since about October even with the onset of FND since November. It's not really mental for me, its functional and sensory and body wide, not just genitals.

[6-Eggs!]

Bit of an update.

Had good recovery of glans erectile function a few weeks ago and then had a sudden crash in numbness like I mentioned previously. The it recovered quickly as mentioned. Then it crashed again about 1.5 weeks later and took about 4-5 days to come back and then it came back to about 90% of the feeling.

Then I had a replete of most of the symptoms over the next week in the same order as from Dec to Jan but not as intense and condensed into a week. Really weird. But my penis sensation is at least 95% back to normal at the moment but struggling a bit with arousal and drive/ erections but it has come on strong a number of time over the last week and improving again slowly

My sleep is good still and my feet and hands are able to keep moist and sweat almost all over the time.

I am still feeling odd ache like feeling in my body and regular dizziness and sleep like attacks while driving.


I finally saw my neurologist on the 30th of March and he agrees that its the serotonin effects of Rexulti and it's withdrawal that has caused all these issues.

I might mention something really strange and concerning to me. I woke up the other night in the middle of having sex with my gf. I don't recall starting it or how I ended up with consensual sex without me even being aware of it. I think I must of sleep sexed? These meds are bad

[6-Eggs!]

Bit of an update. I saw good and rapid improvement in my physical symptoms but saw a gradual decline in libido to the point is pretty much gone atm.

Then the last 4-5 days my mood dropped and I was waking up at night feeling very anxious. The last 3 days I have not been able to sleep again, sleep suddenly shifted by 12 hours (can only sleep in the day). Also these 3 nights I have uncontrollable deep sadness and have one big bought of crying that I can't control but feel ok after and for the next 24 hours. It's really odd and scary.

I also have a return of noctual itching and bad restless legs that I had for a few years when on the Rexulti as well as the mood fluctuations. All symptoms of the delayed side effects that Rexulti brings me. (it helped control the anxiety while I slowly tapered off them again, but the effect has revered and made me sad and anxious as hell, way more than the depression ever did)

I am seeing the doc on Thursday and in the mean time I am going to skip a few doses to see what happens as I have noticed I only get these episodes after 3-4 hours after taking it and I get better the next morning. This will help confirm or rule out the med as being the cause of these issues. I have also had a flare up of the numbness in my fingers and weird feelings in my forearms and belly. Have not had much if any of that in over 2 months but doesn't surprise me as stress flares the physical symptoms. Penis sensation is still good, hovering around 75-85% atm.

I am due for a dose halving in 3 weeks anyway. I will update in the next week or so.

[6-Eggs!]

I took a break from the low dose Rexulti for 2 days and saw an immediate relief. No more sadness and slept good the first night and okish the 2nd. Sex drive went through the roof, especially the 2nd night, massive improvement from virtually 0 drive for the previous 2-3 weeks.

I also managed to 80-90% beat soft glans a number of times last night and the night before and sex was out of this world even though arousal is a bit difficult to initiate, but once it happens Wow!

Seeing my doc in 30 min and discussing this and will request an earlier dose halving to 0.125mg (1/16th of the standard 2mg dose).

[6-Eggs!]

Feel heaps better overall after the reduction. The withdrawals weren't nearly as bad as I thought they would be. They will continue for a couple of weeks yet but quite mild.

Most nights I sleep good, some nights feels nightmareish/electric? Idk now else to describe the feelings. Mood is way better, sadness is gone completely.

Got some flare up of neuro symptoms. Hot feels cold and vise versa sometimes, haven't had that symptoms before but I have had probably 200 different symptoms already. Had the sleep induced choking/stoppage of breathing again. Been nearly over 2 months since I had that. Got weakness for a day in my arms and uncontrolled tremor, gone now. Weird flushing/electric goosebumps like sensation at night (like 2-3 months ago)

Had one bout of intense visual/fractal hallucinations upon waking up, same like a few months ago. But this time the patterns/white lights were much more elaborate. My guess is hypersensitive 5-HT2a receptors as Rexulti blocks them, same receptors that LSD and mushrooms agonize.

Penis glans sensitive dropped slightly but bounced back quickly. I have noticed more improvement in glans erection, now starting to get pretty firm urethra( same type and part of tissue as glans) and the glans itself is more often decently firm than not now. I also have firm glans during night and morning wood (was flaccid during sleep even with hard shaft)

Have worsening of the hands sensation and face but get bouts of near complete recovery. Sex drive is a bit all over the place but that is expected from my experience (same thing happen when I first started coming off the Rexulti, wasn't until it was out of my system for many weeks before drive was constant) but much better than when on the 0.25mg.

I am taking 0.25 every 2nd night until my custom compounded script is ready, this is somewhat equiv to the 0.125mg daily dose but with more swings obviously.

Definitely getting better over time.

[6-Eggs!]

Still haven't got my compounding done, chemist and doc have been really slow. Been very much a roller coaster. Mood swings have not been great but still better than the 0.25mg dosing.

Libido is quite bad atm with occasional burst here and there. ED almost as the worst it's been since I was on the Rexulti 2mg from 2020 to 2021. Glans is quite bad in terms of erections but shaft can be ok. Shaft has still had very strong long lasting erections in the night and morning on alternate nights it seems which is odd but the feeling slowly disappears during the day. I had the same thing happen back in Jan-early feb when I started the 0.5mg for a week and dropped to 0.25mg. My libido crashed for many weeks before starting at night and then being good 24/7.

My skin sensations have been surging bad and then coming good over several min to about 30min, worst when I sit and do nothing and virtually completely gone once I start doing things to keep busy. It's not that I get distracted, it actually physically goes away. I have had a temporary return of genital pain/burning that I got from Sept to Dec last year when I stopped the med but it only lasted a few days and is pretty much gone, so these physical withdrawal symptoms are not as bad and last way shorter than the initial withdrawal last year.

Glans sensation has actually improved even more and close to 100% often, but feels less erotic and more like tactile/pain sensation at the moment and I have linked this to libido, when I feel more normal in the libido department the sensation becomes erotic again.

Sleep is much better but still funny on alternate days. I suspect it's due to the inaccurate and alternate day dosing and might explain the weird alternating symptoms such as the night time wood and sensations on the skin. Also my head felt like it was going to explode a few times with intense noise/buzzing in my head and hearing. It has settled down a fair bit now.

Interesting reading I have been doing about LSD and other psychedelics and the symptoms I have been having for months is same or similar to a lot of the documented ones caused by LSD. It has given me some insight to Rexulti as it shares similarities with the main receptor targets. 5-HT2a and D2 are the main ones the LSD target as well as 1a. These are almost the same as Rexulti but in the reverse direction. LSD agonises these while Rexulti antiagonises these, only thing is that a independent study found Rexulti doesn't bind to 1a much is anything. So it's strongest on D2 and 2a which is thought to be the sites that LSD affect that cause the trips.

My hypothis is that perhaps Rexulti up regulates D2 and 2a and when removing the drug there might be long term symptoms similar to an LSD trip in some ways. They mention for LSD effects listed where, muscle weakness, incoordination and tremor, visual and auditory hallucinations such as visual snow, fractal/geometric patterns overlayed on vision, shimmering of objects and motion, echo or distorted sound and misinterpretation of sounds, altered skin sensation and numbness, profuse sweating, dry mouth, clenching jaw, hyperthermial, dilated pupils, rapid heat rate and high blood pressure, hyperflexia, depressed respiration and gastrointestinal distress. These are just the physical symptoms, the phychological ones are likened to out of body experience and other spiritual experiences. Bad trips often have extreme fear, anxiety and dread.

Over the last 5-6 months I have experienced pretty much all of this and more and still continue to do so, far less now though. Not sure about pupil dilation as I never looked but I had issues with light sensitivity for a few months. Apparently LSD leaves long term effects that last from weeks to about a year after a recreational dose (normally positive benefits) and in the first few days and even weeks there can be spontaneous occurrences of symptoms felt in the initial trip. Some people have persistent flashbacks or hallucinations long after the first trip. My thoughts is that messing with 2a could well explain what I have been going though and that long term effects would be expected given that LSD and mushrooms have similar long term effects after acting on 2a. 2a is said to be key to our perception and sensory system in our brain. It is also found in autonomic peripheral nerves and smooth muscles which might have some link to functions like sweating, blood flow in body parts and erections.

I also found info about another drug I heard a member hear mention gives him persistent spontaneous erections and I found it to be a 2a antagonist, side effect profile confirmed that this was indeed the case. Might help explain why Rexulti helped with sexual function for me at the start before going the other way after 18 months, perhaps the antagonism helped improve sexual function but up regulation over time inhibited it and may also be responsible for the sensory disturbances. After being off it from Nov to early Jan my libido was awesome and constant despite having a virtually total numb penis and flaccid glans.

Take all this hypothesis as exactly that and a grain of salt but seems to me a good clue at least in my particular situation.

From previous research I did last year, it's typical for up regulation caused by APs to return to baseline but they say it takes 2-5 years. AP withdrawal is meant to be done very slowly, halving every 2-5 months on one study and 4-6 months as suggested by another. All the way down to at least 1/40th of the dose to avoid the worst of withdrawals and it can take literally years to taper off in some cases. I plan to go to 1/128th in about xmas time and maybe longer.

[6-Eggs!]

Been very rough the last few day and the pattern I have noticed is the 0.25mg dose on alternating days makes me feel terrible and worsen my symptoms the night taken and somewhat into the next day, but the off med nights I sleep good and feel pretty good the following day until I take the next dose that night.

I had bad dream like state while only half asleep that I didn't know what was going on, I couldn't tell if I was up and about sleeping or even alive. I finally properly fell asleep and I woke up maybe 1-2 hours later at night and holy crap, my lower legs were almost totally numb and felt super weird, just like my onset of this condition back in Nov. But instead of lasting 2-3 months it went away mostly after 30 min, all night my legs and feet stopped sweating and dried up completely, in the morning it completely recovered like nothing happened. I fell asleep again and as I was waking up later (early morning I guess) I felt a numbness and pain start from my left hand finger tips and that flushed down my whole body with excruciating electrocution like pain (like back in Dec that ended me in hospital), I couldn't move and only had partial control over my breathing, I had my worst case of sleep paralysis yet. I tried for prob a min or 2 to move or make a sound to make my gf aware to wake me up. I managed to make some dull moaning sounds and suddenly I jerked out of the paralysis.

My gf did hear me struggling but thought I was having a dream but I wasn't. I was also having trouble understanding sounds again that night and hallucinated a chime like jingle that was not familiar to me and I didn't know where it was coming from and concluded my brain was generating it. Later on when my gf dog was snoring on the bed all I could hear is the dog saying muma-muma-muma with every snore in a babies voice, it was freaky as shit and somehow I snapped my mind out of hearing it and then it just sounded like regular snoring. Went back to sleep and slept ok but was tired as hell the next day and struggled at work feeling physically crap and dazed.

I feel ok today, much better mood and happy and had good libido and erection in the morning and had good sex with my gf. Later around lunch I found I could get a decent erection and ok libido and glans erection was pretty decent, best in about 3 weeks I would say.

Today I picked up my compounded 0.125mg and will take this daily, hopefully side effects and withdrawal syndrome symptoms settle down soon until my next reduction in 3 months.

I did a bit more reading, Rexulti is also a potent 5-HT2b antagonist and from my limited research is highly involved in pain and tactile sensation and sensitization of neurons processing tactile response and found in smooth muscles, liver and kidneys. Not sure if they would by up or down regulated as SSRIs like sertraline are shown to down reg in sort term followed by up reg over chronic use which is thought to contribute in it's antidepressant action over the previous assumption of just SERT blockage. I thought that was interesting. Like 2a it is also involved in hallucination when agonized.

2b is also involved in regulating SERT in other ser receptors and gene regulation in astrocytes which apparently increases their activity when 2b is up regulated. As you can see PSSD and similar syndromes are super complicated and it will take a very long time for researchers and scientists to understand properly.