u/DifferenceCrafty8968

It’s been a while since I’ve last been on this sub, so I just wanted to give an update about how I’m doing ever since I saw results with pimavanserin.

For those who haven’t read it, basically: SSRI induced anhedonia; took pimavanserin; (practically) fully treated

If I mention some things which conflict with my previous post without mentioning it, I apologise as my recall is terrible - just take this post as authoritative.

Non-sexual-anhedonia wise, I’d say I’m about 95% of the way there to being fully normal. I don’t think I’ll get that last 5% but I’m so okay with that, given how I was 0% six months ago. I’ve picked up hobbies I dropped years ago, I WANT to do so many things now (as opposed to out of habit or necessity) and overall I’m just happier. I’m to the point where a good song will have me dancing in the mirror, or if I’m really enjoying an activity I’ll start humming or singing. Cheesy but accurate.

Sexually, the case is interesting. Libido wise and Mechanistically, I’m normal - but the actual act (eg sex, masturbation) isn’t pleasurable. This is something I’m working on fixing independently. Pimavanserin hasn’t fully treated this specific symptom, although in terms of desire it has significantly restored the “wanting” sexual aspect. This somewhat makes sense, given how Pimavanserin works pharmacologically.

I don’t take Pimavanserin anymore and I’ve noticed no worsening of symptoms.

I want to clarify that my response is probably at least partially idiosyncratic. I had no depression (never had and still don’t) and my anhedonia was purely induced by an SSRI. Please don’t assume it’s a blanket fix for all anhedonic phenotypes, especially ones with depression (Pimavanserin failed its stage 3 clinical trials as an adjunct for depression). Also, I never lost my consummatory pleasure, at least not in the same way my anticipatory pleasure took a massive blow. Even at my worst, food still tasted good and music was nice to listen to, even if I physically could not get out of bed. I wouldn’t expect Pimavanserin to restore consummatory pleasure as much as it would desire and wanting - for example it made me want sex more but the act is still blunted.

Please ask any questions you might have.

TLDR: I cured my severe post-SSRI anhedonia with pimavanserin, a potent antagonist at 5-HT2C and 5-HT2A receptors.

I wrote a really long post about this but I fat fingered God knows what button and it disappeared and I can’t find it and I’m really salty about that. I can’t be bothered to write it again so long story short: my anhedonia was being caused by 5-HT2C overactivation which inhibited my dopamine. Agomelatine is a weak to negligible antagonist of that receptor so it didn’t do anything when I took it. Pramipexole, tranylcypromine and bupropion all worked briefly but stopped after a few weeks. Pimavanserin is potent antagonist, so it cured me. I’m normal now and I have been for a few weeks. If you have any questions, please feel free to dm me.

Sorry for the monotone writing style but I’m just trying to keep this short.

The whole “dopamine isn’t pleasure” propaganda led me astray for so long and made me believe my anhedonia was incurable.

The idea that “dopamine isn’t pleasure” refers to an overly reductive idea of pleasure as only the “liking” component. In fact, most of our feel-good states are dopaminergic. Desire, novelty, anticipation, winning, pursuit, excitement are all dopaminergic states. The idea is only true if “pleasure” means “that specific feeling of enjoyment detached from goal or reward oriented behaviour” which is only one specific part of what feels good and is not dopaminergic (involves the endocannibanoid system).

Most of you who have anhedonia, especially if you can still feel comfort, low level bodily pleasure etc probably have a dopaminergic issue.

I’ll start:

Pramipexole
Parnate
Agomelatine
Bupropion

What do you guys think?

I posted on here about two weeks ago when I had been taking pramipexole for five days.

It’s now been 3 weeks in total and I’m currently on 1.875mg (salt). Here’s what’s changed:

TLDR: Massive improvement in functioning and immediate happiness. Only minor improvement in excitement/long term joys and goals, and sex drive.

What Pramipexole has done:

- I’m fully functional now. No more laying in bed all day
- Excitement for the immediate future. Excitement to go to uni, excitement to go eat, excitement for anything happening within the next few minutes to hours
- Immediate joy. I’m usually fairly happy in any given moment in general
- Being able to do things genuinely (hanging out, work, gym etc) instead of forcing myself

What Pramipexole has failed at:

- Substantially raising my sex drive. It has about largely stayed the same, perhaps a minor increase
- Don’t care about anything more than a day away. Don’t care about getting a relationship , job, money, etc. if it’s not happening today I will feel zero excitement when imagining it
- Passive suicidal ideation. I still want to die in general. The intensity of this desire fluctuates but it’s there most of the time
- the happy state is generally constant but I have crashes every now and then where I return to my pre pramipexole state. They usually last a few minutes to a few hours- happiness/normality dominates

Overall assessment:

Pramipexole has done way more than I thought and I’m so grateful. I ideally want to work on fixing the gaps it has failed to fill but for now I’m glad to just be functioning and happy.

Feel free to ask any questions!