Personal Story. OCD, sertraline, clomipramine, pssd - Asking for advice
M26 — Long psychiatric history, OCD, SSRIs, possible PSSD and emotional blunting
I’m a 26-year-old male with a psychiatric history involving OCD , depression and anxiety.
I’ll try to summarize my story as clearly as possible.
I have a complex psychological history. When I was around 14, I began experiencing same-sex attraction and intense internal conflict related to my sexual orientation. At the time, I felt ashamed, depressed and deeply isolated because of it.
At 15, I decided to talk openly with my parents about these feelings. Initially, their reaction seemed neutral, but over time it became much more negative and emotionally invalidating. Since then, I have never really felt psychologically safe discussing my sexuality openly at home.
As a consequence, I progressively developed severe anxiety, shame, hypervigilance around sexuality, and obsessive symptoms. My OCD initially revolved around homosexuality-related obsessions and rumination, but over time it evolved into full-blown contamination OCD and other compulsive patterns.
Looking back, it often feels as if my psyche developed OCD as a maladaptive defensive mechanism to suppress, control or hide thoughts, emotions and aspects of my identity that I perceived as unacceptable within my environment.
I started seeing a child/adolescent psychiatrist and psychologist when I was around 15–16 years old. I was prescribed sertraline (Zoloft), which I took from approximately age 16 to 19, reaching doses around 150 mg.
Unfortunately, the public psychologist I saw did not really take my sexual orientation struggles seriously. She basically told my parents that I simply needed to “grow and change,” which was very painful and invalidating for me.
School was not a particularly supportive environment either. I often felt different, weaker and emotionally disconnected from other boys. Fortunately, I loved studying and school performance became my refuge. I achieved very high grades and focused intensely on academics.
At 19, I was discharged from public psychiatric services because I was doing somewhat better with anxiety and depression and had completed school. I gradually tapered and discontinued sertraline.
However, about six months later, I relapsed and had to start treatment again with a private psychiatrist/psychotherapist. Over the following years, I was prescribed several serotonergic medications, including sertraline again, paroxetine and venlafaxine.
These medications helped partially with anxiety and mood, but they never really resolved the OCD.
After paroxetine, I developed severe sexual side effects that persisted during treatment and even after stopping the medication. That experience made me begin suspecting PSSD or some form of long-term serotonergic dysfunction.
I told my psychiatrist that I wanted to change medications because of the sexual side effects and emotional flattening. I was extremely frustrated and told her that I felt antidepressants may have caused more harm than benefit in my case, especially considering how young I was when treatment started and how little I had been informed about possible long-term side effects.
Her response was that I was becoming “paranoid” and irrationally convinced that doctors had made me sterile.
I’ll let you imagine how invalidating and upsetting that felt.
After that, I decided to switch drug class and started clomipramine (Anafranil), mainly because it is considered more effective for OCD. I’ve now been taking it for about three years and I’m currently on 75 mg.
Ironically, despite being a strong serotonergic drug, it is the only medication that helps my OCD without making me feel completely emotionally dead.
Still, over the years I progressively developed symptoms that now make me strongly suspect PSSD or some broader long-term serotonergic dysfunction.
Main symptoms:
- severe emotional blunting
- reduced emotional reactivity
- loss of motivation and drive
- cognitive slowing / reduced mental sharpness
- sexual dysfunction
- reduced libido
- muted attraction and arousal
- inability to feel emotions “normally”
- feeling detached from reward, pleasure and emotional connection
Another important factor is that I still live in a conservative environment where I still don’t feel comfortable expressing my sexuality openly.
A few years ago, things seemed to be improving, but now the right-wing government is contributing to a climate of hostility and suspicion toward minorities and people perceived as different.
At this point, I honestly can no longer understand how much of my condition is caused by OCD/depression and how much may instead be related to long-term antidepressant exposure.
Sometimes I’m even afraid that I may still be using serotonergic medications to treat symptoms that were partly caused or worsened by serotonergic medications themselves.
Recently, I changed psychiatrist. Fortunately, this new doctor actually listens to me and does not dismiss everything I say as irrational. I also underwent a course of TMS/rTMS with him, which helped significantly with OCD and slightly improved my emotional responsiveness as well. Unfortunately, the full benefits only lasted a few months.
My current goal is to gradually taper clomipramine and eventually undergo another TMS cycle in the hope of managing OCD without relying entirely on medications that may be worsening emotional and sexual symptoms.
I really hope I can eventually recover at least part of my emotional and sexual functioning.
At this point, I would genuinely appreciate hearing from people with similar experiences.
- Has anyone here had similar experiences after many years on multiple serotonergic medications?
- How long did it take before emotions or libido started returning, even partially?
- Has anyone experienced PSSD-like symptoms specifically from clomipramine?
- Has anyone with sexuality-related conflict and ocd or depression had similar experiences with SSRIs or emotional blunting?
Thank you very much to anyone who read this.