Severe Anhedonia, Panic, and Emotional Blunting with Surgical Menopause (one ovary), Insulin Resistance, and High CRP. Looking for insights on my new roadmap.
**Hi everyone,**
I have been stuck in a deeply depressed, flat, "asleep brain" state with severe anhedonia, derealization ("fish bowl" feeling), and sudden panic attacks for a long time. Standard SSRIs stopped working a while ago, and I cannot go to shops or restaurants without extreme spatial overload and wanting to flee.
**My Background & Recent Lab Results (Lancet Laboratories South Africa ):**
**Surgical Menopause:** Had a hysterectomy. No blood pressure issues although can be around 140/85 when I’m anxious or higher).
**Fasting Glucose:** 4.9 mmol/L (3.3 - 6.0)
**Fasting Insulin:** 10.5 mIU/L
**Calculated HOMA-IR:** 2.3 (Confirms early insulin resistance)
**hs-CRP:** 9.2 mg/L (High systemic, low-grade inflammation)
**Total Cholesterol:** 6.2 mmol/L (High)
**Morning Cortisol:** 497 nmol/L (Normal reference 185-624)
**D-Dimer:** 0.43 mg/L (Normal)
**DHEA:** 1.5 (Low/depleted)
**Sex Hormones:** Estrogen 58 pg/mL, Progesterone 1.2 ng/mL, Testosterone 37 ng/dL. SHBG 30.30
Ferritin: 48
Saturation 23
Vitamin D 34
**Medication History & Sensitivity:**
**Lexamil (Escitalopram) 10mg:** Currently taking. It completely stopped working for mood and causes severe emotional blunting/apathy.
**Wellbutrin (Bupropion):** Tried recently but was far too activating; triggered severe jittery panic.
**Morphine:** Was on 10ml PRN for physical pain. (7 spine surgeries) Successfully tapered down to 2ml–3ml only on necessary days, but the taper perhaps leaves my nervous system very raw.
**Hormone Trials:** Tried a 3-in-1 compounded BHRT cream (3mg E2 / 30mg P / 6mg T) which made me feel "weird" and aggravated at times. Tried Utrogestan previously (made me deeply flat) and Angeliq (caused rage). I seem to have a severe progesterone/GABA sensitivity exacerbated by my 9.2 CRP inflammation. Tried Estrogel a couple of days ago and it caused a flat/aggravated rebound.
**Xanor (Alprazolam) 0.25mg:** Prescribed for panic, but I rarely use it (only 1/4 or 1/2 tablet) out of fear of mixing it with morphine.
Thyroid: 100mcg Euthrox Daily and 10mg Liothyronine T3
T3 and T4 levels dropped since starting the BHRT cream.
**Current Action Plan Just Started:**
**Metabolic Focus:** Just started Metformin 500mg XR with dinner (tolerating well, no stomach issues) to treat the HOMA-IR 2.3 and lower the 9.2 CRP.
**Hormone Holiday:** Pausing the all-in-one cream permanently since I don't need progesterone post-hysterectomy, and keeping estrogen gel paused until my metabolic inflammation cools down.
**Nutrition:** Eating mostly low-glycemic, anti-inflammatory fats and proteins (mackerel, nuts, berries, cottage cheese) to stabilize my glucose and stop adrenaline surges. Paused fish oil supplements because they caused an acetylcholine-dominance flat feeling.
Has anyone with surgical menopause and high insulin/CRP experienced this level of treatment-resistant anhedonia and panic? Did treating the metabolic root cause (like using Metformin) finally unlock your brain and make you responsive to treatments again? Any advice on navigating the final morphine/Lexamil taper or trying another SSRI or something else ? once stable would be amazing.
Thanks so much. 🙏🏼