SSRIs and Emotional Blunting | Mechanisms of Emotional Blunting and Treatment | Dr Rege

[@jerryholdcroft4607]

After being on Sertraline (SSRI) for many years following PTSD I was quite content to be 'Comfortably Numb' as Pink Floyd would say, it's like being in a protective cocoon, unaffected by your everyday surroundings and events. My daughter got married in April and I did the usual dad thing with lots of greetings, smiles and a funny speech, but I felt nothing!?. My daughter thankfully understood as she had got used to me being unemotional over the years and said it helped keep her grounded during the hectic event. This made me realise how much I had been missing out on, in my blissful lazy ignorance, happiness and the simple pleasures of life, I am hoping to change to Vortioxetine soon and it scares me to think how much of a grip I'm in and how I'm going to cope with restored emotions. 😕

[@PsychiatrySimplified]

Wow, what a description. Could i ask permission to use this for teaching? This is the best description of EB i have read, but it describes the importance of emotions in all of us. SSRIs reduce amygdala firing, which is a core component of PTSD pathophysiology. However, the same pathway mediates arousal, and threat response mediates reward. A delicate balance. Thank you for such a poignant description. I hope you feel better with the switch. Please let me know if you would like me to attribute the quote to your name if i have permission to use it.

[@jerryholdcroft4607]

@@PsychiatrySimplified Yes no problem, I'm obviously relieved to be heard and understood, after so long being ignorant of the actual mechanisms involved. It's just a shame that I couldn't actually feel the immense elation, at the discovery of the sheer extent of knowledge, on the subject of SSRIs, irony!

[@PsychiatrySimplified]

I’m curious - how do you see the SSRIs as affecting your PTSD? Did they help? This trade off - how do you weigh it? Thanks again for engaging.

[@jerryholdcroft4607]

@@PsychiatrySimplified Sry I didn't like my previous reply, it was partly based on my current knowledge and not my consciousness at the time. The PTSD triggered a 'shutting out' of everything as I became vulnerable and unable to cope, I became a zombie essentially. The Sertraline took a while to 'kick in' and have a notable effect on my moods and emotions. I started feeling less negative and less reactive to my environment, this was very calming and I gradually realised that I could actually function on a basic level much better, albeit with lethargy, disinterest, disassociation, and absolutely no emotional/sexual reaction to anything!. I was also not cognitively impaired at all, in fact I could fully understand my state of mind, think more clearly and communicate in a calm manner, 'untroubled' by emotions. Life was much better and I honestly didn't see it at the time as a trade off, ie: Losing all negative emotions, vulnerability, lack of confidence, depression, anxiety, fear, etc etc in exchange for losing all emotions was not a conscious consideration at the time. Coming from a deep and dark pit into the light (however dull) was In essence such an improvement that it subconsciously far outweighed the loss of something I didn't really miss (at the time). I had become totally seduced by the numbing effects of the drug and although I wasn't happy I was pretty satisfied with my lot.

[@w.okkerse915]

Don't be surprised when your emotional blunting is just a side effect of your anxiety that has nothing to do with your ssri's

[@katrinat.3032]

I have a friend with major depression. I have definitely seen this emotional blunting in her. It’s just so strange. It’s like she doesn’t feel anything about anything. I think she’s doing a little bit better now. But this helps me to understand her.

[@tonydargon3918]

I've taken 200mg sertraline daily for many years now to treat clinical depression, the dulling of emotions is the best part for me as it makes life bearable. Don't think i would still be here without the medication to be honest. Anger is still an issue, but i can usually keep it in check, much better than before the meds.

[@kilianred9890]

Yep 3 year PSSD sufferer. Thanks for speaking out on SSRIs.......sexual issues, anhedonia and emotional blunting is no joke, I wouldn't wish that to my worse enemy. Of course, there are other symptoms associated, especially cognitive-related.

[@cynaptyc]

I am in that zone and it is hard to even feel motivation in any sence. I try to, at least, go to work but I am losing that too. I just don't care about much of anything. I have even dodged my grandkids. My biggest fight is fighting the urge to despise myself. It's hard at times but at least I know it's not my fault and I am not the only one experiencing it.

[@mcb00]

​@@cynaptyc please gradually taper the meds if you're stable. These side effects can endure for years, or even permanent without treatment. Look into a therapy called behavioral Activation to help rewire the brain.

[@brianmeen2158]

@@cynaptycare you currently taking meds? If so try to wean off them .. the emotional blunting and avolition are horrible though.

[@captaincat1743]

Bupropion can be prescribed as an adjunct to SSRIs and it can reverse all sexual dysfunctional symptoms, or it can be taken instead of SSRIs as it also works as an anti depressant.

[@cynaptyc]

@@brianmeen2158 i am currently on Suboxone, now down to 4mg twice a day and also Buspirone 15mg a day. In process of weaning of both. Albeit i know the Suboxone is going to take a lot more time. I do feel a bit moody but it is still way manageable. Also been off of Duloxetine, after wean off, for 2 months after about 5 years. No manic depression this time! In fact i am feeling more emotional lately but it's not as hard as before to deal with it!

[@EDMcIntoshBrocher]

My experience after decades of SSRI treatments is - absolutely no emotions apart from fits of extreme rage periodically. I still feel this is better than the windmill of extreme emotions I go through when not medicated. I have heard it say that depression is the inability to appreciate a beautiful sunrise - same goes for SSRI drugs.

[@michasosnowski5918]

Have you tried alternatives? Diet, exercise, supplements, support group, therapy? I find that when I eat right and supplement, even if I isolate and I am sad about it, I feel better connected to nature which helps me to appreciate actual sunrises and sunsets. I experienced the same thing on SSRI. Bouts of rage, for which psychiatrist gave me mood stabilizers and neuroleptics. Very dangerous combination. I am happy that I am free of drugs. But that is only becouse I kept digging and looking for information about these drugs and psychiatry as a whole. Today I know that they are nothing more than poisons that accidentally keep anxiety and depression at bay - just as alcohol enhances your mood and relaxes you. And that comes with long term consequences, as with any substance. They are not medications, they are just drugs and psychiatry have very little and sometimes conflicting basis in science. Wishing you the best.

[@EDMcIntoshBrocher]

@@michasosnowski5918 Thank you for that answer. I am quite careful with diet and exercise and am aware that most serotonin is produced in the gut and so diet is the key. I have been smoking weed for the past few years and that works fine at keeping the rage at bay but have recently been diagnosed with CHS, so in my case, I think it made things worse over time. I have tried from time to time to stop taking the Venlafaxine but find the withdrawals are too much to cope with. I feel that I gave up on wanting to be free of the drugs a long time ago and that is more of a submission than being happy to be on that hook.

[@intermilan6202]

@@michasosnowski5918- Hi, Thank you for your comment… are there any particular supplements that you know of that help with Anxiety & Depression ?? Would appreciate your feedback?

[@michasosnowski5918]

@@intermilan6202 Its good, but tricky question. I think when it comes to depression, the best one for me is vitamin D. I find that I enjoy nature and weather more. I look at the clouds like I was on some kind of drugs, they mesmerize me :P It certainly enhance my mood, but it doesnt change the painfull emotions you might be feeling - you still will feel them, just with a little pink cloud over them. I dont think there are supplements that will cure depression or anxiety, becouse they are part of life and responses to relationships and the past - that needs to be dealt with seperately(like yournaling, support etc). But junk food and poor sleep can certainly worsen depression. So be sure to eat plenty of fresh and cooked vegetables and some fruits and nuts/avocados/olives. When it comes to anxiety, I find that the more healthy I eat, the more I feel the anxiety(at least initially). Healthy food connect me with deep part of my soul, and that might be scary at start. Mostly when it comes to sleep at night - I get scary dreams. But that might not be your experience. I heard that GABA enhancing foods are good(coconut oil, butter - but you dont want to overdoe them also). Also be sure to eat lots of food containing magnesium and zinc, and cut some diary(diary for me can worsen anxiety, while magnesium containing foods like bananas or whole grains calm me down). Studies show that exercise are as effective or better as drugs for anxiety and depression. 30min of vigorous exercise 3 times a week should be a good start. Wish you good luck, strenght but also plenty of kindness with yourself(that also helps with A&D :).

[@RajeshMoorjani]

@@intermilan6202 please research Andrew Huberman's recommendations on the same. Omega 3 fatty acids ashwagandha saffron Mg threonate theanine are known to help.

[@funkyjunk]

Thank you for addressing these issues. I experienced this when trying a new ssri which led to medication discontinuation. It's been 3 years and I still have not returned to my pre-drug state. This includes sexual dysfunction like others have stated. Doctors don't appear to be informed of this. It's dehumanizing

[@ashuvijay7031]

​​​@OsakaSyndrome​ I m also feeling sexual numbness during forplay... There is no hot feeling when touch a girl ! I get erection pleasure and orgasm also...when I think about sex and do sexy talk with girls on call and do masturbation ! But dont feel hotness When touch a girl body in real ! I feel like I m touching a boy body or a child body... When do forplay with girl 😢😢😢😢 I took 5 mg of Escitalopram and 0.25 mg clonazepam for 4 month.. Then I left it within next 2 month by tappering slowly slowly ! But after 6 month of tappering completely I m facing this issue What should I do 😢😢😢

[@spoonbillyerd]

so what can you do about this

[@Scarlettbankergirl]

Idk I kind of enjoy not having rage all the time. But I agree with some of the rest.

[@EvanRajala]

@@Scarlettbankergirldo u not get angry anymore?

[@EvanRajala]

⁠@@Scarlettbankergirloh did u have rage before and now its permanently gone???

[@romanbrandle319]

The reason I take SSRI's is to blunt emotions it's so tiring trying to keep the emotions in check it does a good job of stopping rumination as well maybe it doesn't work for everybody but it sure helps me.

[@mcsoto]

Same, helps me tremendously due to being highly emotional, my medicine keeps my emotions in check.

[@sarahtaher1531]

Same like me, it is very helpful. I feel like myself more​@@mcsoto

[@CandyGirl44]

My husband asked me to go onto Lexamil, I was permanently on the verge of blowing up at him, a burning, white hot anger. I must say it has really helped in that regard, I can stop myself from an outburst, luckily so far emotions don't seem to be blunted.

[@rab-cnesbit4181]

My mum died and I did not cry .I was on seroxat, but when my daughter turned up crying hysterically.....then I cried.

[@pradeepm8771]

Good information, it helps me. Thank you.. i have been on ssris from more than ten years. My all emotions flattened, it's not simple thing, it ruined your whole life, it's affect your quality of life and you became alone. But most psychiatrist fails to observe and treat this... This emotional blunting more oughtweight than normal depressions.it kills your creativity, love fashion and most important things in your life.. you will live like dead body in this world.. i really suffered from this side effect and I'm done!!!! Trying to fix this but hard.. dont take antidepressant for mild depression , depression is normal thing in your life don't take treatment until it gets severe.. psychiatrists like prescribing antidepressants as chocolate but they're t.. they have some afects in brain..

[@tanyamanna8407]

I just read your comment and I can relate to what you have said. I have been on Effexor for 23 years and to be honest I've also self medicated with other things to try and feel something but now I've decided to stop all other self medications and lower my meds to get off them. What's the worst that can happen right ! Truly cannot be worse than the withdrawal from alcohol or the discontinuation of the Effexor. 🫤

[@keithsmith2859]

Bro I feel the same way you explained exactly how I feel wow bro I wish I never started this

[@SM-by8mg]

Did you find any way out ?

[@Chakko77]

Please Sir, make a video about /PSSD take this condition please very serious, its horrible...... people killed themself already bcuz of that, please help us to make more people know about it.... God bless you

[@PsychiatrySimplified]

Yes will certainly add that to the list. We have done a video on sexual dysfunction where pssd is covered briefly but recognise that it needs a separate video. kzbin.info/www/bejne/mGiUgK2Gqs-Eesk

[@Chakko77]

@@PsychiatrySimplified Thank you so much, you probably cant even imagine how much of a help this might would be for all the sufferers of that condition, mostly nobody believes you.... and the doctors who prescribed you the medication start to gaslight you.... i talked to so many people who made exactly the same experience.... also its hard 2 talk with others about that

[@js7018]

Yes, a separate video on PSSD would be greatly appreciated by me & many of your followers! I would also be curious if you want any full stories i can write mine up and share it with the channel.

[@js7018]

There is also a Sub on Reddit dedicated to the condition with 4 thousand members.

[@PsychiatrySimplified]

@@js7018 sure - with consent I can use it in the video as appropriate.

[@whosaysitmatters]

I took escitalopram for a few monhts, and three years later I still have emotional blunting (as well as PSSD). I doubt I will ever feel as I did. The psychiatrist who prescribed this drug has stolen my life from me. SSRIs (and psychiatry in general) is one of the greatest travesties of the century.

[@PsychiatrySimplified]

Sorry to hear. Hope you can get the appropriate treatment. Wish you well

[@whosaysitmatters]

@@PsychiatrySimplified Thanks. I think it is naive to suggest there is an 'appropriate treatment'. From my reading of the area and from what David Healy says, there is no cure. Its the new (invisible) tardive dyskinesia. And just like when TD began to happen, most psychiatrists pretend it doesn't exist.

[@jaredmreagan]

@@PsychiatrySimplified have you researched any treatment or ideas to healing/repairing the cognitive function of the brain after SSRI or AP exposure?

[@robandrews4815]

​​@@jaredmreaganThere are new drugs. As well and non-drug treatments like magnetic stimulation. And an old one electric shock treatments. Neither is painful.despite the term 'electric shock' ,may sound terrifying.

[@katrinat.3032]

@@PsychiatrySimplified I like that you reply to people that are truly suffering.

[@leftysheppey]

SSRIs have completely changed my life for the better. I have depression. I was never happy and rarely had positive emotions anyway, so a dulling of those is no great loss to me. I don't feel like killing myself on a daily basis anymore. There are some bad side effects though. I can't sleep through a full 8 hours anymore. I normally wake up after 4 hours, or 6 if I'm exhausted. Considering I have a separate health condition that causes fatigue, I'm constantly tired and worn out. I'd still take this over where I used to be any day. I can deal with tiredness lol

[@PsychiatrySimplified]

That's really good to hear. They are helpful. Re sleep there are options that can be considered to counteract this sleep dysfunction. A sleep evaluation, ruling out sleep apnea and synergy with medication to counteract the SE can be done. We have a video on insomnia kzbin.info/www/bejne/iKPHqWRnp6mUb9E

[@leftysheppey]

@PsychiatrySimplified thank you. I'm sorting things out one thing at a time. First things I did was sort out my personal hygiene and start eating more than once a day. I didn't have an ED, just depression things lol. Now I'm working on making healthier choices with food. I think physical fitness is next, and then I might tackle sleep after that. Baby steps, CBT, and all that jazz I'll check out your video though :) thank you for the recommendation

[@captaincat1743]

I am off SSRIs now but spent about 10 years on paroxetine. I have used strong medicines to help me sleep but the quality of sleep was not good on them, but then I tried melatonin and this was fantastic for me, it gave me natural refreshing sleep with normal dreams. I recommend taking it, but you have to inform your healthcare provider first to ensure it is safe for you to take this. Other than that it is very cheap and does not require a prescription. Marijuana can help also but again you need to discuss this with your doctor or psychiatrist first ! These two drugs I mentioned are not perfect for everyone. Good Luck with your sleep and your ongoing recovery. I hope you have a great day today. If today is over already, then I wish you that for tomorrow.

[@GuilhermeGomesmmm]

amazing. you cant sleep anymore. thats really good yeah

[@leftysheppey]

@@GuilhermeGomesmmm suicidal thoughts Vs being tired, I know which I'd pick. Lifestyle changes can help with tiredness, like diet for example. I often sleep for 4 hours, do some housework, errands, whatever I can, relax for a bit, then sleep a bit more. It's far from ideal, don't get me wrong, but before I was just sleeping for 11 hours and not doing anything with my life.

[@fordmustang5856]

I've been on them for 18 years and I don't feel any of these things. I love life! Couldn't live without my meds!

[@tanyamanna8407]

Hi, can I ask which medication you are on? ❤️

[@shaun4443]

You won't know any different for 18 years then! try two years off them and connect!

[@eliw.1197]

Dr Sanil, thank you for raising awareness. This matters a lot.

[@PsychiatrySimplified]

Thank you for your feedback

[@yassiepirani509]

Please do a video about how the anhedonia and emotional blunting from these meds is sometimes irreversible, alongside PSSD, post SSRI Sexual dysfunction

[@PsychiatrySimplified]

Yes it has been requested a lot so will do this one for sure

[@gml122879]

Such an impressively good video. Extremely well articulated. Well researched. You've provided a foundation for me to understand the physiological mechanisms that are activated when this medicine causes my emotional blunting and SD. Keep up the great work!

[@PsychiatrySimplified]

Thank you for your feedback. appreciate it.

[@ashuvijay7031]

​​@@PsychiatrySimplified​​​ I m also feeling sexual numbness during forplay... There is no hot feeling when touch a girl ! I get erection pleasure and orgasm also...when I think about sex and do sexy talk with girls on call and do masturbation ! But dont feel hotness When touch a girl body in real ! I feel like I m touching a boy body or a child body... When do forplay with girl 😢😢😢😢 I took 5 mg of Escitalopram and 0.25 mg clonazepam for 4 month.. Then I left it within next 2 month by tappering slowly slowly ! But after 6 month of tappering completely I m facing this issue What should I do 😢😢😢

[@harrietbisp2367]

Yes I can relate to the blunting on SSRIS! Unfortunately I continued to feel this off the meds as well. I’ve seen some others comment about it, it’s known as PSSD but not many people speak about it.

[@PsychiatrySimplified]

Sorry to hear. Yes many have requested a video on PSSD. Are you saying the blunting has been persistent or secual dysfunction or both?

[@inderbirsingh9711]

How are you now ?

[@ashuvijay7031]

​@@PsychiatrySimplified​​​@OsakaSyndrome​ I m also feeling sexual numbness during forplay... There is no hot feeling when touch a girl ! I get erection pleasure and orgasm also...when I think about sex and do sexy talk with girls on call and do masturbation ! But dont feel hotness When touch a girl body in real ! I feel like I m touching a boy body or a child body... When do forplay with girl 😢😢😢😢 I took 5 mg of Escitalopram and 0.25 mg clonazepam for 4 month.. Then I left it within next 2 month by tappering slowly slowly ! But after 6 month of tappering completely I m facing this issue What should I do 😢😢😢

[@mcb00]

​@@PsychiatrySimplified the blunting can definitely persist after meds are stopped. It's happened to me and many others. It's extremely disabling because you lose normal motivation and reward response. I can function with numbed emotion, but not with avolition, fatigue and lack of normal capacity to care about anything. Can't even shower. It's horrendous.

[@brianmeen2158]

@@mcb00 “you lose normal motivation and reward response” I’m suffering from these right now and have for quite awhile. I exercise daily and that helps but beyond that I just do not feel anticipation for much of anything. I wouldn’t even walk across the street for sex . Yet doctors just want to prescribe more meds

[@bji8942]

I am on escitalopram(ssri) for anxiety and I feel I have no soul, I feel like my life is meaningless like I’m just occupying myself while I age and soon die. I lack purpose, drive, passion, I struggle to do my art or visualise things in my mind I feel like iv lost that spiritual side of a human. WOW actual tears welled up in my eyes, that’s unusual. I feel as tho my conscious is unable to feel a lot of anything but my subconscious is in pain with all the burden of everything my conscience is just not dealing with instead it’s put everything that is “too much” deep inside myself and locked it in a box and now and then I feel that box rattling and everything like grandma passing, brother disowning me, family dog passing, diagnosed infertile.. it all tries to escape the box now and then but the ssri makes sure it’s not let out.. I am christian and I can no longer feel moved I struggle to pray because I literally can’t put emotion to it so I feel like a phoney like my heart is not in it.. I’m not in a good way but I don’t feel too strongly one way or the other about it all I know is I need help to get off the meds so badly but I know how hard it is. Tomorrow I will remember writing this but it will get pushed away quickly and not addressed. I wish I had never got on medication I’d rather have the human experience with crippling anxiety then just exist without any passion or purpose.. it’s funny how many times I said “I feel”

[@PsychiatrySimplified]

Sorry to hear. Have you discussed this with your prescriber? Emotional bluntimg can be treated and there are other antidepressant options as well. Please speak to your doctor. Wish you well

[@asja2793]

​@@PsychiatrySimplified which are the other antidepressants for it?Does brintellix give you an emotional bluntness?

[@jrebtube]

Try Wellbutrin as add on with Lexapro ...

[@danielkanka495]

@@PsychiatrySimplifiedi developed this after ssri but it went back to normal after some months i stopped ssri but not fully sexuality came but not fully so my dr told me to try lamotrigine and wooow it trigger the worst anhedonia in my life what persist still after stopped medication and nothing now helping its living hell i should not try the medication i lost emotions libido good sleep and digestive problems and nothing works .... so desperate its a years living hell

[@nessa3567]

I was completely blank after taking certain medications. I felt nothing. I rather feel my pain then nothing. I've done discussed another issue on another video that was a major issue too. (Sorry about the details but it's a problem.) I enjoy listening to you and your knowledge on the subject matter.

[@PsychiatrySimplified]

Thank you for sharing your personal experience. It is a distressing side effect no doubt.

[@cindyrobertson3780]

The only emotion that I want blunted is sadness and depression, irritability and agitation.

[@ashuvijay7031]

​​​@@PsychiatrySimplified​ I m also feeling sexual numbness during forplay... There is no hot feeling when touch a girl ! I get erection pleasure n hotness in penis and orgasm also...when I think about sex and do sexy talk with girls on call and do masturbation ! But dont feeling hotness When touch a girl body in real ! I feel like I m touching a boy body or a child body... When do forplay with girl 😢😢😢😢 I took 5 mg of Escitalopram and 0.25 mg clonazepam for 4 month.. Then I left it within next 2 month by tappering slowly slowly ! But after 6 month of tappering completely I m facing this issue What should I do 😢😢😢

[@favouritemusic8959]

@@cindyrobertson3780 so so true Cindy. Me too. Sending 💖

[@brianmeen2158]

@@cindyrobertson3780it doesn’t work like that though. Ssris will definitely blunt the negative emotions but also things like enthusiasm and sex drive . I wish they didn’t but they do

[@w.okkerse915]

Very difficult to separate the anhedonia associated with anxiety/depression with the numbness associated with ssri's. For me ssri's reduced anxiety, which was a life saver. I felt less, but was glad to feel less. After a few years I tapered the ssri's down to zero.

[@DildoBorchiato22c]

"Very difficult to separate the anhedonia associated with anxiety/depression with the numbness associated with ssri'"? 😂 ahaahhahahahah

[@clausmehl8731]

Thank you for this video. Pssd is very hard. Including emotional numbness, anhedonia. and severe cognitive dysfunction. Sadly In my case htere was no improvement with vortioxetine. But worsen the condition

[@TheDavveponken]

Anything worked for you? I've found cialis to help and other artery expanding supplements such as arginine, citralline and some chinese herbs. The psych meds are usually vasoconstrictors which exacerbates these issues, if it isn't the very root cause. THere's been a study confirming the relationship between ssri's and cerebral vasoconstriction, as well as peripheral vasoconstriction. This and heavy exercise has been my best strategy. All to get the circulation and vascular tone back to normal.

[@anandtiwari52]

Time period of the clips is very appropriate, thanks.

[@JackJack-pr6mv]

So antidepressants which are designed to help people in emotional distress can end up making them depressed and emotionally numb ?

[@PsychiatrySimplified]

Unfortunately for some the side effects outweigh the benefits.

[@richardmaloneriki1811]

I've felt this multiple times from multiple medications. It's usually creative types who find this side effect intolerable. I now know that my ADHD was getting misdiagnosed as MDD, and you can't increase serotonin to get out of a dopamine deficit. I just wish the psychiatry field had assessed me correctly from the start, instead of pumping me full of incorrect medications for over a decade.

[@brendamoote7304]

Maybe they need to start earning their pay cheques. This would be received on how many patients they actually helped accurately .

[@johnchavez3270]

great video.... im wanting emotional blunting and this video has helped me on my quest

[@timothyhall7606]

You, my friend, are a legend. Such an informative video! Thank you.

[@PsychiatrySimplified]

Thank you for your feedback 🙏🏻

[@Christ_Is_Life10-10]

This is interesting. I have been accused of being unempathetic and mean by coworkers which really hurts because I don’t feel I have to give my medical history to explain what is going on with me. I tried to be transparent with my supervisor but she doesn’t get it and doesn’t seem to care.

[@nikicarrie4071]

They're probably being narcissistic to you. Gaslighting you to get their own way. Ypu don't owe them setting yourself on fire to keep them warm ❤

[@baboom1235]

Excellent video sir.... Please Please do a video on PSSD.

[@playcold32]

My question is how do I permanently repair my emotional blunting without EVER going back to these psychiatric drugs which caused my numbing in the first place? I'm a 5 year and counting sufferer of permanent ssri emotional numbness

[@PsychiatrySimplified]

Sorry to hear. It's a difficult question to answer. A discussion with a medical professional or psychiatrist is recommended as there are a number of aspects to be ruled out.

[@portside228]

Can you explain why emotional blunting/detachment persists past discontinuation? I don't experience anxiety, fear, joy or even love anymore. I also don't get endorphins from exercise anymore as well. I feel completely flat and numb. It's been like this since discontinuing the medication.

[@portside228]

Like someone else has said, There is constant blank mind. It feels almost like a brain injury. If you can address or comment I'd appreciate it. Thanks

[@PsychiatrySimplified]

@@portside228 Good question. The exact mechanism is not known. It is a similar mechanism to persistent sexual dysfunction, which again is not clear. Downregulation and desensitisation of 5HT1A are involved in regulating sexual motivation, and steady desensitisation may be one mechanism. Other aspects such as hormonal changes/changes in prefrontal dopamine may be additional mechanisms.

[@TheDavveponken]

I think it's due to cerebral vasoconstriction that has been linked with ssri's. This can cause your nervous system to not get the blood supply it needs and or the genitalia. Look up reversible cerebral vasoconstriction syndrome

[@portside228]

@@TheDavveponken Thank you for sharing this! I've never heard of this condition before but will look into it.

[@josefdez8258]

I just took 25 mg for just 4 days, and I feel like EMOTIONAL NUMBNESS Vous avez envoyé Can you tell me how did you recovered your physical feelings please?

[@ksdogg]

Would you ever do a video on the mechanisms of how tolerance occurs to a substance, both agonist vs antagonist? In the case of a repeated use of a blocker, is it that more receptors develop on the dendrite to combat the blocker binding to them?

[@PsychiatrySimplified]

Good question. In general in the presence of an antagonist ( blocker) - receptors will upregulate ( more receptors ) as you said and more sensitivity sometimes. In presence of an agonist - downregulation. Could do a short video in future linking to side effect such as tardive dyskinesia. Thanks for the suggestion.

[@ksdogg]

@@PsychiatrySimplified Thanks that makes sense, I'm guessing withdrawal is attributed to this mechanism which goes hand in hand with tolerance? An imbalance in receptors results in an overactive or underactive part of the nervous system in a withdrawal. What doesn't make sense to me is why tolerance builds up quickly, but after cessation in many cases takes far longer for receptors to regain equilibrium absent of the drug? I ask because I have a mirtazapine withdrawal which I did comment on your mirtazapine video. I thought of the Idea of using a H1 agonist to counteract Remeron's H1 antagonism but I don't even know if it's possible to obtain anything like that or even if that would work.

[@jackkerning3478]

I was on Paxil for about a month or two then quit. The emotional bunting never fully went away. I have never been able to feel joy or love like I did before the drug. It has been 20 years now. I have never gotten those emotions back.

[@josefdez8258]

Hello Jack. I just took 25 mg of sertraline for 4 days. I feel emotional bunting now

[@juancortes85340]

@@josefdez8258how are you doing now? Are your emotions back?

[@peachaesthxtic23]

I took an SSRI almost a year ago prescribed by a doctor, and till now I still haven't recovered from this.. I feel like I have lost my mind cuz it feels like sponge or jelly.. and empty and silent all the time as if it's dead.. I feel dead from inside.. it's making me feel hopeless n as if I have lost all the characteristics of a human inside me... I don't feel anything anymore nor I care, I feel lost whenever I go out, like I'm in some different planet with aliens all around, the world is moving on with a flow, while I'm here in a bubble just existing, completely disconnected from the world, not moving back or forth, but in the same position ... I'm not growing not learning anything.. pls help me in this.

[@PsychiatrySimplified]

Please seek a medical opinion again. We wish you well.

[@dannysmith8665]

Thank you for this! I have GAD, and my antidepressant (in this case, Effexor) was phenomenal in helping reduce symptoms of that. However, my other diagnosis is dysthymia (which has been life-long)...and unfortunately, this is where the SSRI-induced apathy REALLY makes those symptoms much much much worse. I'm lazy, feel nothing, and have to strain to enjoy ANYTHING. You mentioned vortioxetine as a treatment option and my psychiatrist also stated similar things as you - I believe he called it a "cleaner" version of an SSRI and actually helps anhedonia. It seems from what you said in this video that you agree. However, he also offered me moclobemide as an option (available here in Canada). This will be my next course of action; currently he's tapering me off the Effexor for an appropriate washout period before we commece the moclobemide. Do you have anything you can say about moclobemide in this respect?

[@PsychiatrySimplified]

Moclobemide is a RIMA and can be broad spectrum just as Vortioxetine. Main issue is twice or thrice daily administration. It has a good side effect profile. Vortioxetine has multiple mechanisms of action - SSRI action is minimal ( 50 percent less SERT inhibition) ; here is an article psychscenehub.com/psychinsights/vortioxetine-mechanism-of-action-2/

[@dannysmith8665]

@@PsychiatrySimplified Thank you so much!!! I will read the attached info on vortioxetine. Interesting that it doesn't reuptake serotonin; I had no idea!

[@boris9331]

@@PsychiatrySimplified What combination is known to be used for those that need the full SSRI effect but need a boost in emotion, reduce apathy, motivation as some people are emotionless, have no drive, apathy etc to begin with prior any treatment yet SSRI helps with anxiety

[@ginjanutta5865]

Thank you for this insightful video! Absolutely fantastic to see coverage of SSRIs! When will you be making one on PSSD? It's an incredibly traumatic condition that is rather widespread~ Would love to hear your insight on that issue.

[@PsychiatrySimplified]

Sorry to hear. There have been a lot of requests for PSSD so it's definitely on the list.

[@tanyamanna8407]

Wow! 🫶 Dr Sanil is amazing. l only discovered this channel today and it feels like l've gone down the rabbit hole of knowledge with watching these uploads. Im amazed at how, after 25 years of my personal experience within the mental health system here in Australia (which is good) , has evolved into one walking, living, breathing human with so much knowledge, it gives me hope that one day they will be able to help rewire our brains to function without the depression, anxiety or any other disorders like tourettes etc without going to the extreme of a labotomy which sometimes feels like the answer 🤔

[@PsychiatrySimplified]

Thank you for your feedback. Appreciate it 🙏🏻

[@noreennormandeau5476]

SSRI affects serotonin and dopamine. Even after discontinuing SSRI, sexual dysfunction continues - no sex drive, no libido. Are there any treatments for the PSSD- post SSRI sexual dysfunction?

[@PsychiatrySimplified]

We have just done a video on PSSD - we cover treatments. However the management can be challenging. kzbin.info/www/bejne/aWWYmHiBr5uegrM

[@emot_think]

Here another victim of that poison of SSRIs, thanks for talking about it! People have know this astonish danger

[@PsychiatrySimplified]

Sorry to hear. Hope things are better

[@Leety-o2j]

I have all these symptoms, my thoughts have gone, my brain is dead quiet, it is scary like you said you feel blank like a zombie.

[@randomguydoes2901]

the blunted or reduced emotional responses can be part of the improvement, but the emotional flatline you get from SSRI's definitely doesn't feel right. Psilocybin, ketamine and mdma have all put me in a more balanced state for days or weeks, after just one dose. Without blunting emotions but rather.. helping you feel them and reducing emotional reactions. Good and informative video. Just sucks that you're not yet allowed to say what I know.

[@justinedse8435]

Those are HIGHLY illegal.

[@cheesemonger6378]

@@justinedse8435 MDMA and Psilocybin are illegal, but the degree to which varies greatly. Psilocybin is being decriminalized in several places and some are even pushing for full legalization. Ketamine is completely legal with a prescription, though its hard to be approved for in most places it is certainly an option

[@pinklady1812]

I wish I had known all this before taking my ssri for 6 years. I feel like I’ve ruined my life. What’s the point of life if you can’t feel emotions?

[@PsychiatrySimplified]

Yes it is such an unfortunate side effect of SSRIs

[@Suttisan78]

Same for me, I was only on sertraline for 2 weeks 6 years ago, life has been ruined by anhedonia, you can't make any life decisions and it's a pretty pointless existence

[@Protracted-Withdrawal]

can you recommend some drug that can upregulate dopamine in prefrontal cortex after ssris? I quit them 12 years ago and cant feel anytihing ever since

[@PsychiatrySimplified]

Dopaminergic agents - agomelatine ( video on this channel), mirtazapine ( video), bupropion, psychostimulants ( video on this channel) ( require specialist input), tricyclic antidepressants and MAOIs ( specialist input. SNRIs. However maoi, tca and snri contain the S component so can still lead to side effects associated with serotonergic activity. ps not advice

[@SuperCody888]

These drugs sound so amazing and wonderful. When will you be doing a video about #PSSD (post ssri sexual dysfunction)? I believe its not as uncommon as once believed, its not diagnosed properly, or suffers are too embarrassed to bring it up. That suffers get gas lighted by Doctors because they've never heard about it, or told its underlying depression.

[@JL2LB]

please look into # PSSD ( post SSRI sexual dysfunction)

[@PsychiatrySimplified]

It is on the list. Will do one hopefully soon.

[@rmxbaby2604]

@@PsychiatrySimplified Thank you!!

[@TheDavveponken]

Just got back from the fourth doctor that gaslit me about it. Even after I referenced the reported side effects of vasoconstriction (a huge part in pssd). The response he had to that was: "well you haven't been diagnosed with that have you?" I'm like, yeah not yet, I'm trying but so far nobody believes me. Next time I'm gonna write an entire thesis about my diagnosis; but that will probably only serve to make me seem even more crazy and conspiratory. Hopefully the neurologist will believe me. There really needs to be a revolution on this subject.

[@hardesttruth0116]

I have 12 years PSSD because SSRI. I used it 2 weeks and stoped! All test are okay that leaves us with nerves (been to over 30 doctors and MRI). Theory is that to much serotonin, or to much anything is causing your brain and body to work more and put stress on your nerves. So that is why I think nerves could be in small amount damaged... not in a sence that you have pain in your extremities like at diabetes, but in a little amount. Maybe this is reversable with time, or maybe could be permanent. We dont know. I find that David Healy talks about nerve C fibers could be altered or a little dampered.. so how do we fix that? Also, SSRi are commonly prescribed for nerupopathy which is paradox. Maybe because SSRI lowers sensitiviry in nerves and then someone with neuropathy dont feel pain. I dont know?! BUT, all SSRI are EVIL drug and should be illegal! That is not drug, its poison. I can not recover from this 12 YEARS! Dont EVER take this SSRI! If I knew that this would happen I would NEVER EVER took this ssri! Only way doctors would learn is to put them selfs on SSRI for a month and see how they would feel, and if they dont commit suicide, then prescribe it to patient! People are commiting suicide because this! Suicide is mentioned in drug manual. Beter of commit suicide in the first place then take this drug, then you are in hell on earth! Thats how I would describe my condition PSSD after SSRI that lasts for 12 YEARS! And no one would look for cure for this!?!!??!

[@PsychiatrySimplified]

Sorry to hear . It is an important topic and unfortunately under recognised. We just released a video on this kzbin.info/www/bejne/aWWYmHiBr5uegrM

[@indaymemeh2426]

How are u right now? I was taking right now that med it feel like im a robot and zombi i will stop this medicine it makes me crazy

[@cyndigooch1162]

@hardesttruth0116 I totally agree with you about the immense harm caused by psychiatric drugs and my heart goes out to you as well! In fact, my life has been destroyed by family members and others who've been on one or more drugs for many years, or even decades, including my late mother. I won't go into the details because you have more than enough to deal with, unless you've improved by now, which I hope is the case. ❤

[@boris9331]

SSRI's such as Zoloft for me were great at anti anxiety which helped get through tedious tasks like nothing but provided no drive, no aspiration to do anything etc. So then what is a common add-on medication that can be used at some time to increase the will power, drive, emotion, drive to do things etc i find i have absolutely no will power to want to try new things laugh to peoples jokes etc and all that . In fact a lot of depressed people have low drive and emotion to begin with which SSRIs dont seem to fix. Perhaps a stimulant that can work complimentary to the SSRI ? And many thanks for sharing your info

[@webw3b346]

This was very insightful. Thanks for covering such a topic with a very detailed explanation it’s an eye opener. How long does the emotional blunting usually last? Does it go away suddenly or is permanent?

[@PsychiatrySimplified]

Do you mean after stopping medication or while on it

[@webw3b346]

@@PsychiatrySimplified i meant while on it but I’d be interested to know how long it would take on both cases

[@PsychiatrySimplified]

@@webw3b346 while on medication SSRIs are usually most associated with it. In general if present after dose is stabilised for > 2 weeks and not reduced then it could indicate dose adjustment needed or switch to other AD: some patient find the blunting helpful as it keeps the anxiety at bay, reduces the hypersensitivity to distresing stimuli. If however one finds the blunting problematic - discuss this with doctor: usually after stopping it goes away in 1-2 weeks ( may will find rush of emotions or emotionality). There are other options which include dose reduction or divide reduction plus another AD which is not associated with blunting e.g agomelatine, vorrtiixetine, bupropion etc: your doctor would be able to discuss these options. With you well. Emotional blunting persisting after cessation or switch to other nedication ( one that is not associated with EB) long term is every rare. Ps not medical advice

[@webw3b346]

@@PsychiatrySimplified thank you so much for the valuable information. Greatly appreciated!

[@riosimpson6019]

@@webw3b346 his lying to you the emotional blunting stays their forever I still feel it till this day and its been a yeat

[@josefdez8258]

Hello , Did you recover your feelings and physical emotions? How long does it last? I just took 25 mg for just 4 days, and I feel like that!!

[@mackk294]

Hello, is switching from SSRI to Maprotiline good idea , will it help with PSSD symptoms? it's a noreadrenaline drug - it's old but some people prefer it over serotonin agents. what do you reckon?

[@PsychiatrySimplified]

We can't specifically provide advice here but in general agents that promote NA and or DA have a lower incidence of Sexual side effects. Here we cover some additional aspects of AD induced sexual dysfunction in general. kzbin.info/www/bejne/mGiUgK2Gqs-Eesk

[@biologyandemotions2861]

Thanks doctor for your very precious dissemination. However, I would also remember that the dampening of negative emotions is not necessarily always a good thing (neurobiologically and evolutionarily speaking).

[@PsychiatrySimplified]

Yes blunting of emotions is blunting the reward pathway and is not a good thing. SSRIs work at low doses in reducing amygdala sensitivity but it’s the higher doses where the blunting becomes the issue

[@Slazerable]

How about bupropion? Stress and anxiety causes emotional blunting too, right? How can you tell for sure if its phrmacoogical cause?

[@PsychiatrySimplified]

Emotional blunting is a very specific symptom. This can be confused with brain fog, or slowed cognition arising from other causes. Emotional blunting is usually described in the context of medication related blunting.

[@CraigWedd]

very informative, i am in the midst of tapering off escitalopram and swaping to agomelatine.. the effect of the ssri on my libedo was the main decider on the swap... i would choose the sexual dysfunction any day over the crippling anxiety i suffered prior, but why not have your cake and eat it too.. i am very excited for the change.. fingers crossed i get the desired outcome... thanks for the vid doc 🙌🙌🙌🙌

[@PsychiatrySimplified]

Was just commenting on the other video we did on agomelatine where a viewer commented on this swap. How is Agomelatine different from other Antidepressants? | A Psychiatrist Explains | Dr Rege kzbin.info/www/bejne/mHrRf2OkqZmGaLs

[@CraigWedd]

@@PsychiatrySimplified haha that was the first video i watched when i was prescribed Agomalatine from my gp.. keep up the great content

[@SM-by8mg]

@@CraigWedd Any success from agomalatine for ssri induced emotional blunting ?

[@Hecatone]

Cover PSSD, I've experienced it for for nearly 25 years.

[@PsychiatrySimplified]

It's definitely on the list. Will plan to shoot soon. Thanks for your patience.

[@Protracted-Withdrawal]

Can it be anyhow reversible? its been 12 years since i quit ssris and cant feel any emotions.

[@PsychiatrySimplified]

Depression can be associated with emotional numbing or blunting. It is important to rule out depressive illness or apathy and treat this. A psychiatric assessment would be beneficial. ps not advice

[@Protracted-Withdrawal]

@@PsychiatrySimplified never had depression, never had emotional blunting before ssris. i has been ruled out long time ago

[@PsychiatrySimplified]

@@Protracted-Withdrawal thanks for sharing. What were the ssri’s prescribed for in your case if you don't mind sharing.

[@Protracted-Withdrawal]

@@PsychiatrySimplified I had mild social phobia, now thats gone too. My personality has been completly removed. How can I bring it back? My sexuallity, cognition, emotions?

[@PsychiatrySimplified]

@@Protracted-Withdrawal sorry to hear. Have any other medications been tried to treat the symptoms you are experiencing

[@jerryholdcroft4607]

I am also curious Dr. Rege, when I try and force positive emotions and feelings it's like someone suddenly puts on the brakes and either steers me into a ditch (negativity) or slows me back to a slow pace (flattening) , it's like my subconscious will simply not allow anything positive (or significantly negative) to be triggered?, the sheer power of something able to so easily override free thought is astounding to me!. This power includes sleep, where dreams are always kept flat and very boring!. I can see clear parity with emotional blunting and sexual dysfunction because of the non-reaction to stimulation, even my historically arousing porn does nothing (pure research!), I am also incapable of holding an erotic thought including dreams for more than a few seconds? Genital numbing is cruel reminder!. Can all this be attributed to 14 years of taking 100mg of an SRRI?.

[@PsychiatrySimplified]

SSRI can be associated with this yes but of course other aspects need to be ruled out. Over time for some dose modulation is needed. In clinical practice in the context of such side effects a gradual reduction often can reduce or disinhinit the blunting ( like lifting the leg of the brake a bit - not completely ) .

[@jerryholdcroft4607]

@@PsychiatrySimplified Yes I should have had a 'maintenance dose' at some point apparently and yes the effects of the original problem (depression/MDD) will have contributed towards my mental state as well my personal circumstances. I realise the many cases of SSRI side effects can be diverse and people can be affected to different degrees, I'm sorry if I seemed a bit 'full on' but I haven't been able to share this with anyone who understands before and express myself to this extent. I see two paths ahead, either gradual reduction of dose or change to Vortioxetine to better moderate the control of Norepinephrine, Dopamine etc as perfectly illustrated in your video. Thanks again.

[@finrdygdbg]

Allright, I will not take them. I don't wanna lose my emotions.

[@Lilianna3564]

Great and informative video. Thanks, Doc. :)

[@PsychiatrySimplified]

Thank you for your feedback. 🙏🏻

[@drsandhyathumsikumar4479]

Excellent info wellnpresented. With gratitude

[@PsychiatrySimplified]

Thanks for your feedback 🙏🏼

[@pilwespoisu]

Can you reccomend a supplement that can help with emotional blunting. I am taking a very low dose of ecitalopram

[@PsychiatrySimplified]

Sorry can't recommend as that would be advice and further to recommend one would need to assess. Your doctor and or pharmacist may be good sources to ask

[@calliopec544]

The emotional blunting can most definitely be permanent, even after coming off a relatively low dose.

[@darkprinceofdorne]

Yep 2 pills of prozac for me. Can’t feel fear for 2 years already. And head pressure during moments when I _should_ feel emotions.

[@amethyste684]

It physically hurts to cry and by cry I mean shed 1 singular tear 🤣

[@isaiahking95]

This must have an individual/genetic component because I’ve been on three different drugs (albeit nos was mirtazapine). I’ve never experienced any permanent effects. Once I’m off, I’ll be just as much of an emotional dumpster fire as I’ve always been.

[@ashuvijay7031]

​​​@OsakaSyndrome​ I m also feeling sexual numbness during forplay... There is no hot feeling when touch a girl ! I get erection pleasure and orgasm also...when I think about sex and do sexy talk with girls on call and do masturbation ! But dont feel hotness When touch a girl body in real ! I feel like I m touching a boy body or a child body... When do forplay with girl 😢😢😢😢 I took 5 mg of Escitalopram and 0.25 mg clonazepam for 4 month.. Then I left it within next 2 month by tappering slowly slowly ! But after 6 month of tappering completely I m facing this issue What should I do 😢😢😢

[@TheDavveponken]

Is it still the same? I've been this way for over a year now after taking methylphenidate for 8 days. On good days I can focus my energi on overcoming the blockage in my head and instead focus on other parts than the frontal lobe and then feel very intensely, to the point of just sobbing. I've found sobbing really works, if you can manage it. My hypothesis is that the sympathetic nervous system is overactive to the point of being paralyzed, which also would mean there'd be little to no room for the parasympathetic nervous system. Acupuncture between your eyebrows really helped as well for me, it took away a lot of the tense headache stemming from there.

[@zaccameron]

Thank you for your explanation. Is it possible for anhedonia/emotional blunting to arise and persist following discontinuation of just 1 SSRI pill? I'm trying to work out if I'm just experiencing depression-related anhedonia or there is something more complex going on with respect to dopamine. I note many with PSSD say they experience anhedonia too.

[@PsychiatrySimplified]

Sexual dysfunction and Anhedonia frequently coexist as similar mechanisms. It is highly unlikely though after one tablet. But I’ve learnt never to dismiss anything but probability is low. Usually the most common reason is an underlying anhedonia related to depression. This is only identified through history and examination. Anhedonia consists of 3 types . Anticipatory ( no point doing it because I won’t like it anyways) , Consummatory ( I want to but I don’t get any enjoyment ) ; motivational ( I don’t want to ) . In depression begins with second then moves to first and then in severe cases third. Anhedonia as you can see with depression depending on duration can be all 3. If all 3 or even two are present this is more likely depression as a single dose is unlikely to lead to anticipatory as that takes time to affect reward learning. SSRI blunting initially affects the Consummatory.

[@zaccameron]

@@PsychiatrySimplified Thank you so much Dr. Sanil. I’ve been spiralling into an anxious mess trying to work out what has been going on the last two days, but your reply is very well explained and has helped me a lot. All the best, so good to hear some helpful info on this topic from a fellow Aussie! 👍

[@josefdez8258]

I just took 25 mg for just 4 days of sertraline, and I feel like EMOTIONAL NUMBNESS without feelings Can you tell me how did you recovered your physical feelings please?

[@iamthefiremanjj]

Why not add something like buspar or atomoxetine? Atomoxetine Increases Extracellular Levels of Norepinephrine and Dopamine in Prefrontal Cortex ; buspar also increases dopamine in the pre frontal cortex as well as the nucleus accumbens . Would this counter those side effects ?

[@PsychiatrySimplified]

These are recommended agents to counteract blunting. Dopaminergic and nor adrenergic agents can treat emotional blunting

[@eugenethomas1248]

When it come to learning how to deal with the affects that you talked about what are some coping skills that you can use to deal with your feeling in healthy matter without putting the community in danger and family and friends, and.

[@PsychiatrySimplified]

This is a really broad topic. Have you discussed this with a doctor or a psychologist?

[@kylercainfitness]

I've been looking for this information for so long. it's hard to research when you're not so familiar with any of these terminologies, and neither are the "Professionals" in the space. I always have heard, we don't know how SSRIs work, but obviously this is very untrue.

[@PsychiatrySimplified]

We don't know exactly how they work in terms of the specific effects on mood/anxiety but there are a number of hypotheses and we can test these in practice

[@nodnarbalak1531]

Love your content. I truly think you are doing the world a lot of good by sharing this scientific knowledge of these medications to the general public in such a digestible format. A friend of mine is on Escitalopram (22.5mg, medium to high dosage) and found that higher dosages caused significant apathy. They've also found that memantine (for their ocd) as augmentation had greatly increased their motivation. I am wondering, is it possible or even probable that memantine could be used as a treatment for SSRI apathy? I'd love to see a video on memantine at some point! Interestingly they did not respond to bupropion which induced anxiety for them.

[@PsychiatrySimplified]

good point - yes via glutamate modulation it can improve cognition and perhaps other symptoms. - it's not used for this purpose though. I;ve covered memantine and indications in this article - psychscenehub.com/psychinsights/memantine-psychopharmacology/

[@javiertorres-bb8lf]

One of the main ingredients in these SSRIs is FLUORIDE. At least this is what a Dr. told me and did not want me on these drugs.

[@larryc1616]

I took cymbalta for 1month and it turned me into a zombie- emotionless, not caring, existing but not living. If there are no blood tests for neurotransmitters, how can doctors prescribe antidepressants?

[@PsychiatrySimplified]

Sorry to hear. Not all antidepressants are associated with this side effect. Also clinically in many patients treating the negative emotions outweighs the blunting effects - th benefits outweigh the risks.

[@larryc1616]

@@PsychiatrySimplified well, I didn't have depression or any mental illness but have disabling ME/CFS. There is no drug and no treatment for this disease still today. But some ignorant doctors back in 2008 thought CFS was just some mild depression when we all know now(and then) it's an immune disease triggered by a virus-flu, ebv/mono, Lyme, enterovirus, covid...

[@PsychiatrySimplified]

@@larryc1616 CFS is a heterogenous condition. Addressing the various components becomes important - mood, fatigue, pem, pots, sleep and circadian rhythm dysfunction, autonomic disturbances, immune dysfunction and Hpa axis dysfunction. We covered this in another video on CFS. Treatments include targeting symptoms - you are correct that there is no one single treatment or cure because it is a heterogenous condition.

[@mieero]

Whats your view on homeopathy regarding depression And anxiety I am feeling better but slowly And no side effects. Its help me in ibs and in emotional blunting also. I tried many drugs but homeopathy is slow but still worth of it. Please make the video on homeopathy.

[@karen4349]

How long did it take to resolve the emotional blunting? How long did you suffer from emotional blunting? Were you completely numb to all emotions? And whya medications did you take in homeopathy?

[@SM-by8mg]

Did you get emotional blunting from ssri ? And homeopathy helped you completely from recovering emotional blunting . Please comment as I have hemopathy tonic but I am not using it.

[@mieero]

@@SM-by8mg help me in start little but still no recovery hope you will fine.

[@stevebierman9988]

Thank you, Dr. Rege! As always, you’re a godsend. What would be a better proposal to my psychiatrist for further reducing my anxiety: Increase Lexapro dosage (currently 20mg for 3+ months), or add buspirone as adjunct?

[@PsychiatrySimplified]

Advising over a forum would be in appropriate. Lexapro is evidence based and effective for anxiety and dose can be increased - this will depend on tolerability. Buspirone is also evidence based for anxiety - this is a discussion best had with the treating doctor as they will know the plan and your specific circumstances. Thank you for your feedback and wish you well.

[@stevebierman9988]

@@PsychiatrySimplified Thanks, always look forward to your videos: You help make research actionable, because when we understand the evidence we're better able to discuss with our providers.

[@boris9331]

@@PsychiatrySimplified Yep out of all tablets i tried and it was many, Lexapro was the best for anti-anxiety.

[@seasidepatio832]

Is there a notable risk for serotonin syndrome with ssri/snri augmentation with mirtazapine? I usually augment with bupropion since it wouldn't have an additive serotonergic response to an ssri/snri being that it's primarily a dopamine agonist. BTW, love your channel!

[@PsychiatrySimplified]

Ssri and snri augmentation is an established augmentation strategy with minimal risk of serotonin syndrome as mirtazapine has minimal serotonin increase and has serotonin antagonist properties. STAR- D trial had venlafaxine and mirtazapine combination as 4 th line in TRD. I've covered this in the video on melancholic depression and also done a separate video on mirtazapine where I cover properties in more detail. Mirtazapine - Mechanism of Action and Psychopharmacology By Dr. Sanil Rege kzbin.info/www/bejne/kJKmnZuNqJuFsLM Bupropion is a good choice for augmentation. Thank you for your feedback.

[@SM-by8mg]

I have used paroxetine ssri for a month and its been 5 year that I haven't recovered from low brain energy and emotion blunting . Also , reinforcement learning has been affected with the ssri . Now I am thinking of mirtazapine, agomelatine, bupropion for treatment of emotional blunting but don't have the courage to again inject these chemicals in my body with a lot of other side effects. My question is that Doctors himself uses these SSRI for depression or they only injecting it in other people.

[@Augustin712]

Can SNRIs like Venlafaxin also cause apathy/anhedonia at high doses? Because that seems to be how I feel! And what can one do? Switch to another SNRI like Milnacipran? Or add Buproprion? Lower Venlafaxin?

[@PsychiatrySimplified]

Venlafaxine can lead to emotional blunting as it's sert affinity is significant and continues to increase with higher doses without at higher doses NA and some DA comes in. Agents with lower sert affinity snris are desvenlafaxine, milnacipran, duloxetine, levomilnacipran. Other agents that are mainly dopaminergic and noradrenergic are bupropion, psychostimulants, agomelatine ( milder), mirtazapine at higher doses etc. Ps not medical advice. You can view the video on antidepressants mechanisms we did

[@Augustin712]

@@PsychiatrySimplified Thank you :) Can Venlafaxin be combined with Buproprion?

[@PsychiatrySimplified]

@@Augustin712 Bupropion inhibits CYP2D6, which can increase venlafaxine levels - hence caution is advised. Also, the combination creates a very activating AD, but it depends on what Sx need to be treated. There are other safer ways to get the combined effect which you can discuss with your doctor. Pharmacologically if combined, one would need to be mindful of the interaction as if the dose of venlafaxine is high already, this can be concerning. so it depends on the doses of venlafaxine used. this is a question for the doctor as the dose of venlafaxine is variable. PS not medical advice.

[@Augustin712]

@@PsychiatrySimplified What do you mean by 'activating AD' and 'Sx' in your Answer? Sorry i am not familiar with medical Jargon

[@PsychiatrySimplified]

@@Augustin712 activating antidepressant. Sx - symptoms.

[@levistacey1267]

Please address the sexual side affects no more orgasms at all. It seems permanent after being off the medication

[@PsychiatrySimplified]

We have done a video on PSSD - kzbin.info/www/bejne/aWWYmHiBr5uegrM

[@johns966]

If your depression is characterized by anhedonia should you steer clear of ssris?

[@PsychiatrySimplified]

Very good question. Anhedonia is linked to Dopaminergic activity. SSRIs can reduce DA in the reward pathways in some individuals more than others hence the blunting and sexual dysfunction . Agents such as Vortioxetine, Agomelatine , bupropion , Mirtazapine are agents that treat depression without this issue. SNRI’s such as duloxetine and Desvenlafaxine are others that have lower SERT blockade compared to venlafaxine hence address anhedonia well due to NA and DA activity. Your doctor will be able to advice the best option . Ps not medical advice

[@alexo6836]

i was on isotretinoin for 14 days but on 15 i suddenly start lossing my feeling. I am emotionally numb and lost my libido. What should i do ??? Should I wait and watch????

[@PsychiatrySimplified]

Please discuss this with your doctor as genital numbness if present and loss of libido can also be initial signs of PSSD ( see the other video) - isotretinoin is associated with it.

[@wonderboyj8]

Great explanation.

[@PsychiatrySimplified]

Thanks for your feedback 🙏🏼

[@Pareshrannaware_]

Please make videos on how to overcome from it by which medication or any other way. Hi mr . Dr I'm from india.please I'm suffering from these kind issue.

[@Guillermof20]

Great video. Please do one about PSSD and how to deal with it please. Thank you!

[@PsychiatrySimplified]

Will do

[@joeshugabowski1444]

Get viagra, phizer gor u covered💪

[@lindaphillips3440]

I have been on effexor for 15yrs, i cannot cry and feel disconectec. What can i do?

[@PsychiatrySimplified]

Please discuss this with your doctor. This can be addressed. Dose reduction with or without augmentation with agents that treat emotional blunting is an option. See videos on Vortioxetine , Agomelatine . Most importantly venlafaxine should not be stopped after taking it for a long period. Dose reduction and augmentation is usually an option for patients. Ps not medical advice

[@diartahazrolli9411]

Will all of those symtoms go away after we stop SSRI because it doesn’t have sense if the numb continue

[@PsychiatrySimplified]

Yes in the majority the emotional blunting ceases.

[@diartahazrolli9411]

@@PsychiatrySimplifiedso i will be able to feel again🥹🥹

[@PsychiatrySimplified]

Please discuss this with the doctor as I don't know the specifics. I can only comment generally

[@Adrem37733]

​@@diartahazrolli9411My emotions never came back

[@diartahazrolli9411]

⁠@@PsychiatrySimplifiedthanks it’s just anxiety and dissociation so i know that is normal even that i feel so baf when i don’t feel love i understand that is part of anxiet thanks anyaway❤

[@lisawest1556]

Thank you Dr, Rege. I have been on fluoxetine for a very long time and experience emotional blunting. No matter what add on, I would end up in the same numb place. My doctor added a low dose of Vyvanse to the fluoxetine and although at times I still struggle with depression and motivation, it is the only med so far that has given me any type of brightening affect. I fear discontinuing Vyvanse at any point, dreading the nonexistent feelings. Any comment to this statement would be very appreciated.

[@PsychiatrySimplified]

Vyvanse is dexamphetamine which is dopaminergic - the mechanism of ssri indices blunting is reduction of dopamine in ventral striatum - which vyvanse will counteract. This is an appropriate strategy if indicated and monitored.

[@liorlevi7677]

Try rhodiola rosea, its very safe, fights stress makes my mood more vibrant and colourful. Its slighly stimilating (dopaminergic) but also it helps anxity

[@mcb00]

Stimulants tend to stop working and in some cases cayseta rebound effect, so you're left more apathetic and numb thsn before. Please be careful.

[@Creestle]

If someone has residual emotional blunting from SSRIs, are there any lifestyle choices/non-medication options that may help them heal, if they're too reticent to try another medication? Could exercise potentially help the frontal lobe rebalance itself? (I will ask a doctor before making any notable changes to diet/exercise/supplements etc.)

[@PsychiatrySimplified]

Generally emotional blunting post SSRI is due to residual non medication effects than a post SSRI effect. So the things you mentioned will help if mild. Exercise, activity, regular routines, goal directed activity are things that help with Reward enhancement through dopamine. Otherwise medications that are dopaminergic are considered Rx.

[@TheDavveponken]

vasodilators can help. Psych meds are vasoconstrictors and also affect venous tone, which can even further issues. Exercise, arginine, citrulline, creatine, protein powder, cialis (tadalafil) has helped me. Oh and saffron too. Make sure you have your overall vitamin and mineral needs met.

[@silentjellybean]

I just found out SSRIs reduce dopamine, some people are saying salt can help increase dopamine.

[@PsychiatrySimplified]

SSRIs indirectly can reduce frontal dopamine but this may not be clinically evident in all individuals. SSRIs by acting on 5HT1A receptor ( agonist) and 5 HT2C ( antagonism) can increase Dopamine . So the relationship isn’t so clear cut. Salt in excess can be harmful. Please discuss this with a medical professional who can explain this taking your individual needs into account.

[@silentjellybean]

@@PsychiatrySimplified thanks, currently 20mg escitalopram, just trying < 1/4 teaspoon of sea salt for a while to see if it helps with motivation, presuming the reward connection with dopamine is valid.

[@Poetry-For-The-Itch-Of-It]

How do older drugs like trazodone affect emotion

[@PsychiatrySimplified]

According to the mechanism of action. It does not have a blunting effect.

[@MikouLove]

Are these effects permanent or can they be undone, or go away with time after stopping the use of SSRI’s?

[@PsychiatrySimplified]

Emotional blunting is reversible in the majority of cases on cessation. In some treatment is needed to reverse it.

[@MikouLove]

If I have been blunted for 3 weeks now should I continue waiting or consider treatment now?

[@MikouLove]

This is 3 weeks post discontinuation

[@MikouLove]

What treatment is available?

[@PsychiatrySimplified]

Ruling out other conditions , throrough assessment for other coexisting symptoms, alternate treatments for identified symptoms

[@pinkfloyd30stm]

SSRIs saved my life but the fatigue is everlasting 💀

[@PsychiatrySimplified]

There are ways of addressing this - please discuss this with your doctor

[@pinkfloyd30stm]

@@PsychiatrySimplified tried many antipsychotics and mood stabilizers to try to negate the fatigue which made me restless and have involuntary movements. Rather be tired than not in control of my body functions. 😭

[@lo9761]

Can u give me the article where u found this chocolate thing

[@PsychiatrySimplified]

www.ncbi.nlm.nih.gov/pmc/articles/PMC2828549/

[@tawseef8755]

Due to some shock i am feeling anxiety and fear, my doctor prescribed antidepressants 5mg....i am on second week taking this.....sir whats your advice, shall i continue, how long i can assume dosage is safe....if doctor discontinues before 2 to 3 months, am i still prone to emotional blunting

[@anushkadnanayakkara]

Dr. Sanil. Your vedios are very interesting and helpful. Could you please do a vedio for Mental breakdown and recovery process 🙏 🙂

[@PsychiatrySimplified]

Thank you for your comments . What Depression and Anxiety Look Like in the Brain kzbin.info/www/bejne/rKqcaKqQht54qJo Recovery - The Neurobiology of Recovery in Mental Health - Understanding Motivation and Reward kzbin.info/www/bejne/imi3l4eCbMlsgrc

[@lumenrt.1373]

I've been on Prozac 20mg for about 2 and a half months for my depression. I was almost cured 'till 2 weeks ago the emotional blunting happened and i miss the good feelings i had. My doctor agreed yesterday to drop the dose to 10 mg. How much time will i need to see if this actually works? 😅

[@PsychiatrySimplified]

Usually 1-2 weeks the effect of any changes is noticeable . Ps not advice

[@mcb00]

Some people never get better. Please do not stay in meds that cause blunting. It can become permanent. For many of us this is not a temporary side effect, but a neurotoxic brain injury.

[@kersbomb]

The thought of knowing this probably means more medications in my life coming soon 😮‍💨 starting to feel just as flat as when I started them 🥲

[@louisskulnik7390]

I am going to go to get psychiatric help after the first of the year. Going to get tested for ADHD, too. Here is what I want: Hyper focus on work tasks, and silence besides that. I want to be a piece of useful furniture, a tool. That is my goal.

[@lydiamoore142]

I have bipolar, anxiety and panic anxiety diorders. If doctors could feel what we feel, they would be on meds too, and if they went through detox, they would say,” what did I do to my patients. “ they have no idea what we go through.

[@muzammilkhan4482]

Sir please make a video on endoxifen

[@erickfernando18]

Hey man, does this applies to stimulants? vyvanse, adderall, ritalin

[@PsychiatrySimplified]

No this does not as they are all dopaminergic. Dopaminergic potentiation improves drive.

[@Smashachu]

I would like to call ssri's the "psychopath simulator" drug. I couldn't cry even while at the funeral of people i loved and missed very deeply, i couldn't feel blissful joy. All i could feel is hollow, and it made faking my emotions and lying much easier. I think a big part of why people take them is to make saying whats on your mind easier, unfortunate the way that it does this to our emotions is akin more to using a hammer during a surgery rather than a skalpel like is needed. Because feeling anxiety is definitely important, otherwise we will just run around and tell people exactly what is on our mind all the time. No beauno, calling my girlfriend out every time they're acting abit emotionally irrational recipe to become single.

[@allanpradorocha7265]

After one year of the publishing of this video, has there been any news on how often do this manifest? And is there's a way to PROPERLY treat it? Thanks in advance

[@PsychiatrySimplified]

There are treatments for emotional blunting - switch / agents such as Agomelatine / Vortioxetine / bupropion. Ps not advice

[@Mordeomaneater]

I need emotional blunting.

[@PsychiatrySimplified]

Some patients describe the emotional blunting as helpful.

[@SubmitTheKraken]

lexapro works from 2 weeks to couple of months and gives you that false sense of serenity and then it disappears

[@lisawest1556]

Thanks!

[@PsychiatrySimplified]

Glad you found it useful.