Mental Health Can APs induce permanent anhedonia?

[timsul999]

After multiple failed trials of psych meds for treatment-resistant dep/OCD, a doc in rehab prescribed me Prozac + Zyprexa. I was only on the Zyprexa for 6 months, and while it worked effectively for anxiety, I ditched it because of the emotional blunting. So I've been 2 years AP-free, and I'm pretty positive that's where my persistent low-pleausure baseline/anhedonia comes from. I never had it before I hit my 20s and was medicated. It's pretty fucking discouraging to read studies on AP-induced brain shrinkage and numerous anecdotal reports online that state APs cause apathy, avolition and anhedonia even after cessation. I've already scoured sites like /r/nootropics and Longecity for answers and it's pretty fruitless. Has anyone been on antipsychotics long-term, came off and still feel like who they used to be? It's been 2 years and I still refuse to accept the fact that this is the new normal, and I really hope somewhere down the line I eventually recover.

 

[Ligaturd]

I have never been on anti-psychotics but I have a feeling that when I go for my psychiatric assessment they will try to put me on them. I have been reading countless stories of long term side effects of neuroleptics but I have read of people recovering from them and it just doesn't seem worth it whatsoever. Anhedonia and also Parkinsonianism, Tardive Akisthesia, Tardive Dyskinesia can all come on long after cessation of the usage of many anti-psychotics. I will exhaust every single other avenue of treatment options before I would ever consider taking AntiPsychotics.

 

[Ozle]

If you have treatment-resistance depression, isn't that more likely to be the cause?

 

[timsul999]

I have never been on anti-psychotics but I have a feeling that when I go for my psychiatric assessment they will try to put me on them. I have been reading countless stories of long term side effects of neuroleptics but I have read of people recovering from them and it just doesn't seem worth it whatsoever. Anhedonia and also Parkinsonianism, Tardive Akisthesia, Tardive Dyskinesia can all come on long after cessation of the usage of many anti-psychotics. I will exhaust every single other avenue of treatment options before I would ever consider taking AntiPsychotics.

Yeah, I don't recommend it unless you're full-blown psychotic. They're way overprescribed, and IMO they're not suitable for long-term maintenance therapy in any case.

If you have treatment-resistance depression, isn't that more likely to be the cause?

I actually hope so, because that ironically sounds more treatable. If APs really cause a loss of DA neurons there's no way I can get that back, it's like a crucial element of my humanity has been stolen. I lived a really clean life the year after I left rehab; vigorous exercise regularly, consistent sleep, decent diet and social life, and I still felt motivationally impaired and unable to enjoy what normally interested me before. I'm convinced something went awry, and I'm not sure if it was antipsychotics or some kind of lasting effect from addiction.

btw I just realized you were referring to my original post - It was rather the OCD that was unresponsive to SSRIs and caused the depression, which was more of an active despair than constant anhedonia.

 

[LookingForSelf]

Yeah, I don't recommend it unless you're full-blown psychotic. They're way overprescribed, and IMO they're not suitable for long-term maintenance therapy in any case.



I actually hope so, because that ironically sounds more treatable. If APs really cause a loss of DA neurons there's no way I can get that back, it's like a crucial element of my humanity has been stolen. I lived a really clean life the year after I left rehab; vigorous exercise regularly, consistent sleep, decent diet and social life, and I still felt motivationally impaired and unable to enjoy what normally interested me before. I'm convinced something went awry, and I'm not sure if it was antipsychotics or some kind of lasting effect from addiction.

APs kill the dopamine but the brain fights back by creating more dopamine neurons. The bad part? When you come off the APs you are OVERLOADED with all the additional dopamine. I'm currently in this situation, trying to self taper and keeping an eye on signs of mania. Actually thats a darn good question to answer: Does increased dopamine cause feelings of mania?

One thing that was a blow to me about this is that your not suppose to have too much dopamine inorder for cause sleep to naturually occur. With all my new dopamine friends I now may start to suffer even more debilitating chronic insomnia. Nothing is worse than incurable sleep deprivation.

 

[timsul999]

Yeah, I can confirm the manic/impending doom feelings when I attempted to stop a few times before finally stopping for good. A really gradual taper (splitting the tablet into halves and then fourths) seem to eliminate it/

 

[swisscurrie]

Antipsychotics can significantly shrink your brain and cause permanent brain damage.

http://www.ncbi.nlm.nih.gov/pubmed/15756305

^That study compared olanzapine wth haloperidol and shows the significant shrinkage.

Atypical antipsychotics like risperidone and olanzapine are not directly neurotoxic as typical antipsychotics like Haldol are, but they can still shrink your over time and cause a strong disregulation of neurotransmitters.

Despite being dangerous, Symbax (olanzapine and fluoxetine) is used for treatment resistant depression as in your case. Is it possible that your anhedonia was a part of your treatment resistant depression? I think its possible, but unlikely that significant permanent damage would occur after 6 months of use. Are there any other neurotoxic drugs you used in this time? MDMA or prescription stimulants? Persistent low grade anhedonia is common after heavy amphetamine abuse and can be permanent. This is due to neurotoxicity. Olanzapine is supposedly effective against anhedonia and it is often prescribed for negative symptoms in people with schizophrenia. It is possible though that it causes brain damage which may translate into a worsened anhedonia. Unfortunately practically zero research is done into the detrimental effects of psych drugs on the brain. If this research was done and the results were published, I doubt anyone in their right minds would take them. Every class of psych drugs will permanently change your brain if taken over many years.

Even if there is some permanent damage, I think it is best that you look foward. Eat healthy, do tones of exercise and maybe look into some natural remedies for depression.

 

[Ozle]

In excess, I suspect they do. In fact most psychoactive drugs (alcohol, stimulants, antidepressants, opioids, etc) can induce anhedonia with prolonged high dose use. The big problem is that what constitutes an excessive dose can vary considerably from one individual to another, and prescribing doctors seem to lack any rigorous process for determining the appropriate dose for a given patient, often resulting in prescribed doses far above what they should be receiving.

The alleged brain damage and shrinkage issue doesn't seem particularly clear. Pretty much any substance that has a significant effect on brain chemistry will produce changes that can be interpreted as "damage". Comparable decreases in brain mass have also been observed in unmedicated controls suffering from bipolar, schizophrenia, and even depression; I'm not even sure it's been shown that the same process doesn't occur to some degree with age in perfectly healthy individuals. IMHO, it's tenuous (at least at this stage) to assume that there's a direct causal link.

I believe the main reason there have been so many studies on the subject of possible cognitive deficits induced by these classes of drugs stems from the fact that they are/were often used in patients with dementia, where even relatively minor changes can make a considerable difference.

 

[timsul999]

In excess, I suspect they do. In fact most psychoactive drugs (alcohol, stimulants, antidepressants, opioids, etc) can induce anhedonia with prolonged high dose use. The big problem is that what constitutes an excessive dose can vary considerably from one individual to another, and prescribing doctors seem to lack any rigorous process for determining the appropriate dose for a given patient, often resulting in prescribed doses far above what they should be receiving.

The alleged brain damage and shrinkage issue doesn't seem particularly clear. Pretty much any substance that has a significant effect on brain chemistry will produce changes that can be interpreted as "damage". Comparable decreases in brain mass have also been observed in unmedicated controls suffering from bipolar, schizophrenia, and even depression; I'm not even sure it's been shown that the same process doesn't occur to some degree with age in perfectly healthy individuals. IMHO, it's tenuous (at least at this stage) to assume that there's a direct causal link.

I believe the main reason there have been so many studies on the subject of possible cognitive deficits induced by these classes of drugs stems from the fact that they are/were often used in patients with dementia, where even relatively minor changes can make a considerable difference.

I somewhat agree. The research on the long-term, adverse effects of APs is underdeveloped, and I think it would be unwise to draw any solid conclusions from it. However, if some direct, causal link is discovered between the brain shrinkage and worsening of negative symptoms, I think it would pretty much be game over. To further paint an impression of a reasonable "trade-off" of psychosis or OCD for enduring a life of negative symptoms is also ridiculous. I had a shrink try to rationalize staying on APs in this way; like maybe your interests and passions are removed, but you can function better. I'd honestly rather toil away in psychosis than amount to some drone slaving away striving to fit some societal mold with no windows of feeling whatsoever. /endrant

To be fair though, I did so many drugs and was on and off psychotropics so frequently I can't really 100% pin it on the antipsychotics. I've read a lot of similar anecdotes online about the PAWS anhedonia though.

 

[Ozle]

But aren't all drugs essentially a tradeoff between benefits and side effects?

I've actually often had the same thought as you, that if there is a correlation between observed changes in the brain and the worsening of side-effects, it would be something worth looking into much more closely. Unfortunately, so far I've not read anything that shows this, and it still wouldn't solve the causation issue; brain changes may make a person more susceptible to the side effects of a drug, but that doedn't necessarily imply that the drug itself provoked those changes.

Current knowledge is severely lacking.

 

[silverwheel]

I had a shrink try to rationalize staying on APs in this way; like maybe your interests and passions are removed, but you can function better. I'd honestly rather toil away in psychosis than amount to some drone slaving away striving to fit some societal mold with no windows of feeling whatsoever. /endrant

To be fair though, I did so many drugs and was on and off psychotropics so frequently I can't really 100% pin it on the antipsychotics. I've read a lot of similar anecdotes online about the PAWS anhedonia though.

That's terrible advice for a shrink to give because the right AP for you won't remove your passions and interests one bit. I'm a creative person who writes and performs music, and who also dealt with severe bipolar II depression for most of my life. My creativity has always suffered far worse from improperly treated illness than any medication I've ever been on. An onset of severe fibromyalgia a few years ago destroyed the previous balance I had found, and since I've found the right med combo to treat the new scenario, my creativity has returned in spades. The right med(s) will allow you to pursue your passions without the illness dragging you down.

I think that you've never found the ideal treatment for your symptoms. Your 20's is when illnesses like these often present themselves. Your treatment-resistant depression is what's causing your symptoms, not 6 months of a mild med combo that you were on a few years ago.

 

[Ozle]

It's much the same problem as with antidepressants, which have a similar reputation for zombifying people and causing innumerous other side effects. If a med is just making you feel lousy, whatever the reason is you're on it, it's not the right drug/dose for you. If your doctor won't accept that, find a new doctor.

 

[Julianb]

Thank God, some one else feels that way. I was on that damn thing for five years. The problem was that at first it kind of worked and it really helped me sleep. So when I started feeling really depressed (anhedonic), none of the so called pdocs guessed that my deterioration was because of Olanzapine. It got so bad that I couldn't leave my bed and once I was found starving. Then I developed really bad psychosomatic pains. I guess my body was trying to tell me something but the pain was so bad that they put me on morphine to which off course I got hooked. Then I went into rehab who stopped everything else that I was taking except Olanzpine. I was in so much pain that I was having spasms even three weeks after morphine withdrawal. They accused my of faking it. So, I left and had to go on the street to get pain killers. After three months, I went on Methadone but I developed all sorts of other problems. In the mornings I felt paralyzed. My teeth were ruined and I developed a heart murmur that lead to aortic valve replacement. Then I went through every medication that I had been on since this whole thing began and I realized that the only that hadn't changed was Olanzapine. While still incredulous, I stopped taking it. Within a week, I started feeling better and some of the anhedonia was gone. at least to the extent that I could at least get out of the bed in the morning or bother to buy food and eat. I still couldn't believe it. So after a month, I went back on it and within three days I was a total zombie again. That is when I stopped taking it for good but by then I had been on Methadone for six months and no matter how much I tried I couldn't get below 15ml without getting impossibly depressed. So, I was put on Subutex which finally took me out of debilitating depression. I managed to get it down to 2mg but I am still anhedonic, have problems concentrating and my memory has never recovered. It has been eight years now and I can't get below 2mg Subutex. Before Olanzapine my depression was periodic and at least I could express myself and used to get excited about things but now I walk around half dead and nothing really gets me going. Whether it is because of brain shrinkage or not I am just not the same person and I was only on 2.5mg of the stuff. I remember that when my mother died, I couldn't even grieve for her.

 

[paranoid android]

I doubt Zyprexa would cause long term anhedonia. Hell i have been on and off different anti-psychotics (mostly Quetiapine but also Risperidone for maybe 2 years and Zyprexa for emergencies) and have never suffered any long lasting effects unless you count feeling sane as a side effect. High potency D2 antagonist can cause severe rebound symptoms though which is why Risperidone and older high potency Typicals such as Haldol get such a bad name for it. But Zyprexa is not a really high potency D2 antagonist so i wouldn't expect it to cause much in the way of long term side effects in reasonable doses. I have taken about 10mg's a day or more for a few months at a time and came off it suddenly when i could no longer get free samples with basically no side effects.

Depression as well as anti-depressants would be a more likely culprit here imo. I have never seen a few months of Zyprexa use harm anybody. Also for anyone suggesting that people not take their meds if they are Psychotic numerous studies have shown that Schizophrenia shrinks the grey mater in your brain not to mention you won't exactly function well if you are bat shit crazy psychotic

 

[Ligaturd]

Olanzapine seems rather benign in terms of side effects, it didn't make me feel like a zombie like I thought it would. The only side effects I didn't like are the weight gain and prolactin increases, it's a shame though. I'm starting on abilify (aripiprazole) and it makes me feel zonked out. It's a partial agonist though, so I'm not really sure where it would stand as far as potential long term effects? Apparently compulsive gambling and eating are possible side effects.

 

[Dresden]

One of the symptoms of schizophrenia is anhedonia.

 

[AlphaMethylPhenyl]

Abilify tends to be more stimulating, and have a higher antidepressant effect, at lower doses. It is a partial agonist, but with low efficacy. I don't think there's much danger of excessive eating or eating at doses that battle psychotic symptoms.

Yeah schizophrenia can make one feel that things aren't pleasurable. It's too bad that antipsychotics don't help out more with that, and some do make it worse. But I believe the industry is getting closer to battling negative and cognitive symptoms well.

 

[SixBuckets]

I'm maybe the wrong person to give advice on this, because I've been on psych meds (including a few different antipsychotics) for nearly fifteen years and never experienced anhedonia as either a symptom or a side effect, but I definitely observed that my feelings, interests and passions started getting naturally less intense around the period you're talking about. I've also encountered a lot of people around your age who don't have the same treatment history reporting the same thing and being really concerned that something's wrong with them, when they're actually just getting older.

I'm not saying your experiences aren't real - they could very well be symptoms of your illness or (maybe and/or?) side effects of your medication - but also bear in mind that people in their mid twenties just don't feel things as strongly as teenagers do.