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Is it better to be depressed and feel feelings or on meds and apathetic and uncreative?


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I am on Paxil, Vraylar and Seroquel. I am apathetic. I am emotionally numb. I am creatively dead. And I don't know if I like it. Yes, I'm not suicidal or crying day in and day out like I would probably be without it but damn, I want to feel something! I want to be able to write again...write poetry... be me!  I don't know what to do. It's the lesser of two evils. How have you compensated?

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Same here.... I constantly debate which is better. I get told when I am apathetic & numb that it's a better state than the other, but in reality I don't know if I agree. I guess it depends on how bad things were before...(and sometimes, we selectively forget how bad it was)

Is there a way to lower the dose of your meds? Or switch one out with a PRN? Sometimes that can help with the degree of numbness. I totally understand though, over time you begin to feel as if you are already dead and that is no way to go through life. I try to take the lowest dose of medications & deal with breakthrough symptoms, because complete anhedonia for years & years is no better!

it is really a balancing act. All I know is i must stay on something, otherwise, I'll go completely off the rails.

Edited by Blahblah
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Blahblah's ideas sound like they're worth a shot if you like the sound of them

Also I wonder if while in this numb state you can do work that will make you prepared for what things might be like with a lower dose...
Building new habits that fight or prevent, that you could keep up once the dose was lowered and they became more important
Working with a tdoc
Having plans in place for what to do on the darkest days
Having a self-care toolbox (a literal physical box)

I mean the body itself can turn us numb to protect us from difficult emotions, and meds can also do that for us, and either way we can kind of gradually and cautiously reintroduce those feelings in a safe way with work and with a little help from people who care about us and our process


 

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I'm not a artist but I know I would not get anything done, that is similar like reading or learning a language, without my meds when they are working currently. I can get super creative when I'm manic but its no use since I can't accomplish anything. My big problem is memory issues. I am constantly forgetting the names of things. 

To the original poster, perhaps you are on too many APs. I don't know your current situation but I could see how being on two APs could be too sedative and make you feel apathetic. Maybe something to talk to your pdoc about.

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I am dealing with this very issue now that Effexor has failed me after a decade. I'm on my survival combo of wellbutrin/adderall, which keeps me from setting fire to myself, but I'm feeling things again, and that's not so good for an autistic depressive. It's nice that my muse has started talking to me again, up to the point that some random wave of anguish leaps on me like unawares like some leopard that has been eyeing me hungrily from a nearby tree and decided I looked enough like a Thompson's gazelle to give it a go. As it is gnawing on my cervical vertebrae I miss the dull sense of mental peace I experienced on Effexor. Note: I did not say 'enjoyed', just 'experienced'. I've never reached a point in either state that I could call enjoying life. I just hope the leopard enjoys the meal, at least.

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  • 2 months later...
On 11/7/2020 at 5:38 AM, ApathyandDew said:

I am on Paxil, Vraylar and Seroquel. I am apathetic. I am emotionally numb. I am creatively dead. And I don't know if I like it. Yes, I'm not suicidal or crying day in and day out like I would probably be without it but damn, I want to feel something! I want to be able to write again...write poetry... be me!  I don't know what to do. It's the lesser of two evils. How have you compensated?

That's a big decision, be careful and talk with your family/doctors/etc...before you decide....I can relate, when I took certain medications that worked for a few months I was not as creative as I was when I was not on them, and I felt a bit apathetic... However, since I've been dealing with this for decades and only a few medications worked for a few months or so, I would honestly give anything to feel less anxious and depressed , even if it meant my creativity were to fade away... I am so tired of feeling so anxious and depressed. You need to be careful with medications, because they don't work for most people, I consider those that they work for lucky,....I wouldn't mess with it , but that's just my personal opinion after 25 years of dealing with this illness.

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  • 3 weeks later...
On 11/7/2020 at 2:38 AM, ApathyandDew said:

I am on Paxil, Vraylar and Seroquel. I am apathetic. I am emotionally numb. I am creatively dead. And I don't know if I like it. Yes, I'm not suicidal or crying day in and day out like I would probably be without it but damn, I want to feel something! I want to be able to write again...write poetry... be me!  I don't know what to do. It's the lesser of two evils. How have you compensated?

A higher dose of Paxil did that to me, and it sucked balls. It may have helped a little with my regular flavor of depression, but I was left in an apathetic and uncreative state. Trying to write music was like pulling teeth. It was most unenjoyable. 

I can say that, when meds have *really* helped me, that I did NOT feel apathetic or emotionally numb. Quite the opposite. It seems to me that you are likely still very much depressed; you’re simply not in the ‘death throes’ of the turbulence that comes with the deeper states (or other flavors) of depression. If that’s the case, then your meds would appear to be only working part way, at least ATM.

There’s even a term for this type of depression: anhedonia. It’s no fun, either, as you apparently realize. I am currently in similar state, although it has eased up in this regard, and now my main nemeses are lack of motivation and lack of energy. Everything is a Herculean task, and I am just not up to doing any of it, really. 

As for what might help, perhaps a med tweak is in order. One thing that might help is the addition of a stimulant. That doesn’t pull me out of the anhedonic state, but it does lessen it some. 

Edited by Goofball
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On 2/26/2021 at 1:27 PM, Goofball said:

There’s even a term for this type of depression: anhedonia.

Anhedonia is not considered a type of depression, but rather a symptom of depression. Types of deep-seated depression are usually diagnosed as Major Depressive Disorder (Unipolar) or Bipolar Depression, Dysthymia (chronic depression).  There are also types based on external or non-mental physical factors, such as Seasonal Affective Disorder (SAD), Peripartum/Postpartum Depression, Premenstrual Dysphoric Disorder (PMDD) and general Situational Depression. Psychotic Depression is also a type, based on different causes. Refractive, or Treatment-Resistant, Depression is a description, but I believe it can apply to more than one type if the case does not respond to treatment.

Anhedonia, the loss of the ability to feel pleasure in things one formerly enjoyed, is symptomatic of more than one type, but not necessarily all - it often becomes most noticeable, and in my experience has progressed to a gradually more acute state, over the course of long-term, protracted depression.

Anhedonia does play a part, I think, in the growing sense of numbness some of us feel who have been on medications for the long haul. If our mood states are like trying to walk from one point to another, depression is like falling into a crevasse; bipolar is having to climb out of the Grand Canyon and then straight up Everest just to get across the street. The meds' job is to level the terrain, but science doesn't yet know how to make them work subtly; they work like bulldozers, and leave everything flat. No downs, but no ups, either. Without sadness, joy is meaningless. If we're safe from despair, what do we need hope for?

The cruelty of the situation for depressives is that it's dangerous for us to try to ease back into the risky nature of the human experience. While people not prone to depression can experience the ups and downs of life with resilience, those same downs run the risk of tipping us depressives back over the edge into the crevasse again. We want to feel normally, but we know deep down that it wouldn't take much to trigger another long, dark spell. That, I think, is why therapy in combination with medication has been shown to be more effective than medication alone. When we develop the mental cognitive resilience to resist the tendency toward depression, we can take greater risks to try to live normally. 

The entire premise of this site is that we're all in a sucky situation with no good alternatives, and the best we can do is decide for ourselves which sucks less - the meds or the MI. One way or the other, something's going to suck. That doesn't have to mean life isn't worth living. There's always something that could be worse, and six days out of seven you can say, "At least it isn't Thursday." (Eeyore had it so right.) The empowering thing is that we get to make that decision ourselves.

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7 hours ago, Cerberus said:

Anhedonia is not considered a type of depression, but rather a symptom of depression. Types of deep-seated depression are usually diagnosed as Major Depressive Disorder (Unipolar) or Bipolar Depression, Dysthymia (chronic depression).  There are also types based on external or non-mental physical factors, such as Seasonal Affective Disorder (SAD), Peripartum/Postpartum Depression, Premenstrual Dysphoric Disorder (PMDD) and general Situational Depression. Psychotic Depression is also a type, based on different causes. Refractive, or Treatment-Resistant, Depression is a description, but I believe it can apply to more than one type if the case does not respond to treatment.

Anhedonia, the loss of the ability to feel pleasure in things one formerly enjoyed, is symptomatic of more than one type, but not necessarily all - it often becomes most noticeable, and in my experience has progressed to a gradually more acute state, over the course of long-term, protracted depression.

Anhedonia does play a part, I think, in the growing sense of numbness some of us feel who have been on medications for the long haul. If our mood states are like trying to walk from one point to another, depression is like falling into a crevasse; bipolar is having to climb out of the Grand Canyon and then straight up Everest just to get across the street. The meds' job is to level the terrain, but science doesn't yet know how to make them work subtly; they work like bulldozers, and leave everything flat. No downs, but no ups, either. Without sadness, joy is meaningless. If we're safe from despair, what do we need hope for?

The cruelty of the situation for depressives is that it's dangerous for us to try to ease back into the risky nature of the human experience. While people not prone to depression can experience the ups and downs of life with resilience, those same downs run the risk of tipping us depressives back over the edge into the crevasse again. We want to feel normally, but we know deep down that it wouldn't take much to trigger another long, dark spell. That, I think, is why therapy in combination with medication has been shown to be more effective than medication alone. When we develop the mental cognitive resilience to resist the tendency toward depression, we can take greater risks to try to live normally. 

The entire premise of this site is that we're all in a sucky situation with no good alternatives, and the best we can do is decide for ourselves which sucks less - the meds or the MI. One way or the other, something's going to suck. That doesn't have to mean life isn't worth living. There's always something that could be worse, and six days out of seven you can say, "At least it isn't Thursday." (Eeyore had it so right.) The empowering thing is that we get to make that decision ourselves.

Sorry for not being more precise. I meant it the way you described it.

My experience jibes with yours about it usually becoming more noticeable during a lengthy depression. Personally, I find it occupies a prominent place during the lion’s share of my protracted depressive episodes, which they all seem to be these days, lasting right up until the depression lifts. Perhaps it is always there throughout my depressions, but it is masked by more noticeable symptoms earlier on. Then, as the other symptoms dissipate, the anhedonia becomes more and more apparent. IDK.

While I am not going to end up in the hospital while anhedonia is my most apparent symptom, I am still far from functioning normally. Things don’t get done, and that can occasionally lead to issues that are just as problematic as those incurred as a result of a manic episode. Ironically, I’ll pour boatloads of alcohol on the wound in order to not feel the not feeling, if that makes any sense. It subtly diverts my attention away, numbing the numbness, as it were. But ultimately, all it’s doing is changing the flavor of numbness, leaving behind a truly epic alcoholic in the process.

I think it’s worth noting that some bipolar types feel like some level of mania is their normal, say a milder hypo. I myself felt that way many a time. But, after having a reasonably long “remission” a number of years back, I realized that normal was not that elevated, and was, sadly, a bit of a disappointment when you’re used to the exhilaration and energy that accompanies (hypo)manias, even during the milder stages, like in one that has a slow onset.

So previously I would miss the warning signs when I was becoming (hypo)manic, because I just thought I was finally getting back to normal. I mention this here, because if your main symptom has been anhedonia for a long time, be especially aware of how you feel if you think the depression is lifting or has lifted. What you might initially perceive as normal could be a (hypo)mania taking root. I’ve found that it’s a lot easier to halt a (hypo)mania in its tracks early on, and sometimes very difficult to stop once it has been left to its own devices for too long.

So no matter how much I want to feel “that feeling” (if you’ve had it before, you’ll know what I mean), I’ll take my prn at the first sign of (hypo)mania and dispense with it (mine is VERY effective for me if taken early on). It sucks, because I invariably end up back in anhedonialand. No normal. But no out-of-control (hypo)mania, either. And, perhaps most important of all, no crash. At least that’s been my experience. It can be very tempting to let the (hypo)mania run its course, even if only for a little while. But that’s playing with fire.  

 

 

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Is it better to be depressed and able to have, and engage feelings?  Answer:  That depends.

In my case, given that my form of depression was pretty mild -- it would be worth it to me.

But, fourteen (14) years ago, I took Effexor XR. To resolve my depression and anxiety. It permanently changed me; it gave me some souped-up form of anhedonia from hell (taking most of my memory, feelings and intuition, offline. Poof-- gone. Even to this day). Losing my ability to have feelings (and other feel-related skills) screwed my decision making, big time; which has cost me a lot in my life.

But everyone's situation is different.  As someone else said:  Be careful. 

Talk to your doctor.

 

 

 

 

 

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My current doctor is really good at optimizing acute dose vs maintenance dosing. When in an episode he tends to act somewhat aggressively (totally warranted given my history) but once things are leveled out he looks for opportunities to ease back a bit (slowly). This is helpful because I feel less “dulling” and more productive but still have enough coverage to allow us to catch a problem quickly. 
 

it sucks, because for a lot of meds the ideal long term course is not fully studied (although many say something like stay on effective dose and periodically re evaluate - super helpful there... incidentally @browri do u have anything in your study canon for this). Once we identified my main, most effective med (clozapine) it seemed a little safer to play with others cuz I knew I was grounded. However, I know that this approach is not practical for many, I just know that it helps me find some sort of a middle-ish ground 

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On 3/2/2021 at 3:14 PM, Iceberg said:

My current doctor is really good at optimizing acute dose vs maintenance dosing. When in an episode he tends to act somewhat aggressively (totally warranted given my history) but once things are leveled out he looks for opportunities to ease back a bit (slowly). This is helpful because I feel less “dulling” and more productive but still have enough coverage to allow us to catch a problem quickly. 
 

it sucks, because for a lot of meds the ideal long term course is not fully studied (although many say something like stay on effective dose and periodically re evaluate - super helpful there... incidentally @browri do u have anything in your study canon for this). Once we identified my main, most effective med (clozapine) it seemed a little safer to play with others cuz I knew I was grounded. However, I know that this approach is not practical for many, I just know that it helps me find some sort of a middle-ish ground 

Unfortunately I don't have a lot of information on the "re-assess" part. I've spoken with my pdoc about that before, and he has said that at least for valproate, they dose you to 50-100mcg/ml for the delayed release 12-hour formulation and 80-125mcg/mL for the extended release 24-hour, but that levels <50 have been used in bipolar 2 before or bipolar disorder maintenance where there hasn't been a mania recurrence in some time. For valproate in particular, it does have the potential to lose anti-manic efficacy over time, so dialing back the dose if the patient is sufficiently controlled may be important to ensuring that the patient will continue to respond to valproate if it is needed at full levels in the future. This might be due to the fact that valproate increases GABA synthesis, and our brains develop a tolerance to higher and higher levels of that neurotransmitter. This is one disadvantage of valproate over lithium.

I'm not sure necessarily how it would apply in cases like clozapine or carbamazepine though. You certainly want to find yourself somewhere between the most efficacy you can get from the medication, the lowest dose, and the least side effects. So after an acute episode has resolved and there haven't been any further episodes, a patient is often able to be maintained on less. If the patient reports tolerability issues, then slowly decrease the dose and monitor for episode recurrence. This would be the re-assess part. Key thing being: "If it ain't broke, don't fix it." So if the patient doesn't report any tolerability issues, there's no indication of symptoms, and labwork indicates no cellular or metabolic dysfunction, then why change it? So if you tell your pdoc that you haven't noticed any symptoms and you don't mention any side effect issues, the next thing would be to look at the labwork and make sure there isn't like elevated glucose or lipids, or if there are that they have remained steady since starting the medication and haven't gotten any worse over time (or they are dose-dependent).

However, this thread is about anhedonia. It's the one symptom that is so difficult to treat when everything else may have resolved. And if you are experiencing true anhedonia, then your treatment is incomplete, and you should discuss with your pdoc. There may be better options. 

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I know it feels like choosing the lesser of two evils — would I rather be shot or stabbed — but realistically neither is good and I don't think you should set your expectations at that level. Plus, that's not to say it all boils down to medications that influence you to end up on one side or the other. There's also therapy — whether you're in it or not, is the therapist and you a good fit, is the style of therapy appropriate, etc. — and general life stuff, like sometimes you're just depressed because life sucks or certain aspects of life are hard. 

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  • 1 month later...

I can relate.  First let me say that I love my antidepressant Trintellix (because it takes away my need to self medicate with pain pills to feel good/normal). At first, my medication Trintellix caused me to be really active creatively. I read A LOT and published poetry several years in a row. I became a girl who went from depressed to enjoying everything, even basketball. 

Lately, I feel like I have the flattening affect (blunted emotions). I’ve been unable to concentrate and enjoy basketball games like I used to when I first started my antidepressant. I skipped a day of my antidepressant by accident yesterday. Today, I felt relaxed and more engaged in the game. 

But I wouldn’t recommend going off the meds. Every time I’ve gone off my psych meds for a period of time, got back on, and stopped again, my psych symptoms came back sooner every time like it could’ve made my illness more treatment resistant. 

I’m an award winning poet, and I used to be able to pen many poems in a day. Now I feel that my writing is dull and droll. But I need the seratonin from the antidepressant to keep me stable. 

One solution that I’ve found is to keep a daily checklist, such as make bed, tidy up, 20 minutes of reading, and an hour of writing, watch tv, write in Scrivener on my phone while watching tv. Just getting started when I have anhedonia is important because the writing is what gives me pleasure. I would literally stare at my wall doing nothing or moving from one room to the next for no reason to outrun my depression. A checklist helps if you can look at it daily. 

We are creatives, and having side effects of medication can be frustrating. If you like music, sing even when you’re sad. Discover new music when you can’t compose. This is what helps me. It’s very simple and music as therapy for me. Keep a weekly log of what new music you find. Keep a journal about your emotions that could be put in a song or poem later. You might surprise yourself with how creative you still are, even on meds. 

Hang in there,

Davina

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I think Davina’s idea of keeping a daily checklist or schedule that you at least try to follow is a very good idea. I was definitely much more productive when I did that. The problem is getting past that initial hurdle, overcoming the “inertia,” as it were. But once you actually start doing it, it’s not so bad. Unfortunately, when you are very depressed, you can feel paralyzed, and unable to do something as simple as that. I am currently not setting a good example, because I am not following my own advice here ATM. But I fully intend to. I just need a swift kick in the arse, I guess.

Edited by Goofball
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so going back to the OP, the medication combination that you are on is going to lead to the truncation of the emotional spectrum and i don't know what disorder(s) you suffer from and at what severity but there may be another combination out there that will keep you stable and not lead to emotional blunting so severe that you really can't feel much of anything.

 

that said, there are going to be tradeoffs when it comes to mental illness and its treatment because psychopharmacology and psychotropic development lag behind other areas of medicine. again, to someone else's point above about going off medication and restarting seeming to make the individual harder to treat and thus their disorders more treatment refractory -- i've experienced this very phenomenon, not necessarily via stopping as i simply cannot at all function without medication, but rather with frequent medication changes, so my advice to you is to seek out the very best, most competent psychiatrist in your area and consult with that physician, bringing your medical files over and discussing at length your goals and the severity of your disorder(s) because while one doctor may switch you from paxil to celexa, another more savvy physician may try to switch you from paxil to trintellix or viibryd. i haven't been on either of the latter, although reportedly, they're much better, particularly trintellix, when it comes to emotional blunting. as for the antipsychotics -- i really don't know that world, but a competent psychiatrist very well should.

good luck (even though i don't think the OP has been around in some time) but good luck to anyone else reading this. bottom line: see an expert psychiatrist (one with a ton of published research, one associated with a prominent university's staff, one who has contributed to a specific area of study). if you are far from a major city, it is worth the drive to consult. do your research and go for it.

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