Due to an exacerbation of my OCD, I went through a few week period in December 2015/January 2016 where I stopped sleeping. This culminated in me being admitted as an inpatient. Due to the severity of my sleep issues, the psychiatrists suspected that I was in a bipolar mixed state and started me on olanzapine (5mg) and valproic acid (1500mg). I stayed on this regiment for a few months, before lowering the valproic acid to 1000mg and adding lamotrigine (50mg) and trazodone (100mg). Following this, I began to slowly reduce the valproic acid.
Around this time, I started seeing an excellent OCD therapist, and we began using exposure response prevention (ERP) to treat the OCD. I decided around this time to start reducing the medications, as I am generally staunchly anti-drug (I was an opiate addict in my teens), and I was never happy to be on them in the first place. I was able to reduce the valproic acid and lamotrigine to zero without too much trouble. However, I ran into a lot of trouble trying to discontinue the olanzapine. I slowly chipped my dosage from 5mg down to 1.25mg over a couple months. Each reduction was met with horrible insomnia and general feelings of panic/malaise. When I got down to ~1mg olanazapine, I was hit with a sudden severe akathisia. I had to take leave from work, and it became so dire that my parents had to alternate days off work to come sit with me. I eventually found a new psychatrist who agreed to help me wean off the medications and explore alternative treatments. He immediately discontinued olanzapine and substituted 50mg quietapine. Luckily, the akathisia faded, but afterwards I seen to have developed severe anhedonia and other issues.
I have been slowly reducing my medication, alternating drops biweekly, and my current doses are 2.5mg quietapine and 20mg trazodone.
When I first made the switch and came out of the akathisia, I was greeted by fairly severe anhedonia. Interestingly, as time went on and I continued to drop my doses, my symptoms changed drastically. I ended up in a depression that felt markedly like 'dopamine deficiency', and I would often come home from work and immediately fall asleep. I lost all motivation or drive, and was left with little motivation or libido.
There have been signs that things are improving, albeit slowly and non-linearly. My current daily symptoms are as follows:
This sucks. I have always been obsessive about numerous hobbies, and I could now care less. There have been some small signs of improvement. The other day I cared enough to buy a nice vintage cast iron pan (I collected them before this whole mess). Generally though, life is joyless and grey. It's like being in a mental straightjacket.
This comes and goes. I can feel it in my teeth sometimes when it gets bad. Usually the pressure is in the front, though sometimes I feel it in the middle/back of my head.
-Loss of libido/sexual dysfunction
This is the one my OCD is currently latched on to. I can't stop myself from thinking that I've developed PSSD, even though the only ssri-like drug I took was trazodone, and I took relatively low doses. I also had sexual dysfunction arise very quickly after the olanzapine -> quietapine switch, so I want to think that it is unlikely to be the culprit. I don't have the classic presentation in that there is no numbing, I am still very ticklish, etc. I definitely have lack of interest/libido, and I have trouble getting/maintaining erections.They are also not quite as hard, though all of this could be tied back to arousal. I also had some orgasmic anhedonia, though this has improved significantly. The sexual issues may just be just part of the anhedonia. There have been some improvements as time progresses, though it is still very disturbing to me.
-Loss of appetite/nausea
More than likely from the antipsychotics, olanzapine in particular. Improving a bit.
-Constant bad taste in my mouth
I generally feel like I am living in an alternate reality where everything is awful. Interestingly, I went on a small vacation right after the switch from olanzapine to quietapine. I felt anhedonic, etc. the whole time. I forced myself to go fishing (One of my favorite activities) and exercise. The last day I was there, I had an OCD episode about something, and had to use ERP techniques to calm myself down. After this, however, I was 100% back for a short period. It only lasted a night though, and things got worse afterwards.
I am currently doing a lot to try to improve my situation:
- rTMS - I have been doing this daily for a couple of months
- Exercise - I probably run ~20-30 miles a week
- 10000 Lux light therapy
- Fish oil, B-vitamins, vitamin D
- Biofeedback 2x weekly
There have been improvements. At the beginning, the anhedonia was actively painful, where it mostly now just feels like severe depression. It seems like every day is different. The anhedonia/loss of pleasure is a constant. I mostly feel the no-dopamine feeling, though other times I feel what I can only describe as 'serotonin overload'. It is similar to the nasty feelings that you get when you first begin an SSRI. In general, I just feel unstable.
Thanks for reading. I am mainly making this topic to serve as a personal journal during this process, but I look forward to talking to everyone here.