Treating PSSD

August 1, 2013 • 15 comments

Editorial Note: This is the fourth in a series of PSSD posts, with more to come. The earliest was Buried Alive, but in this recent series the first was Drugs and Sex don’t Go, followed by PSSD: If a Drug Caused Blindness and then No Sex and the City.

Possible treatments

In Drugs and Sex don’t Go, we outlined how the PSSD community has tried most of the obvious treatments – S1 agonists and antagonists, S2 antagonists, and others along with dopamine agonists, Viagra and related drugs and hormones with little effect.

Ondansetron?

Some related drugs that do not appear to have been tried have been the S3 antagonists ondansetron or granisetron. These are usually given for nausea. They can stimulate libido. If anyone has tried these and can offer feedback it would be helpful.

Ketamine

Several subjects with PSSD have recently tried a completely different kind of treatment – ketamine, which is an anaesthetic. However where other anaesthetics sedate, it stimulates. It acts on the glutamate system which is the major excitatory neurotransmitter in the brain.

Ketamine can flip a switch in people who are profoundly depressed. People, who are psychotically depressed one day, contemplating treatment with ECT, can be well the next day and stay well without further medication for months. Almost as though a switch had been flipped.

When given intramuscularly, the effects of ketamine come on within minutes. The subject dissociates. The experience may be profound. People report marked changes in their perceptions of time and space and typically report a sense of meaningfulness and connection with the Universe.

Ketamine appears safe to give to people who have had SSRIs in that doctors regularly used it combined with cocaine when clubbing – in a combination called Calvin Klein.

We have been able to collate the reports of three people who took ketamine to see if it might make a difference to their PSSD – if it might flip the switch back and reconnect them.

All three reported having a comfortable experience after ketamine 100mg – this is not always the case; ketamine can cause very unpleasant effects in people who have SSRI dependence and withdrawal. The question was whether there would be a benefit afterwards over the following week or two. One of the three reported some benefit but this was not sustained and it was difficult to link the outcome to ketamine.

But there was sufficient here to warrant a further course of treatment at a slightly higher dose. It seemed a good idea for the three subjects to repeat the treatment. Again it went smoothly. Again there were some hints of benefit in the same subject who had a benefit the first time around but not a cure.

Based on this it does not seem at present that ketamine is the way forward in PSSD.

Donepezil

One other treatment that has come to our attention is donepezil. This choline esterase inhibitor was used for Alzheimer’s dementia, marketed as Aricept. Patients with dementia are not likely to report its effects but younger people taking it report that it can make touch and other sensory experiences more vivid and readily triggered.

PSSD involves a profound depersonalization generally and an anaesthesia that is most profound genitally but can be more extensive. So it looks like a drug that made skin more sensitive might help. Donepezil fits this bill.

The present status of usage for this is that two subjects have reported trying a 5mg dose in the morning for two weeks. One had no effect. The other reported much more vivid dreams and in particular dreams of a semi-sexual nature.

One of the surprising things about this is that he became aware that he had not been dreaming for years and asked the question whether this might also be a feature of PSSD that people have not noticed to date. Does PSSD inhibit dreams?

We are interested to hear from anyone with PSSD whether they dream or whether the condition has affected their dreams.

We are aware of a number of other treatments in use for PSSD and will be reporting on these immediately if there are any hints of a benefit.

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Filed Under: RxISK Stories | 15 comments

Comments (15)

  1. I use Ondansetron on a fairly regular basis to ward off nausea before an adrenal crisis occurs and it hasn’t improved libido.

  2. thank you for this EXXCELENT ARTICLE.

  3. Re; the dreams and sleep. NO, i am not sleeping very well at all, due to pssd. Its a serious situation. we can imagine why not…. normal activity results in very deep sleep, and now my sleep is very bad. shallow, i am almost not sleeping at all. dreams : none. no deep sleep = no dreams. thank you for the analysis of these treatments for pssd. I would like to try all of these myself. again thank you for the good work. and I would like to learn more about the substances here listed and experiment cautiously myself with a prescription. I cannot have kids in my present condition, but I want to have kids. so i need a solution. thank you again for the research and info. :)

  4. Is ketamine’s effectiveness supposed to be a purely chemical thing — or does it depend in part on the kind of experience (“trip” or otherwise) it leads to? One reason I think this might matter: I’ve talked to lots of people who’ve had steroid injections in their spine and other minor but stressful medical procedures under ketamine anesthesia. They never talk about feeling euphoric or joke about wanting to go back for more, like some people do with nitrous oxide at the dentist. The steroid injections are a nasty experience even when they help. Maybe the minor trauma and overall bad atmosphere of Same Day Surgery cancels out the euphoria – if so, does a positive experience help? It wouldn’t have to be sex, necessarily – what you lose in this condition extends to all kinds of joy or empathy. Some people might want to spend time with the grandchildren, or go fishing, or listen to Bach, who knows.

    The articles I’ve seen about ketamine for depression all seem to miss this — many stress the need to develop a drug that works just like K but does not cause what one writer called “symptoms of schizophrenia” (an obvious reference to “tripping” effects). Most also assume people will have to be on ketamine maintenance for life, which sounds dangerous to me. None consider the idea of a “reset” experience that you mention, much less how to benefit from it.

  5. i have suffered from this for almost 4 years now. No sexual thoughts, no pleasure in sex, genitals are numb. I have not had a dream in all this time with the exception of maybe 10 or less. On these occassions I would say sentativity in the morning after the dream was somewhat improved but by very little.

    I definialty have noticed a lack of dreams and a lack of sleep activity i,e i used to sit up or imagine things like snakes or ghosts. None of this happens anymore.

  6. 6 years since citalopram ssri and persistent symptoms of pssd, low motivation, apathy etc. I dream every night, find dream recall hard though.

  7. I have PSSD since 2009 and recently dreams have returned. About maybe 2 months ago I started dreaming again, or at least being able to remember that I dreamt. No improvement in sexuality though.

  8. Everyone should try valerian root, i used it for a couple weeks and i havent used it in about 3 now and its still fixed the problem of premature ejaculation. But i still dont have much interest in sex so only part of the issue was fixed i just believe there may be something to this so people should try it out and maybe it will help some of you.

  9. I tried the peptide PT141 worked awesome but felt like a artificial feeling. I also dont like knowing if theres any serious side effects.

    I just want to be feel normal with a natural sex drive.

  10. Why does no one try nitrous oxide supplements?

  11. Rhe page about PSSD was removed from Wikipedia :(

  12. i tried NO supplement but it didnt help to me

  13. I have been struggling with pssd for some time, and I to have noticed that I only dream once in a very spaced out time frame. And even then Ithe dream only lasts what seems like a second.

  14. I’ve had pssd for about 13 years, and I’m 28 now. I used to dream a lot before pssd.I don’t dream anymore. I have very weak dreams may be once in a couple of months, which feel so the opposite of intense, and almost as if there is a layr of insulation between me and my own dreams. It sucks.And the visual arousal is totally not there. And i took fluoxetine only for a couple of weeks, 13 years back, and never before or after. I noticed lack of arousal two days into the treatment, and my pnis shrunk to a size I had never seen it before, and that small size has been my flacid size ever since. It sounds unreal, but its true, and sadly doctors are not aware of pssd, and claim that NY medicine when stopped, stops having what ever effect it may have had. That to me, sounds like insult to injury, afternharming me, kind of saying that my complaint is lies.

  15. I have pssd since october 2010 paxil/escitalopram no sex drive numb penis – after doing tremendous amount of research I finally upregulated my dopamine receptors with a lot of supplements and drugs .. that solved the deprssion ahnedonia but did nothing for pssd .. I tried ropinirole with testo booster for a month and it caused me hyper sexuality .. i wanted to f*** every women i see . masturbated all day. and did nothing except sex . it felt amazing after all these years like70% improved sex rive and sensation was improved 60-70% after a month. too bad couldn’t tolerate the side effect.. adderal & weed had the same effect. so does PT141 …. epidium has benefit too .. moclobemide was awesome too. Mao’s are awesome..all are “take it as you need it” and it is suppose to work for 6 hours …
    I guess its not a cure because you have to take the pill everytime for making you normal and they are expensive .. also there are long term risk of dopamine regulation after 10-15 years of use !

    But still better than nothing !

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