Posted 06 November 2017 - 08:43 AM

I have to respond to Kinesis because I cannot stand this kind of ideology, and this kind of dangerous misunderstanding of mental health conditions is at the very core of the field of psychiatry.

Anhedonia is a standalone condition from depression. The neuropathological origins of anhedonia are separate from those of depression. They can also be comorbid. Just like anxiety and depression. This isn't even up for debate. If you are using the DSM as a benchmark of mental health conditions, you are part of the problem that is perpetuated by psychiatry.

Yes, anhedonia can be a symptom of depression. But depression can exist without anhedonia, and anhedonia can exist without depression. Either one could precede the other. An inability to enjoy or feel anything anymore could make you lose hope and become depressed. Being depressed can wind up making you feel like nothing matters anymore and lose interest in things you used to enjoy.

A symptom, at face value, can overlap with any number of conditions. That does not mean that the ORIGIN of the symptoms are the same. Fatigue is a symptom of many conditions but the origin of it is vastly different across the board. Anhedonia and depression can produce similar symptoms, impact peoples' lives in similar ways, but for entirely different reasons. By only taking their symptoms at face value without viewing them contextually, you misunderstand the entire point.

Instead, read some medical papers on the conditions that actually discuss the underlying pathologies of the disorders. Just as one instance, you can read this study that shows weakened pVMPFC connectivity with reward-related brain regions is uniquely associated with anhedonia. This paper is on point with the fact that "complex psychiatric disorders such as MDD need to be more fully characterized by identifying potentially distinct neurobiological mechanisms associated with individual symptom clusters."

Someday, "symptoms" that were previously lumped under depression will undeniably be proven as having neurobiologically unique pathologies that are separable from depression. Anhedonia is for certain, one of these prominently incorrectly generalized conditions.

But, we don't even have to get this technical and specific to figure this stuff out. It's obvious enough if you take the time to listen to people and understand, there are people that have depression without anhedonia, and people who have anhedonia without depression. That in itself should tell you the two are separable and distinct. I primarily have anhedonia and emotional numbness, and I often have no symptoms of textbook depression. Any symptoms of depression I have are usually caused by the emotional numbness and anhedonia -- I cannot cry, feel anything with any depth, care about anything that should matter, and that makes everything hopeless and pointless. It is not the distress of depression that takes the joy out of activities that were once enjoyable, as is the case for many primarily depressed people with symptoms that could also overlap with anhedonia at face value.

If you need more convincing, just ask yourself why there are so many anhedonic "depressed" individuals who are labeled "treatment resistant depression." The article I linked here discusses this as well, saying that “anhedonia is a predictor of poor treatment response in MDD.” The reason for this is obvious: because many of these people are probably individuals that have been persistently misclassified as depressed patients. They did not FAIL depression medication (that phrasing makes it seem as though the patient's lack of response to a medicine renders them incurable). The reality of it is that these medications are not meant to address neurobiological origins of anhedonia and should never be expected to WORK on someone with this condition -- they are improperly prescribed to anhedonic individuals and then these individuals are consequently written off as untreatable.

Suddenly, ketamine comes along and everyone's mystified how it miraculously helps many people with "treatment resistant depression." The answer to this is obvious as well - it's one of the first major mainstream treatments that actually had a glutamatergic mechanism that significantly and instantly addresses the origin of anhedonia in the mPFC.

At some point, you have to ask yourself why depression medications don't address anhedonia. It's not because the depression medications "leave something to be desired." It's because the medications fundamentally are not designed with the underlying neurobiology of anhedonia in mind.

You cannot compare this with something like cancer or diabetes that is more easily united as one condition by physical, observable symptoms. Mental health symptoms are much more easily misunderstood because they are not as concrete. Because these conditions are often only defineable by subjective interpretation of another person's mental experience, they are also subject to being misconstrued by the misinterpretations of horrible people that are not very empathetic or understanding of what goes on in other peoples' brains.

With conditions like cancer or diabetes, the diagnoses are obviously much more clear cut. And so it is clear that the shortcomings of the treatments for these disorders are for other reasons - not because the diagnosis is wrong (i.e. not yet discovering an ideal solution to treat the problem, progress being slow in the medical system due to red tape and needing to go through safety/testing for years, etc.) Whereas the inadequacy of the medications prescribed for anhedonia are due to a misunderstanding of the origin of the condition altogether as a "symptom of depression," in which the depression needs to be "fixed first" for the anhedonia to go away.

The problem with people who think like you about this stuff (almost every psychiatrist thinks this way) is that you are being overly pedantic about this instead of using some common sense. In the end, the DSM does not matter - what treatments you respond to will reveal the actual neurochemical origins of what is going on in your brain and that is the only thing that matters and should unite conditions as falling under a specific diagnosis.

You think that our brains care and respect the DSM outlines? You think those are any way of properly understanding these conditions? Some old white guy who understands nothing about what it feels like to have depression or anhedonia or any of these mental conditions wrote it on a paper years ago, and it's somehow the unquestionable authority now that governs all of psychiatry. I'm not even going to attempt to measure myself by some inaccurate standard, because it’s a disservice and insult to peoples’ actual complex mental conditions. The DSM is hardly worthy of being toilet paper.

Psychiatry will never acknowledge the fact that their diagnoses are not accurate, and so they prescribe based on the medications available for each of these categories, stuffing you under one that sounds most like you (a poor fit, at best.) Instead, they should be only paying attention to the mechanisms of their medicines and how you respond to them, how they change how you feel, to try to deduce the neurochemical origin(s) of your condition(s). At that point, we can come to understand the separate diagnoses that exist on this basis. In mental health, the treatment is a better diagnostic tool than the misinterpretation of your symptoms by a soulless psychiatrist according to an ancient rule book. Let people speak for themselves on what they feel the heart of their condition is, because they know themselves and are the authority on what applies to them.

If you have anhedonia, doctors just cannot help you right now. What Kinesis said about consulting a doctor and not self-diagnosing and experimenting is a joke. People like to play make believe doctors can help you because, I don’t know why, it helps them sleep at night? Anyone who has been through the hell that is psychiatry with a condition like this knows that, at this point in time, you are far better off and safer trying supplements and medications on your own to find ones that work for your condition, so long as you are willing to take the responsibility upon yourself to do your research well -- and it is not at all difficult to exceed the knowledge of your average psychiatrist.

Psychiatrists are dangerous and they will only lump you under a category that doesn't really fit you and play russian roulette with which medication at their disposal that they can try on you next. I would never recommend seeing one, I have been through many psychiatrists as well, and like Deaden says, this is not an uncommon experience. All of them have made me worse, all of them I regret seeing, none of them understood my condition and placed assumptions on me based on the closest fit DSM diagnosis which was "depression" instead of truly understanding the heart of my issue as anhedonia and an inability to feel emotions.

All of the standard medications commonly prescribed for depression - and I'm including ones that they will off-label prescribe for depression that "treat" other conditions like anti-psychotics, stimulants, and mood stabilizers - have mechanisms that neurologically end up numbing you even more. By aiming to suppress negative emotions or extreme moods, they suppress all emotions.

I also agree with what Deaden said earlier in this topic. Let’s stop pretending we don’t know the origins of anhedonia in the brain. Psychiatrist have this hands-off attitude about medications where they pretend that no one understands why they work and how they will affect people. They treat medications like some whimsical fanciful thing that might magically work for some people and not others - which is just blatantly a lie that covers up for their laziness and inability to keep up with any research on the brain and mental health conditions despite all of the research, studies, information, and anecdotal evidence out there. And that because even psychiatry doesn’t know why or how these work, you, the patient, can’t possibly know. Only “experts” have the authority to know this stuff.

If I could go back, I would have never seen a psychiatrist. And I wouldn't recommend to anyone with my type of condition to see a psychiatrist, unless you are using them to get some sort of medication or treatment that you have researched to be right for yourself. But never to blindly gamble with the medication they will prescribe you without even understanding the neurological origin of your problem and the mechanisms you respond to. I had a psychiatrist who told me SSRIs couldn't be bad because even bananas have serotonin in them, and another who looked at me with a blank, dead stare when I started discussing glutamate (a trained psychiatrist could not discuss the mechanisms of the mood stabilizer she was more than happy to prescribe improperly for my already, flatline-stabilized mood) - this is completely “normal” and (for some fucked up reason) accepted behavior for the morons who worship the DSM and are given the reigns on their patients' mental health.

Side effects are things like headache, nausea, and diarrhea. They are unintended effects that are unrelated to the intended mechanism of the medication, that are inherent cross-system results of affecting neurotransmitters. Emotional numbness is not a "side effect" and don't let anyone tell you that. The problem is not that "we have good medications for depression that, oops, accidentally might cause emotional flatness also!" But that we have medications for depression that are intended to control excessive emotions being improperly prescribed to people who already can't feel a normal range of emotions, numbing them. Compounded on top of my natural, initial anhedonic condition is a bunch of neurochemical changes artifically induced by improperly prescribed medications because I was lumped simply under "depression."

How about people on these forums try to make some actual progress and help people by trying to define these conditions by the actual neurological mechanisms behind them and not by the DSM's generic bulleted list of rigid symptoms with no context? The information is out there, and while psychiatrists may ignore it in favor of repeatedly, beyond all evidence, prescribing their beloved monoamine antidepressants, that doesn't mean we have to. There already is substantial medical evidence for a lot of this stuff but it's going to take years for the medical system to even acknowledge it, let alone actually get to the point where it can help people.

I think it was an overstatement on Deaden's part to say that this is the official cure guide for anhedonia, and he has acknowledged that, but it should be obvious Deaden's intent was not to speak for everyone and steamroll over depressed people who also have anhedonia. It was to help others like himself, who will know who they are when they read what he's said.

Before I get attacked on this as well, I want to be clear and say that I’m not seeking to even unify the diagnosis of anhedonia, even though I’ve generalized anhedonia in my post a bit for the sake of simplicity in discussing this, without getting caught up on details that are inconsequential to the point I am trying to make. I think anhedonic individuals could also be diverse in the origin of their condition and that needs to be considered. But what I am saying is that if we go by the treatments we respond to, we can define ourselves by the actual underlying mechanisms instead of broad terms like these.

People like Deaden aren’t harming other people by trying to draw conclusions or make theories about treatments that might work with individuals experiencing anhedonia based on medical papers we’ve read, our own experiences, and anecdotal evidence from others. The intent is to share these theories from others who are experiencing anhedonia, others who have had similar responses to treatments, and see if through a collective experience we can come to some understanding about our conditions.

I got the same kind of crap for trying to post about a treatment that could be potentially helpful to consider for others like myself. Even if you write disclaimers so you don’t get attacked on things that are beside the point you are trying to make, you will still get crapped on by people who think they are spreading god's word by pointing out irrelevant fallacies in your post (according to their poor understanding) and in doing so, are missing the point entirely. It’s this kind of thing that made me stop wanting to even post on these forums.

If this topic had been about discussing anhedonia vs. depression and whether or not they are distinct conditions, Kinesis’s post would have been a warranted offering of his opinion (although still, in my argument, completely misinformed and dangerous.) But derailing a topic like this is only serves to discourage a discussion that is meant for the people who this might actually be revelant to. I haven’t been able to care enough to add some actual meaningful discussion to this topic and I hope I can contribute in the near future, because there should be somewhere on these forums where a collective effort is being made to figure out treatments for anhedonic individuals. But when I see crap like this (which seems to happen all the time on these forums) I have to step in and reply because the least I can do is shut people like this down for obstructing valid and needed discussions like this.