Anhedonia and
emotional flatness (blunted affect) are two major symptoms I suffer from, and for me are the worse symptoms that I have.
There is a difference between anhedonia and emotional flatness (blunted affect), although they are related and often arise together.
Anhedonia is defined as a lack of sense of pleasure or reward from life's normal activities. The reward circuits of the brain are inactive in anhedonia, so the experience of pleasure and reward on completing tasks is absent.
So normally, whereas you might have felt satisfaction and reward after doing something as simple as tidying your desk, cleaning the bathroom, or going for a walk, you find with anhedonia that the sense of reward is absent or only weakly present when you complete the task. You just get the most awful feeling of mental vacuum instead. Metaphorically it feels like working hard from Monday to Friday, only to find that your boss pays you nothing at the end of the week. But that metaphor does not really fully capture to horrendous sense of vacuum and meaningless emptiness delivered by severe anhedonia.
Severe anhedonia will bring on thoughts of suicide very quickly, as I have observed in myself. A long time ago, I had quite bad clinical depression for a couple of years, but never once did the thought of suicide even occur to me during that entire depressed period. But when I got severe anhedonia, even though I only had mild depression (if at all), I just was hoping every day that I would drop down dead. It's hard to explain to someone if you haven't experienced anhedonia; anhedonia seems like all you reasons for living have been taken away.
Anhedonia is further divided into two subtypes: consummatory anhedonia, which is where you don’t feel much reward or satisfaction on completing a normally enjoyable activity; and anticipatory anhedonia, which is where you don’t get any good feelings when you look forward to doing an activity that is normally enjoyable.
Emotional flatness (blunted affect) is slightly different to anhedonia. In emotional flatness, the normal emotional responses (love, sadness, compassion, surprise, guilt, shame, anger, joy, etc) are weak or absent. So for example, if you watch an emotional drama on TV, you tend to experience the drama in a cold, often cynical way, as you don't really engage with the emotions in the story.
With my emotional flatness symptoms, I find the same thing happens when I speak to say an old girlfriend that I have remained friendly with. Usually in these circumstances, a normal person will often feel quite a few emotions as a result of talking about say old times. But when you have emotional flatness, you just can't tune into this type of conversation.
Emotional flatness is not at all the same as autism, incidentally. Contrary to popular belief, people with an Asperger's bent may not necessarily be people-oriented, but often posses and express extremely strong emotions towards the non-human things that interest them (like abstract academic subjects, engineering hobbies, and so forth). I have a touch of Asperger's, and know how much love I had for many abstract academic subjects; now that love and rapport I had for these abstract subjects has mostly vanished, along with the love and rapport I used to have for my friends.
Note that "blunted affect" is defined as the lack of emotional
reactivity to emotional stimuli; a very similar concept is "affective flattening" which is defined as the lack of emotional
expression in an individual.
Another closely related condition is lack of motivation (aboulia):
Lack of motivation (aboulia) results in a reduced inclination to start or engage in tasks. Lack of motivation differs from anhedonia. In aboulia, you don't tend to intellectually initiate into tasks and purposeful activity; in anhedonia, you don't get the feeling of reward or satisfaction on completion of a task a reward which is the psychic payoff we all need to receive when we have done something useful.
Supplements I have found helpful in reducing the anhedonia / emotional flatness symptoms are:
Anti-Anhedonia Supplements:
EGCG (green tea extract) 1000 mg daily, boosts mood, motivation and mental focus (this is probably the best anti-anhedonia supplement I have found; however, there is a comedown for a few days when you stop taking it, so best to taper off slowly). But high dose EGCG can cause liver problems in some people, so these high doses may not be advisable for long term use of many months.
Choline bitartrate 500 mg +
vitamin B5 500 mg twice daily
Manganese 5 mg daily
Colostrum powder 8 grams (= 2 heaped teaspoons) twice daily on an empty stomach
Hydrogen rich water drinking several glasses throughout the day
Vinpocetine 10 mg daily
Horny goat weed (Epimedium) herb 3000 mg daily
Bacopa monnieri herb 1000 mg twice daily
Acetyl-L-carnitine 500 mg twice daily
He shou wu (Polygonum multiflorum) 500 mg twice daily
Korean ginseng 500 mg twice daily
Vinpocetine and horny goat weed seem to work for sexual anhedonia too. Treating and reducing brain inflammation will also significantly lower anhedonia, I find. For me the two most effective anhedonia treatments in the above list are colostrum and hydrogen rich water.
Low doses (10 to 20 mg daily) of tricyclic antidepressants such as
amitriptyline or
imipramine are useful for anhedonia. A useful anti-anhedonia drug is
amisulpride. I detail my experiences with amisulpride
here.
Amantadine 25 to 50 mg daily I find good as well.
More recently, an antidepressant drug called
agomelatine (which is structurally similar to the hormone melatonin), has been shown effective for treating anhedonia. Several studies have demonstrated agomelatine's anti-anhedonia effects. Refs:
1 2 3
Unfortunately agomelatine is quite expensive, around $60 for 28 x 25 mg tablets. However, it's often stated that sublingual agomelatine is 8 times more effective than oral, so to save money, you can crush each tablet into powder, and use just ⅛ of the tablet sublingually each night (agomelatine is taken before bed). This may be equivalent to a 25 mg tablet taken orally.
Phosphatidylserine seems to make my anhedonia worse, in doses higher than around 200 mg.
If taking high dose EGCG for some time, it may be worth taking some folinic acid, as EGCG has an
anti-folate action: it inhibits the enzyme dihydrofolate reductase (DHFR). Folinic acid is used to correct for DHFR deficiency.
Treatments For Emotional Flatness:
Supplements that I have found help return some emotional strength and responsiveness to the mind include the following list. The general rule with these supplements is that they boost emotions for a few hours, but I find if you take them every day, they stop working. So they are best used occasionally, to remind yourself the fact that emotions exist. It is easy to forget that emotions exist, when you have blunted affect.
Allicin 1,000 mg daily (6 x 180 mg allicin capsules taken once daily) seems to have a good emotion boosting effect. Allicin is a garlic extract. This is one of the few supplements that seems to work long-term for ameliorating emotional flatness.
Terminalia arjuna herb 6 grams — takes about 5 hours to kick in, but then boosts emotions for the rest of the day.
Myrrh essential oil 10 drops mixed in 30 ml of a carrier oil (like baby oil), and rubbed on the skin of the body, where is it is slowly absorbed transdermally (not be taken by pregnant women).
Royal jelly 1500 mg + vitamin B5 500 mg seems to bring my emotions back online quite strongly, but temporarily (it only lasts for 3 or 4 hours).
Green coffee bean (50% chlorogenic acid) 2000 mg produces a strong cathartic and loving emotional response within a few hours of taking it. May not get repeat effects if the chlorogenic acid is taken every day.
He shou wu (Polygonum multiflorum) 3 grams
Carnosine 1000 mg
Glutamine powder 2 heaped teaspoons (12 grams)
Choline bitartrate 500 mg +
vitamin B5 500 mg
Vinpocetine 10 to 20 mg
Bacopa monnieri herb 2 grams
Bael fruit powder (bilva powder) 3 grams
Fludrocortisone (Florinef) 0.1 mg, a drug for treating adrenal insufficiency and POTS, I found has a profound emotional boosting effect; in particular, it boosts your emotional emotional empathy (and a study showed this to be the case in BPD
1). Unfortunately I found this emotional boosting effect only appears when you first take fludrocortisone, and like with many of the supplements above, it disappears with repeat use.
Emotional flatness can occur several months after using benzodiazepines.
I hope you will find some benefit from these.
