I have been trying to understand my experience of PSSD by looking at the sequence in which the changes actually happened, rather than assuming that every symptom appeared at the same time or came from the same mechanism.
The most important distinction in my case is that the primary change did not initially feel like cognitive decline, memory loss or âbrain fog.â
The first thing I noticed during antidepressant treatment was the disappearance of my spontaneous internal mental activity.
Before antidepressants, my mind was constantly generating and connecting things. Thoughts naturally led to other thoughts. Feelings, bodily sensations, memories and ideas seemed to influence one another continuously. I was extremely self-aware and naturally introspective. I would analyse myself without consciously deciding to do so. My thoughts seemed to have a kind of internal momentum.
My brain used to internally connect things.
That was not simply âthinking a lot.â It was more like an ongoing internal process in which one thought generated another, one feeling changed my physical state, and that physical state could in turn influence my thoughts and emotions.
During antidepressant treatment, this seemed to disappear.
However, I did not initially experience it as a loss.
I felt lighter.
The negative thoughts that previously made me anxious, sad or distressed became much quieter. I experienced what felt almost like an automatic lift. I did not go through a period in which I felt dramatically worse before improving. In many ways, I felt better almost immediately.
But, retrospectively, I think something much more fundamental may have changed.
I was there, biologically, but it felt almost as if I was not there at all.
I was in what I can only describe as a vegetative or automatic state. Not necessarily constantly sad. Not necessarily consciously unhappy.
I was numb.
When people talked to me about their problems, I remember thinking that things were simply much more straightforward. I would think: âItâs not that complicated.â I did not seem to naturally generate the same layers of thought, emotional interpretation, empathy and internal associations that I had before.
At the time, however, I did not fully recognise what was happening.
This is important because I was previously an extremely self-aware and self-analytical person. I now wonder whether the reduction in spontaneous internal mentation also reduced my ability to observe and recognise the changes occurring within myself.
In other words:
I may have lost part of the internal process that would have allowed me to notice that I was losing it.
This is why I do not think my experience can be adequately described simply as âemotional blunting.â
I was not necessarily sitting there thinking âI feel numb.â
The internal observer that would have naturally examined that change also seemed diminished.
The change became much more obvious to me after I stopped taking antidepressants, particularly after I reconnected with someone who had known me before treatment.
He told me that I was completely different. He described me as having previously been much âcolder.â This was particularly striking to me because I remembered myself as someone who was emotionally intense and deeply affected by things. I had always been a very emotional person, but I also had an internal structure that seemed to force me to analyse, contain and give meaning to what I felt.
I was not âcoldâ because I felt nothing.
I think I was emotionally intense but internally structured.
My feelings had weight. They had meaning. I could become deeply distressed by what other people were experiencing because I could not simply ignore or mentally filter out the things other people were feeling. I would imagine their experience, emotionally register it and be affected by it.
After antidepressants, something about that internal process seemed to disappear.
When I reconnected with this person, I remember feeling different around him. I remembered, at least partially, how I had felt before. I remembered how deeply I had loved him and how significant he had been to me.
And this was one of the moments that made me stop and think:
âWait. What happened to me?â
It was almost as if I had been in autopilot the entire time.
There was nobody inside.
This is also where I think I need to distinguish between emotional reactivity and affective or sentimental meaning.
Today, I may talk about something and feel emotional, want to cry, or have a strong bodily reaction.
But before, I think I was much more connected to what the experience meant to me.
I could focus on the feeling itself, on its significance, on what the person or experience represented internally.
Now I often feel that the emotional reaction exists more independently from the deeper meaning.
I can feel emotional without feeling the same depth of sentiment.
This may be why I sometimes describe myself as having become more emotional but less sentimental.
The primary change, therefore, does not seem to me to have been a simple loss of intelligence or even a simple loss of emotion.
It felt like the disappearance of the internal generative system that previously produced thoughts, connected them to one another, generated emotional meaning and allowed me to continuously observe myself.
I later began noticing much more obvious cognitive and linguistic problems: difficulty retrieving words, a reduced vocabulary compared to before, losing the structure and meaning of what I am saying, grammatical errors I would previously have detected automatically, incorrect conjugations, mismatches between singular and plural, stopping sentences halfway and struggling to maintain a coherent train of thought.
However, these were not the first changes I noticed.
During treatment, I could still speak relatively fluently.
The first thing that disappeared was the internal world.
Only later did I begin to realise:
âWait. I can barely speak.â
This is why I currently wonder whether the cognitive and linguistic symptoms should automatically be considered the primary phenomenon.
My current hypothesis is that a profound alteration in spontaneous internally generated mental activity may have occurred first, during treatment.
The initial reduction in negative thought and emotional distress may have been experienced as therapeutic relief. However, the same broader alteration may have affected the spontaneous generation and integration of internal thought, affective meaning, self-awareness and interoceptive experience.
After discontinuation, I experienced a marked shift towards much greater anxiety, agitation and internal hyperarousal. I do not necessarily think this state caused the original alteration. I wonder whether it may instead have interacted with, amplified or made the consequences of the earlier change much more visible.
My experience therefore feels less like:
âThe antidepressant made me emotionally numb.â
and more like:
âThe antidepressant may have altered the internal process through which thoughts, emotions, bodily states and meaning were spontaneously generated and connected.â
The DMN and other large-scale brain networks may be relevant to this, but I no longer see âDMN undershootâ as the theory itself.
The phenotype I am actually trying to describe is the loss of spontaneous internal mentation and the loss of the internal continuity that previously made thought, emotion and interpersonal experience feel naturally connected.
My brain can still think.
I can still analyse.
I can still, sometimes, reconstruct things deliberately.
But I no longer naturally enter the same internal states or move between thoughts in the same way.
And the most important distinction in my experience is that my deliberate cognitive abilities appear to have partially recovered over time, while the spontaneous internal system that generated and connected my thoughts, feelings and sense of meaning has never fully returned.
I do not feel like I simply became less intelligent.
I feel like the internal process that made me feel like myself became quiet first, and only later did I begin to understand the cognitive consequences of that loss.
Edit:
Before, anxiety could come from anticipation, but it could also seemingly appear out of nowhere as a very strong, pre-verbal feeling of âsomething is wrongâ or âI need to go home.â I had these intense internal states as a child and throughout my life. I donât really experience that same kind of spontaneous affective state anymore.
I notice something similar with positive experiences. I can still cognitively recognise that something is interesting, beautiful or meaningful, and I can understand the significance of an idea or connection. The problem is that I donât seem to register it through feeling in the same way anymore. I can understand that something is important, but the emotional experience of that importance isnât really there.
So I wonder if what I am describing is not simply a loss of thoughts or emotions, but a loss of spontaneous affective salience, the internal process that used to give thoughts, experiences and things around me their emotional weight.
This may also be why I keep describing my mind as âquiet.â It is not just that there are fewer thoughts. There seems to be less happening internally that spontaneously generates the next thought, feeling or state.