I don’t think PSSD is just a loss of desire. I think something changed in how information becomes meaningful to me

TL;DR at the bottom for anyone who doesn’t want to read the whole thing

I’ve been trying to understand what changed in me after antidepressants for a long time, and only recently have I started being able to put together several things that I used to experience as completely separate problems. The more I think about them together, the less the word “blunting” seems sufficient. I don’t just feel less emotion or less sexual desire. It feels like something changed much earlier in the process, in the way my brain takes information from the world, differentiates it, processes it, gives it significance, integrates it with everything else I know, and turns it into something that I spontaneously care about, feel, understand or want to act on.

One of the best words I’ve found for the subjective experience is “filter.” I don’t mean that there is literally one neurological filter somewhere in the brain. I mean that before antidepressants, there seemed to be an automatic layer of processing between experiencing or perceiving something and producing a reaction to it. Information would come in, and my mind seemed to automatically determine what was relevant, what mattered, what something meant, what consequences it had, and what response was appropriate. I didn’t have to consciously perform this process. It happened so automatically that I experienced the result as simply being who I was.

This is important because I think some of the changes in my personality may be consequences of changes in this processing rather than a simple change in what I value.

Before antidepressants, my mind was extremely internally active. I didn’t have to consciously decide to analyze things. I would naturally keep going until I understood what was underneath something. When I say “understood,” I don’t mean simply having an explanation. I mean getting to the deepest level I could reach: what someone actually wanted, what they were afraid of, what was motivating them, why they behaved in a particular way, what mechanism was producing a situation, and then what was underneath that mechanism. It was recursive, but it wasn’t something I experienced as a problem. It was simply how my mind worked.

That process was also where a huge part of my sense of self came from. My creativity and the way I experienced myself came from being able to take something in, make connections, notice distinctions, form a very detailed internal representation of it, and eventually reach a conclusion that felt internally complete. I was extremely serious about myself and about my internal experience. I had a very strong sense of who I was, and I was proud of being able to understand things, control myself, notice things other people seemed to miss, and internally work through things without needing other people to do the processing for me.

The strange thing is that I didn’t initially experience the antidepressant change as “I am less intelligent” or “I can’t reason anymore.” It was much more subtle and, in retrospect, much more fundamental. I started losing the spontaneous processes that made reasoning possible for me in the first place. My thoughts became blank. Associations didn’t appear automatically. I stopped spontaneously noticing things. I could still think if I deliberately tried, but the automatic generation of thoughts and connections that used to happen in the background was much weaker.

That distinction has become extremely important to me. I don’t think I simply lost the ability to think. I think I lost a lot of the automaticity with which thinking used to happen.

Before, I could have an entire problem, generate different possibilities, connect things, understand my own reaction and arrive at a conclusion inside my head. I didn’t need to talk to someone to process it. People around me would sometimes tell me that I needed to talk more, but I genuinely didn’t feel that I needed other people’s opinions in order to understand myself. I felt like I had already thought through everything they could tell me.

Now, when I’m overwhelmed, talking can actually make the thoughts appear. During a recent panic attack after my grandmother went to the hospital, I found that once I started speaking out loud, I could organize what I knew, distinguish what I was actually afraid of from what my body was predicting, and move through the reasoning much more easily. The strange part is that I can recognize that this is useful while simultaneously feeling that it isn’t how I used to function. Previously, the process was internal and the outside world saw the result. Now I sometimes have to externalize the process in order to reach the result.

That is why I don’t think “metacognition” or “intelligence” alone captures what I am trying to describe. I can still deliberately analyze something. What feels different is the automatic process that used to select information, generate associations, determine relevance and turn all of that into a coherent internal representation without me having to consciously initiate every step.

One of the clearest examples was makeup. Makeup had always been a form of art and self-expression for me. I would wake up extremely early to do it even if I hadn’t slept, because I had a very specific vision of how I wanted to look and I could translate that vision into what I was doing almost immediately. I could look at my face and intuitively see what needed to change. I noticed extremely small differences and knew how those differences affected the whole picture.

After starting antidepressants, I remember reaching a point where I simply couldn’t do that anymore. It wasn’t that I suddenly forgot how makeup worked. It was as if the image I used to have in my head was gone. I also noticed something more difficult to explain: I could look at two things and know they were different, but I couldn’t necessarily identify what the difference was. It was like the information was perceptually present but wasn’t being extracted with the same level of detail.

That distinction matters to me because it seems to appear in other areas too. It doesn’t feel like I literally cannot see or detect things. It feels like the information is there, but it is not represented with the same resolution or granularity, or it doesn’t automatically become the information that matters.

I see something similar in the way I perceive people now. Before, I could look at someone and automatically notice very small things about their face, eyes, expressions, movements, posture and voice. Those details weren’t isolated pieces of information. They immediately entered a larger representation of the person. I could notice a tiny inconsistency between someone’s words and their expression, connect it to the context, and spontaneously start understanding what might be happening underneath. I wasn’t consciously sitting there analyzing every microexpression. That was the point. It happened automatically.

Now I can look directly at someone and know exactly who I’m looking at, understand what they’re saying and follow the conversation, but sometimes it feels like I’m not really seeing the person in the same way. I might know that something about their appearance is different without being able to tell you what it is. I might notice their body moving but not spontaneously register the details of how it moves. Sometimes looking at someone’s face even feels like a distraction from the conversation, so I end up focusing more on their voice because it is easier to process the conversation that way.

What is interesting is that when I deliberately force myself to pay attention to their face or body, I can sometimes start noticing details again. And when I actually notice those details, they can affect me. For example, I recently had the experience of deliberately paying attention to someone’s facial and bodily characteristics in a way I hadn’t been doing automatically, and I noticed that it actually increased my attraction to them.

That makes me wonder whether the problem isn’t simply that attraction is gone. Maybe some of the perceptual information that used to automatically become relevant to me is no longer being selected, amplified or integrated in the same way. The person is perceptually there. I can see them. But the details that used to make the person become a meaningful, attractive, interesting representation may not automatically reach the same level of salience.

This distinction also seems relevant to my social behavior.

I have noticed that I can seem more inconsiderate now, but I don’t think that necessarily means that I care less about people. One of the things that made me considerate before was that I automatically picked up on information about other people. I could notice subtle changes in someone’s expression, tone, behavior or emotional state and immediately understand what was happening. That information would automatically influence what I did next.

If that information is no longer being extracted with the same automaticity, then the consequence can look like a change in character even if the underlying value hasn’t disappeared.

Before, if someone around me was distressed, I would automatically notice it and think about how my own behavior might affect them. I could be extremely aware of what I was feeling while simultaneously remaining very controlled in how I expressed it. I remember being physically extremely anxious and sick and still not wanting to tell my parents how bad I felt because I didn’t want to make them worry. I would contain it until I felt I actually needed help, and then explain what was happening in a very calm and controlled way, often minimizing it rather than making the situation more emotionally intense.

I wasn’t consciously thinking through a checklist every time this happened. It was almost automatic. My own distress was one piece of information, but so was the effect my distress would have on the people around me. I knew that if I showed them how bad I felt, they would become worried, and then I would have to deal with their distress on top of my own. I was also extremely sensitive to other people’s emotional states and often felt responsible for people close to me because I assumed they experienced distress as intensely as I did.

Now I can experience the same kind of physical anxiety and instead become extremely outwardly expressive. During the recent episode with my grandmother, for example, I had a full-blown panic attack and became extremely expressive in a way that would have been very unlike me before. I could not imagine myself previously screaming or displaying that level of distress outwardly even if I was experiencing something equally intense internally.

The important distinction is that I don’t think I suddenly decided that other people’s feelings no longer matter to me. The automatic information that used to tell me, “This is what is happening to them, this is how your behavior is going to affect them, and this is what you should do about it” may not be arriving in the same way.

That is what I mean by the “filter.”

It isn’t necessarily a filter that suppresses emotion. It is more like a filter that determines what information gets through, what becomes relevant, how it is interpreted, and what ultimately becomes behavior.

Before, there seemed to be a substantial transformation between internal experience and outward behavior. I could feel something intensely and still have the context, consequences and other people’s states automatically integrated before it became an action. Now sometimes the internal state seems to reach expression much more directly, and only afterward do I consciously analyze what happened.

The same idea applies to perception. Before, I didn’t have to deliberately search for what was important in someone’s face. I noticed it. I didn’t have to deliberately search for the detail in my makeup that would produce the result I wanted. I saw it. I didn’t have to deliberately search for the next association in a chain of thought. It appeared.

This is why I think “automaticity” might be as important as “blunting.”

The change is not necessarily that every capacity disappeared. It is that processes that used to happen spontaneously now often have to be initiated consciously.

This is also why I don’t think my sexual symptoms can be reduced to “low libido.”

The sexual change is not only that I don’t spontaneously want sex. The actual sensory experience changed. Before, sexual sensation could have value in itself. I didn’t necessarily need to already be extremely horny for stimulation to feel pleasurable. If I was touching myself in a particular way, or someone touched me in a particular way, the sensation itself could generate pleasure and could then increase my arousal.

When I was already excited, this effect became much stronger. Very small or indirect sensations could become extremely noticeable and satisfying. There was a kind of amplification between arousal and sensation: becoming aroused made my body more sensitive to sexual information, and the information then reinforced the arousal.

That is very different now. I can engage in sex even when I am not particularly aroused, and I know that I am being touched, but the sensation itself often doesn’t produce the pleasure it used to. Sometimes there is an actual numb quality to the genital sensation, including at the beginning of stimulation. It isn’t simply “I don’t care about this.” The sensation itself can feel less sensitive, less differentiated and qualitatively different.

I can know that something is touching me while simultaneously feeling that the experience doesn’t contain the same amount of information or intensity that it used to. This is why I’ve started using words like “resolution” or “granularity.” I don’t mean that literally my nerves have simply lost spatial resolution. I mean that the subjective representation of the stimulus seems impoverished.

Before, a sensation could contain many distinguishable qualities at once. Now sometimes it feels reduced to “I know there is contact.”

This makes me wonder whether there are actually several processes that have become dissociated. Sensory detection is one thing. Sensory discrimination is another. The richness of the representation is another. Then there is salience: whether the stimulus automatically stands out as important. Then hedonic valuation: whether it feels good. Then motivation: whether it makes me want more. These are related, but they aren’t the same thing.

I think PSSD research could benefit enormously from separating them instead of putting everything under “libido.”

My experience with dopaminergic or stimulant substances also made me question a simple dopamine explanation. I’ve taken substances that clearly increased my general activation. I could become energetic, jittery, physically activated, shaky, alert, sometimes extremely stimulated. But that didn’t restore the missing sexual experience. I could have a highly activated organism while still not experiencing sexual stimuli as they used to feel.

That doesn’t prove that dopamine is irrelevant, and it certainly doesn’t prove that the problem is somewhere downstream of dopamine. Different dopaminergic drugs affect different systems, and increasing dopamine is not equivalent to restoring normal sexual processing. But it does demonstrate something important to me: increasing general physiological or motivational activation is not sufficient to recreate the missing sexual sensation and salience.

That is what led me away from the idea that the problem can simply be “not enough dopamine.” If the sensory representation itself is impoverished, increasing downstream activation wouldn’t necessarily reconstruct information that isn’t being represented properly. Turning up the volume on a recording doesn’t restore information that was lost from the recording. You can make the system louder without making it more detailed.

So the model I’m currently interested in is something more like a chain:

sensory information - representation - selection/attention - integration - salience - affective/hedonic valuation - motivation - behavior

These processes constantly influence one another, so I don’t think this should be treated as a simple linear pipeline. My hypothesis is that antidepressants may have disrupted one or more points in this system, or more importantly, the coupling between them.

For example, before, a person’s face could automatically capture my attention because individual features were highly informative to me. Those features would become part of a rich representation of the person, and that representation could acquire emotional or sexual significance.

In the sexual system, a small physical sensation could become salient, pleasurable and motivating, while arousal could in turn increase the sensitivity to further sexual stimulation.

In both cases, perception and motivation were interacting with each other.

Now, I can still detect the person. I can still detect the touch. I can still understand what is happening. But the automatic transition from information to significance seems weaker.

I have to deliberately attend to things that used to capture me automatically. And sometimes, when I deliberately attend to them, I can recover something. That makes me wonder whether at least some of the information is still accessible but is no longer being spontaneously selected, amplified or integrated in the same way.

This also makes me wonder whether what I’m describing as a “filter” could involve several different neural processes rather than one thing. Attention, perceptual precision, salience attribution, valuation, executive control, interoception, language retrieval and large-scale network interactions could all contribute to the subjective experience. I don’t think it would make sense to pick one brain region and say, “this is the filter.” I’m more interested in how these systems interact.

That is also why I’ve been interested in the default mode network, although I don’t think “DMN dysfunction” is an adequate explanation for everything. The DMN is relevant because of its involvement in internally generated thought, self-referential processing, autobiographical cognition and spontaneous mental activity. The loss of my spontaneous internal thought is one of the most profound changes I’ve experienced.

But I don’t think the model should stop there.

What interests me much more is the interaction between internally generated cognition, attentional systems, sensory processing, salience and reward/valuation systems.

In other words, perhaps the relevant question isn’t simply “is my DMN lower?” It might be something more like:

Has the relationship between spontaneous internal processing, perceptual representations, attention, salience and motivational valuation changed?

Could a person have relatively preserved individual capacities while the information is no longer being integrated into the same coherent, self-relevant and motivationally meaningful experience?

That is also where my idea of a “DMN set-point overshoot” came from. I don’t mean that as an established mechanism. I’m wondering whether, in some people, antidepressant-induced changes in large-scale network organization and serotonergic regulation could move spontaneous cognition and internally generated processing below that person’s individual baseline, rather than simply bringing an abnormal system back to normal.

If something like that were possible, it could potentially help explain why someone might experience a persistent reduction in spontaneous thought, self-generated meaning and internal associative activity after discontinuation, even though the drug itself is no longer present.

But I don’t think there has to be one mechanism explaining every symptom. There could be a combination of altered sensory processing, altered salience and reward valuation, altered motivational coupling, altered emotional gating, and altered large-scale network dynamics. Different mechanisms could converge on a similar subjective phenotype.

The important point is that I don’t think the phenotype is simply “less.”

It may be different processing.

That distinction also matters for my sense of self.

I have changed enormously as a person since antidepressants. I became less proud, less confident, more ashamed, more confused and less certain about who I am. I don’t want to romanticize who I was before or pretend that every aspect of that person was perfect. I had anxiety, depression, an enormous ego, intense reactions and other things that were difficult. But I also had a very strong sense of self.

What is strange is that many of the things I valued then, I still value now.

I still value precision. I still value understanding. I still value being perceptive. I still value creativity, beauty, sexual expression, autonomy, self-control and being able to understand myself and other people deeply.

In fact, I’m beginning to understand more clearly now why those things mattered so much to me then.

Before, I knew that they were valuable to me, but I didn’t necessarily have the conceptual language to explain what was underneath them. Now I can increasingly see that a lot of my identity was built around being able to take information in, differentiate it, understand it, integrate it and transform it into something meaningful.

So I don’t think my old personality was simply a collection of arbitrary traits.

A lot of it may have been the emergent result of how my brain naturally processed information.

If you change that processing, the person can look radically different even if some underlying values remain intact.

For example, I can still value being considerate while being less spontaneously aware of the cues that previously told me how to be considerate. I can still value beauty while having less spontaneous access to the details that allowed me to create it. I can still value sex while sexual stimuli fail to become as pleasurable or motivationally salient. I can still value understanding while spontaneous associations and recursive thought no longer arrive automatically.

That can produce a profound identity disturbance because the person is still there in terms of values and intentions, but the machinery through which those values used to express themselves has changed.

And I think this may explain why I sometimes feel like I’m not simply “less myself,” but that I have to consciously operate myself.

Before, so many things were automatic.

I noticed things automatically.
I made connections automatically.
I became interested automatically.
I knew what mattered automatically.
I knew how to express myself automatically.
I could regulate myself automatically.
I could perceive other people automatically.
Sensory information could become meaningful automatically.

Now I often have to deliberately initiate these processes.

And when I can force myself to do it, I sometimes discover that the underlying ability hasn’t completely disappeared.

That’s one of the most important things I’ve noticed.

It is why I don’t think this is adequately described as simply becoming less intelligent, less caring, less sexual or less emotional.

There seems to be a difference between having information available and having that information automatically selected, integrated and transformed into something meaningful.

There also seems to be a difference between having a value and having the automatic perceptual and emotional information that allows that value to guide behavior in real time.

That is why I think the “filter” concept is useful. Again, I don’t mean a literal single filter in the brain. I mean the automatic processing between stimulus and significance, between internal state and expression, between perception and action, and between thought and language.

Before, I experienced the result.

Now, I often experience the machinery.

I have to consciously look for the detail.
I have to consciously search for the association.
I have to consciously figure out what I am feeling.
I have to consciously look at someone’s face to extract information that used to come to me automatically.
I sometimes have to speak in order to organize thoughts that previously organized themselves internally.
I can know that a sexual stimulus is there without it automatically becoming pleasurable or motivating.

That is why I think the most interesting question for PSSD research is not simply:

“Why don’t these people want sex?”

It is:

“What changed in the process by which information becomes differentiated, salient, affectively meaningful and motivationally relevant?”

And I think that question should be applied beyond sexuality.

If someone reports genital numbness, is the problem detectable at the level of peripheral sensory thresholds, cortical sensory representation, interoceptive processing, hedonic valuation, or some combination?

If someone reports loss of attraction, can they still recognize and discriminate sexual features normally but fail to assign them motivational salience?

If someone reports emotional blunting, are emotional stimuli being perceived normally but assigned less affective significance, or is the problem earlier in the processing chain?

If someone reports loss of spontaneous thought, is internally generated cognition reduced, or is information being generated but failing to reach conscious awareness in the same way?

If someone can deliberately attend to a stimulus and temporarily recover some of its richness, does that suggest that at least some representations remain available but are not being automatically selected or amplified?

If someone becomes highly physiologically activated by a dopaminergic drug without recovering sexual pleasure, what does that tell us about the relationship between general arousal, sensory representation, reward, salience and sexual motivation?

And if several of these things occur together, could they represent different manifestations of a broader alteration in how information is filtered, integrated and assigned significance?

I don’t know the answer.

I also don’t think my subjective experience is enough to establish a mechanism. These are hypotheses that need to be tested, falsified and compared with alternative explanations.

But I think the phenotype I’m describing is more specific than “emotional blunting” or “low libido.”

I don’t feel like an entire system disappeared.

I can still perceive.
I can still understand.
I can still deliberately focus.
I can still become physically activated.
I can still sometimes recognize the relevance of things.
I can sometimes get glimpses of the old experience when I deliberately direct my attention toward something.

What feels fundamentally different is the automatic connection between these processes.

Before, information seemed to naturally become meaningful.

Now, I often have to make it meaningful.

And that is the part I think we should be studying.

TL;DR: I don’t think PSSD is simply a loss of libido, emotion, or motivation. My experience feels more like a disruption in how information becomes differentiated, salient, meaningful, pleasurable and motivating. I can often still detect things, but they don’t automatically acquire the same resolution or significance they once did. This seems to affect perception, attraction, sexual sensation, emotion and spontaneous cognition in different ways. I think research should investigate the individual stages and coupling between sensory representation, attention, salience, hedonic valuation, motivation and spontaneous cognition, rather than reducing these symptoms to “blunting” or “low libido.”