I admire your willingness to continue to engage! I think I probably would have deleted my account after having 20+ notifications 😂😵‍💫

no obligation to continue this thread, just know I totally feel you, you're not alone in this 🤗 hopefully it'll get better for both of us.

Woah you can medicate rejection sensitivity????

Basically, yeah.

I wouldn't go into this with the expectation that medication will eliminate it but the working hypothesis is that rejection sensitivity on the nervous system level is a lot like what happens with a PTSD trigger; you get this inordinate response to stimuli and your body goes into a fight-or-flight mode, or at least something pretty close to it.

Rejection sensitivity (at least in ADHDers) is really closely linked to heightened emotional reactivity at its core. I'm of the opinion that there's a lot of environmental factors that feed into this, where a person gets into a positive feedback loop where they are exposed to a lot more negative feedback and rejection by others compared to their peers and the response to this compounds over time. I'm also of the opinion that with emotional reactivity in ADHD it tends to follow one of two major paths over the course of a person's development - you have the outwardly expressed form which is much more closely linked with hyperactivity, and that is where you get the more oppositional defiant disorder-style of responses (I object to the framing of this disorder and I don't really like how it's understood or pathologised but I'm using it as shorthand here) and then you have rejection sensitive dysphoria style of responses, which is more closely linked with the inattentive type of ADHD and which I see as the inwardly-expressed form of this phenomenon.

So if you can use medication to reduce emotional reactivity and the associated physiological response then you can reduce the symptoms of rejection sensitivity and that's what can make a really big difference in developing or implementing behavioural strategies to manage this. Obviously if you've gone through your whole life experiencing rejection sensitivity then it will take a good amount of time to adjust to things and to develop a different approach and a different understanding of things so I see medication as being the first step in a strategy to treat/manage full-blown cases of RSD.

With all of that in mind, for ADHDers the two medications that have the best outcomes for emotional reactivity are guanfacine and clonidine but because I'm no psychiatrist or anything I can't say that they would be just as effective for a non-ADHDer that is, for example, autistic. If the rejection sensitivity is more akin to a sort of low-grade PTSD due to the cumulative effects of socialising as an autistic person who is in an unsupportive environment or because they went undiagnosed as a child then my hunch would be that beta blockers might be more useful here.

Beta blockers and clonidine have an immediate effect. For guanfacine it's a bit more of a mixed bag - the physiological effects should be fairly immediate but they say that it takes a few weeks for the full effect to be achieved, and I'm assuming that this is mostly because of how guanfacine affects the brain (but that's a long story in itself). One of the good thing is that these meds are much easier to start on or to taper off of compared to antidepressants.

I've taken aripiprazole as an adult and I definitely noticed a reduction in my experience of agitation due to sensory overload and similar autism-related stuff.

I tolerate antipsychotics well so I didn't notice any significant emotional blunting and, unfortunately, I struggle with anhedonia in a major way so I didn't notice it affecting my anhedonia significantly in a positive or a negative way.

Aripiprazole is a complicated drug with regards to dopamine as it's a partial agonist so at low doses it increases dopamine in the hippocampus and the prefrontal cortex, but not in the nucleus accumbens. At a moderate dose it reduces dopamine release in the nucleus accumbens but not the prefrontal cortex. At a high dose it reduces dopamine in both regions.

To add to the complexity, it's an antagonist for one serotonin receptor and it's a partial agonist for a different serotonin receptor and to put it in simple terms serotonin sorta competes with dopamine in the brain so if the partial agonist effect is increasing serotonin at a particular place in the brain then it could be negatively impacting upon the dopamine levels there too.

Because of all that I think it would be really hard to figure out exactly what the cause of the emotional blunting and anhedonia was without having a better understanding of the dosage range that you were at and also looking at how you have responded to other meds that affect dopamine/serotonin in similar/opposite ways, particularly in the regions of the brain mentioned above, but in short this is something that's way above my paygrade and you'd need the supervision of a psychiatrist who is attentive to this stuff to start to puzzle out exactly what caused tjese effects in you. You could say that it's very common for antipsychotics to come with side effects of anhedonia and emotional blunting but that feels a little bit of a dismissive response tbh.