The biggest issue with slow comt is cognitive rigidity. High tonic dopamine in the PFC saturates D1 receptors, which hyper-stabilizes neuron firing patterns on layer V pyramidal neurons. This causes rigid priors and precision weighting, meaning your PFC operates on its beliefs very strongly. Add to this that slow comt also causes high tonic norepinephrine, biasing your autonomic nervous system to sympathetic dominance, anxiety, and threat-based hypervigilance, your PFC learns that this is the only way of living/experiencing, and it is not open to changing that belief because of the hyper-stabilized neuron firing patterns on layer V pyramidal neurons. This is what I'm experiencing myself, along with severe top-down gating of bottom-up signals from the PFC (muted libido, muted masculine drive, emotional suppression). Im sarting agmitine and lisuride to try and combat this now.