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Re: MAOIs--types of depression/sexual side-effects

Posted by JD on June 3, 1999, at 7:32:44

In reply to MAOIs cause sexual dysfunction?, posted by John on June 1, 1999, at 18:05:02

Gee, John, if this is one person behind this myriad of postings you sure seem to be doing a thorough job of researching MAOIs! :-)
Who could blame you though--they're interesting meds (just as much for me too) and aren't as widely discussed as many others...

As for your questions, I'll throw in the following based upon what I've come across in what often seems like my own personal correspondance-course in pharmacology.:

(1) MAOIs have a pretty good reputation in chronic or longer-term depressive states that have been refractory to first-line treatments. As Elizabeth noted, melancholia and dysthymia are generally two pretty distinct things--the first usually refers to an acute syndrome of "classical" symptoms like guilt, despair, mournfulness, insomnia, lack of appetite, etc.; the second usually refers to a less acute but more chronic (and I can assure you, equally unpleasant!) pattern of lowered mood and anhedonia. This being said, I can imagine that certain aspects of both could present at the same time in complex ways. While there has been a lot of debate about whether MAOIs work best for a certain kind of patient, there's still no full consensus on this. Nonetheless, while MAOIs don't necessarily have a stunning track record in treating "simple" melancholia (they are rarely used for this nowadays anyhow), they are frequently said to work well in situations that feature so-called "atypical symptoms" (such as overeating, oversleeping, mood fluctuating in response to outside events) or, somewhat relatedly, in people who show "heightened interpersonal sensitivity" (fear of social rejection, etc.), often in a pattern that goes back to early childhood. (This is one of the reasons that MAOIs often work pretty well for people with social phobia. I should throw in anxiety and panic attacks too, as these symptoms will often respond well to MAOIs too, perhaps best of all with Nardil.) There is plenty of controversy on these issues, as some studies claim that SSRIs can work just as well in many of the above situations, but I think many would agree that for people who present complex depressive problems with chronic or semi-chronic histories (often seeming to blur into long-term personality traits), MAOIs can sometimes be the best bet. As I'm sure you've heard, in some cases the results can be very dramatic.

(2) As the other responders have said, MAOIs are known to cause sexual side effects as with most antidepressants. Whether it's as much as with SSRIs is something that I'm not really sure has been well studied. My guess is that while they probably cause their fair share of dysfunction (and then some perhaps), it may not be *as* bad as with SSRIs, since the dopamine-boosting effect of MAOIs may help to counteract some of the libidinal chilling associated with serotonin reuptake blockers. People's responses to meds are different though, so this can be very tough to predict and probably varies somewhat among the different MAOIs.

Best regards,

> Hi all. I am considering an MAOI after trying lots of other stuff and counseling. I gather MAOIs are good for chronic stubborn melancholic depression like mine. Anyone who knows, two questions: 1)Are they good for melancholic depression (dysthymia/anhedonia)? 2)Most important, are they known to cause sexual dysfunctin with guys, specifically lack of interest, inability, or genital anesthesia, or all of the above? We all know the SSRIs almost universally cause sex problems, but what about MAOIs? Thank you for your time and replies. John.




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