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Reprint of Toby's advice on sexual side effects

Posted by Roo on July 26, 1999, at 7:17:59

This is a reply Toby sent to a poster about SSRI's
and sexual dysfunction. I thought I'd copy it in this
months posts b/c I saw so many posts regarding this issue,
and I thought it was a very helpful response.

How to treat? Several options are available, especially if the problem is mainly loss of orgasm but the libido is fine. 1) Some folks do well with a drug
holiday: stop the medication on Friday and resume on Monday, planning the desired interlude on Saturday or Sunday. You just have to be sure and not
forget to start back on the medication on Monday so that the depression won't recur. 2) There are also medications that do not cause this side effect
(the reason loss of orgasm occurs with SSRI's is that one of the serotonin receptor subtypes is responsible for allowing an orgasm to occur and most
SSRI's block this receptor to some degree): Wellbutrin, Serzone, Remeron do not block that particular serotonin receptor and so sexual function
remains intact. 3) There are medications that can reverse this side effects, either through unblocking that receptor or overriding it by antihistamine
effects. These include adding Buspar 15 - 60 mg per day; adding Wellbutrin SR 150 - 300 mg per day; adding Periactin (a powerful antihistamine, so a
side effect may be drowsiness, but if it works like it should, you may be drowsy that evening anyway) 4 - 8 mg, 1 to 2 hours before intercourse (costs
about $35 for 60 tabs); adding an over the counter amino acid called L-arginine 500 mg, 4 tablets on an empty stomach 1 to 2 hours before
intercourse (cheapest: GNC stores currently have a sale on for 60 tabs for $9.99 with the second bottle for $5.00). The results vary with individual
people, although I am beginning to hear very consistent, good results about the L-arginine, and since it is OTC you don't need a prescription or a
doctor's visit every time you run out. Also, the Periactin and L-arginine do not have to be taken every day, just when you need it.

You could always try Serzone or Remeron, but these are usually used in very anxious depressed people and may make you too sedated if anxiety is
not a part of your depression




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