Posted by SLS on May 25, 2000, at 16:24:32
In reply to Re: Social Phobia: Nardil or Paxil ? (SLS), posted by Judy on May 24, 2000, at 18:18:53
> > I had absolutely no problems with sex after a few months had passed (with the possible exception of wanting more of it).
> Scott - so that this isn't totally off-topic, I'll first cast my vote for Nardil as a wonderful help for social phobia. It would still be my drug of choice if I could get around the nasty edema side effect.
This must be very demoralizing for you. I believe I ran across your posts regarding this earlier. It frustrates me to see this. What sorts of things did you try to deal with it? Did the severity of edema change with dosage?
Crap. I wish I knew more about this phenomenon to be able to help.
> Now - *NO* problems whatsoever with sex after a few months???
Sorry. None.
> Is that a typical response or yours alone?
Actually, I initially thought it was more typical than atypical. When I began to post statements that any anorgasmia produced by an MAOI would disappear with time, I was bombarded with a shower of angry protests describing the contrary. Prior to visiting this board, I had never encountered long-term anorgasmia as a complaint. I don't know. Maybe there is a bias in the biology of the population here representative of treatment-resistance or the result of exposure to many different antidepressants. I was probably just ignorant.
> What about before that? Did you lose your libido as well as mechanical ability for the first few months?
It is quite difficult to lose a libido that doesn't exist. My depression affects just about everything. >:-(
As far as the mechanics are concerned, I experience a change in the orgasm itself (retrograde ejaculation), but I don't have too much trouble reaching it. This seems to disappear within a week or two. I may be atypical with respect to orgasms, as this seems to be a forte of mine. It's hard to say that without seeming pretentious, but...
A more relevant experience of mine would be with a powerful MAO inhibitor called clorgyline. Initially, I had quite a bit of difficulty reaching orgasm. The drug seemed to be persistant in this regard. I guess I (and my partner) was more persistant than clorgyline. I found that with each successive orgasm reached, it became easier and easier to get there. I wish this were the case with everyone. Perhaps there is a "retraining" of the orgasmic pathways - sort of like constructing new highways. If this is true, I encourage you to have as many orgasms as possible, despite your unwillingness to do so. :-) Masterbate if necessary.
Actually, I would really like to know if others have experienced this same sort of recovery of orgasmia.
> The reason I ask is because I've been taking Parnate (60 mg/day) for about three months. It's working relatively well for my depression (nowhere near as well for anhedonia) - totally different drug for me than Nardil - except I almost immediately lost all sexual ability and desire.
The first thing that comes to mind would be to add a dopaminergic drug with the hope that it will help with anhedonia, libido, and anorgasmia. If you find the right one, perhaps all three will resolve.
Ritalin
Dexedrine
Adderal
Parlodel
Permax
Mirapex
SymmetrelDespite viscious rumors to the contrary, these drugs can be safely combined with MAOIs. As a precaution, it may be a good idea to have your blood pressure monitored for a few hours after taking the first dose of Dexedrine, Adderal, or Ritalin
I think either Ritalin or Mirapex would make a good first choice.
I am looking into the feasibility of adding amisulpride to an MAOI. This may be a drug to put on your list.
> Just this past weekend, I started to "recall" some of those old feelings and was actually able to reach climax (took a while, but it was a real one!).
Hopefully, it will become easier to have the next one, and the one after that, and... Keep pushing.
> Of course, being the total pessimist I am about any AD, I panicked that Parnate was pooping out on me.
That I began to regain my ability to orgasm did not signal the beginning of any kind of "poop-out".
> Within the same time frame, I've started to have Cecil B. DeMille-type colorized dreams in the early morning (I've never remembered my dreams, if I had them, while taking an MAOI before). This added to my poop-out fears. What do you think? I feel the same. Have I passed some kind of three-month test, or is Parnate letting me down softly at first?
This is a very astute observation. The appearance of the type of dreams you describe is very similar to what someone experiences when they discontinue an MAOI, especially if they do so abruptly. I don't know how to interpret this at this point. With some people, the dosage of an MAOI must be adjusted from time to time. The therapeutic dosage range of Parnate is 40mg - 80mg (I don't care what the PDR says). Some people need more than 100mg. I have been as high as 150mg. You have some room yet.
My prescription: Be wary, but not pessimistic.
I would wait to see if any adjustment in your dosage of Parnate is necessary before you start adding things to treat the residual anhedonia or sexual side effects.
- Scott
poster:SLS
thread:34436
URL: http://www.dr-bob.org/babble/20000517/msgs/34637.html