Posted by jb on March 29, 2001, at 10:26:02
In reply to Re: Treatment for Social Phobia w/o MAOI ,benzo, SSRI?, posted by SalArmy4me on March 29, 2001, at 4:24:46
Hi, Sal. Thanks for your thoughtful response. I think I should take another look at Mirtazapine, at a minimum. Regarding Venlafaxine, I'm wary of its high level of sexual dysfunction (see PubMed article, below). With Nardil, I already have sexual dysfunction, but I also get a high level of relief from SP. Desipramine, although an agent with predominant nor-adrenergic activity, I understand to be less efficacious than Fluvoxamine, which is less efficacious than Nardil.
So, I guess I'm trying to get around the sexual dysfunction of drugs with prominent 5HT2a activity (mostly SSRI's, venlafaxine), and the prominent cognitive/memory impairment of benzo's. Sometimes, I feel like a dog chasing its tail.
I did see a post where someone was claiming Adrafinil as a 100% solution for Social Phobia, but I guess I'd like to see others making similar claims. Separately, I know more people are trying various "cocktails" of augmenting and combining agents to address social phobia, such as using Modafinil to offset the decreased alertness of Klonopin. However, research on PubMed has shown Modafinil does not reverse the short-term amnestic effect of Klonopin. The conclusion is the amnestic effect is not related to the decrease in vigilance or psychomotor impairment of benzo's.
Oh, well, guess I'll continue to chase my tail.
Thanks.
JB
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Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F
University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain. angelluis.montejo@globalmed.es
BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
Publication Types:
Clinical trial
Multicenter studyPMID: 11229449
poster:jb
thread:57815
URL: http://www.dr-bob.org/babble/20010327/msgs/57914.html