Posted by SLS on May 12, 2001, at 11:02:29
In reply to Re: Yes - sexual dysfunction take variety of forms, posted by Pharma on May 12, 2001, at 6:08:20
I forget where I stole this from.
The dosages and reported beneficial effects might not match well with the real-life experiences of Psycho-Babble participants, but it makes for a pretty good basic list.
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- Interventions for Sexual Side Effects -There are several ways to manage sexual side effects attributed to antidepressants. The choice of management needs to be tailored to the individual patient and may change throughout the course of treatment. General management strategies include waiting for the side effect to diminish over time if it is mild and/or intermittent; reducing the dose of the antidepressant to a minimal effective dose; using pharmacologic antidotes; or switching to another antidepressant that is not associated with sexual dysfunction.
Pharmacologic antidotes can be a useful strategy to manage sexual side effects during antidepressant treatment. The following are pharmacologic antidotes for antidepressant associated sexual dysfunction (Table 4): stimulants, Ginkgo biloba, cholinergic enhancers, estrogen creams or lubricants, and amantadine. There has been a lack of controlled trials regarding the true efficacy and safety of these strategies. Most of the literature is based on case reports or noncontrolled trials. The choice of antidote for a particular patient should take into account several factors, including:
- The overall efficacy of the primary antidepressant
- Potential medication interactions
- Potential additive side effects
- Potential antidepressant-enhancing effects
- Potential effects on managing any other side effects
- Cost
- Overall adherence to taking additional medication.
- Daily standing doses are recommended for most of the antidotes because little is known about how long it takes for them to become effective.* One exception is sildenafil, which can be prescribed on an as-needed basis, similar to prescribing instructions for male erectile disorder.
------------------------------------------------------Table 4. Pharmacologic Antidotes for Antidepressant-Associated Sexual Dysfunction
5-HT3 = serotonin-3
MAOI = monoamine oxidase inhibitor
SSRI = selective serotonin reuptake inhibitor
TCA = tricyclic antidepressant* Reported Effects: The sexual phases that the antidote is reportedly effective in treatment out of 3 possible phases that may be affected by the antidepressant.
† non-FDA-approved use.
---------------------------------Format:
Antidote
- Dosage
- Comments
- Reported Beneficial Effects *---------------------------------
Methylphenidate †
- 5-40 mg/d
- For SSRIs or venlafaxine
- Libido, arousal, orgasmDextroamphetamine †
- 5-40 mg/d
- Avoid night dosing (insomnia)
- Libido, arousal, orgasmPemoline †
- 18.75-75 mg/d
- Check liver function
- Libido, arousal, orgasmGinkgo biloba extract †
- 180-240 mg/d, tid, divided doses
- Potential increased clotting time, possible flatulence
- Libido, arousal, orgasmBethanechol †
- 10-50 mg prn 1 hour before sex
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalNeostigmine †
- 200 mg/d, tid divided doses
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalEstrogen creams or lubricants
- As needed
- For vaginal dryness, atrophy of vaginal tissue
- ArousalAmantadine
- 100 mg bid
- Caution in patients predisposed to psychosis
- OrgasmCyproheptadine
- 4-12 mg qhs
- MAOIs, TCAs, SSRIs, venlafaxine; watch for reemergence of depressive symptoms; sedating
- OrgasmBuspirone †
- 30-60 mg/d, bid divided doses
-
- Libido, orgasmBupropion †
- 75-150 mg/d, qd or bid divided doses
- For SSRIs or venlafaxine, fluoxetine may raise bupropion levels; usual precautionary measures for bupropion
- Libido, arousal, orgasmMirtazapine †
- 15-45 mg/d
- For SSRIs, venlafaxine
- OrgasmNefazodone †
- Start 50 mg/d, up to 150 mg/d
- SSRIs, venlafaxine
- OrgasmGranisetron †
- 1 mg prn
- ? Use of other 5-HT3 antagonists
- OrgasmSildenafil
- 50-100 mg/d
- Contraindicated with nitrates
- Libido, arousal, orgasmYohimbine †
- 5.4 mg tid
- Can be anxiogenic; ? safety with MAOIs
- Libido, arousal, orgasm
5-HT3 = serotonin-3
MAOI = monoamine oxidase inhibitor
SSRI = selective serotonin reuptake inhibitor
TCA = tricyclic antidepressant* The sexual phases that the antidote is reportedly effective in treatment out of 3 possible phases that may be affected by the antidepressant.
† non-FDA-approved use.
poster:SLS
thread:11607
URL: http://www.dr-bob.org/babble/20010507/msgs/62612.html