Posted by Trevpr on October 7, 2012, at 17:48:04
In reply to Re: Sexual Problems - Permanent or Not? » Trevpr, posted by ChicagoKat on October 7, 2012, at 16:38:19
Thanks for the post! Yeah this has really been the most confusing symptom of mine. My Testosterone is fine, I'm healthy, young, and everything appears to be okay. I tried Wellbutrin at the max dose, 450mg, for a whole 2 months. It seemed to help lift symptoms such as anxiety, focusing issues, etc., but did not touch my anhedonia or sex drive. I also tried Adderall, Mirapex, Desipramine, Abilify, and now Vivactil without any positive effect. I've also tried the gambit of supplements such as DLPA, L-tyrosine, L-Theanine, Rhodiola Rosea, SAM-E, etc.
Ritalin helped a very small amount, but for reasons discussed before, it was not a sustainable solution and quickly formed a tolerance.
I'm just at a loss here because I've lost all interest in everyone and I'm still single! I kind of wanted to date and marry, but now it seems that I won't be able to.
The low libido problems have been literally constant and I haven't gotten a break from them since the beginning of the depression. So far no libido and anhedonia/apathy/lack of emotional responsivity have been my only symptoms.
From my research, I've compiled a list of meds that seem to be best at helping to alleviate these issues:
THE MEDICATION ROUTE
NOTES ON MEDICATION STRATEGIES
Now, there is a sort of catch-22 situation with anhedonia because serotonergics can blunt hedonic response, but the administration of dopaminergic agents also can worsen the problem. Downregulation, desensitization, or tolerance may develop. In addition, many dopaminergic/norepinepheric agents have many side effects such as elevated blood pressure or heart rate (such as Ritalin) and may produce chemical dependency or addiction. Many available drugs that modulate hedonic response are not available in the United States. Not all drugs work the same way for different people. Many people find relief from more activating SSRIs such as Prozac or Zoloft, others may find relief with SNRIs like Pristiq or Effexor, while still others may find relief from stimulants. There is no universal cure, because each brain has different metabolism and chemistry.STIMLANTS
Stimulants are drugs that force the release of catecholamines (neurotransmitters like dopamine and norepinepherine). Stimulants usually work very quickly, usually within an hour, but their effects do not usually last very long. Extended release versions of stimulants exist, but the amplitude of the response is spread over a longer time duration, thus making it lower. Stimulants like Ritalin usually take around 20 minutes to start working, but only last from an hour and thirty minutes to three hours. Adderall is stronger and can last longer, so dosages are correspondingly lower. The main disadvantages to using stimulants is the building of tolerance, a crash after the effect wears off, insomnia, high heart rate, stress on the cardiovascular system, high blood pressure, psychosis at high doses, and short duration of response. Stimulants may also be addicting.Ritalin (Methylphenidate), Dextroamphetamine, Adderall (mixed amphetamine salts), Focalin (Dextromethylphenidate), Modafinil, Mazindol
DOPAMINE AGONISTS
Dopamine agonists are dopamine substitutes which bind to specific dopamine receptors like dopamine. Dopamine agonists are typically prescribed for Parkinsons Disease or Restless Leg Syndrome patients, but many studies have shown efficacy in treating depression. Dopamine agonists have the potential to cause compulsive habits or addictions or make a person tired. Dopamine agonists may lower prolactin levels, cause hypersexuality, compulsive gambling, or even psychosis. These drugs are typically thought of as nonaddicting, but a withdrawal syndrome may occur.Mirapex (Pramipexole), Requip (Ropinirole), Dostinex (Cabergoline), (Apomorphine), (Bromocriptine), (Rotigotine), (Amantadine)
ANTIPSYCHOTICS
Antipsychotics antagonize certain dopamine receptors and may bind to others or leave extra free dopamine somewhere else. This may be useful for depression, but some dopamine agonists increase prolactin or can cause Tardive Dyskenesia, restlessness, or agitation.Abilify (Aripiprazole), Amisulpride, Sulpride, Zyprexa
SEROTONIN RECEPTOR ANTAGONISTS
Serotonin receptor antagonists may disinhibit dopamine which is normally inhibited by certain serotonin receptors. These medicines may even be used in some cases to ward of SSRI induced sexual dysfunction.Buspar (Busiprone), Low dose Prozac (Fluoexitine), Remeron, Periactin (Cyproheptadine)
DOPAMINE REUPTAKE INHIBITORS
DA reuptake inhibitors do just what their name suggests, though they may be addicting in some cases.(Amineptine), To a small extent Wellbutrin (Bupropion)
NOREPINIPHERINE REUPTAKE INHIBITORS
Norepinepherine reuptake inhibitors inhibit norepinepherine which may increase alertness or feelings of stimulation or wakefulness. These drugs may have an indirect effect on dopamine. These drugs may cause tachycardia or blood pressure problems.(Desipramine), (Atomoxetine), Vivactil (Nortryptaline), Wellbutrin (Bupropion)
MAOIs
MAOIs inhibit monoamine oxidase, which normally breaks down neurotransmitters. The inhibition of MAO means that more neurotransmitters will be left floating around, improving mood. MAO-B inhibitors work primarily to increase dopamine, while MAO-A inhibitors work to increase all monoamine neurotransmitters. These medications typically work quickly; within a day to a week or two. MAOIs are not typically considered a first line of treatment due to a large number of side effects including dangerous side effects. There are also food restrictions with these medications.Parnate, Nardil, Selegiline, Marplan
MOOD STABILIZERS
Mood stabilizers help keep mood at a normal level, and thus help with depression in many cases.
Lithium, LamactilSUPPLEMENTS
Supplements may include monoamine precursors or other items which improve neurotransmission.L-Tyrosine, L-Theanine, L-Glutamine, Saint Johns Wort, Phenylethylamine, Levodopa, SAM-E, Saffron, Fish Oil, Magnesium, Zinc, Calcium, Vitamin B Complex, Multivitamins, Vitamin D
SELECTIVE SEROTONIN-NOREPINEPHERINE REUPTAKE INHIBITORS
Effexor, Cymbalta, Strattera, Savella, AnafranilOTHER
Testosterone, Exercise, ETC, rTMs
poster:Trevpr
thread:1027954
URL: http://www.dr-bob.org/babble/20121001/msgs/1027957.html