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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by Lamdage22 on November 13, 2015, at 10:38:10
So i can only trial it at 50mg!!
Posted by SLS on November 13, 2015, at 15:56:23
In reply to 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 13, 2015, at 10:38:10
> So i can only trial it at 50mg!!
Why not give it a week or two to see if it disappears? What do you have to lose?
- Scott
Posted by Lamdage22 on November 13, 2015, at 16:00:33
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by SLS on November 13, 2015, at 15:56:23
Hmm. You think it may subside?
Maybe after i have been on 50mg for 4 weeks.
Posted by Lamdage22 on November 19, 2015, at 5:01:55
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 13, 2015, at 16:00:33
I am afraid now even 50mg cause orgasm and erection problems.
What are my options?
Maybe a TCA with a short half life that i take in the evening???
Posted by Lamdage22 on November 19, 2015, at 5:06:01
In reply to @SLS 50!mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 19, 2015, at 5:01:55
Combining the TCA with Cyproheptadine?
I need some help here
Posted by Lamdage22 on November 19, 2015, at 5:24:38
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 13, 2015, at 16:00:33
Buspirone?
Posted by SLS on November 19, 2015, at 7:36:29
In reply to HELP sexual dysfunction, posted by Lamdage22 on November 19, 2015, at 5:24:38
I would consider switching from nortriptyline to desipramine if you want to continue with a TCA. Adding buspirone or Wellbutrin are possibilities. Periactin (cyproheptadine) can be very sedating due its antihistaminic effects. It wouldn't hurt to try it. Some people use if immediately before having sex so that the delayed sedation does not interfere.
If anorgasmia is your only concern, you might want to continue raising the dosage of nortriptyline just to see if it help you feel better. It is good information to have. You can then decide whether to continue with it and continue to treat the sexual side effects or make the switch to another TCA based upon this information. In other words, if full therapeutic dosages of nortriptyline produces a robust antidepressant effect, it would give you good reason to continue to work with TCAs. You might get lucky and see your ability to maintain erections and achieve orgasms if higher dosages of nortriptyline produce a full remission.
Frustration and fear. I know what it's like to want to trash a drug when sexual side effects appear. I don't think it makes sense to remain at 50 mg/day of nortriptyline. Either go up to at least 75 mg/day or discontinue it. I would go up. Seriously, what's the worst thing that can happen? I have never heard of a TCA producing residual sexual impairments the way SSRIs can. If you go up and it doesn't work, then it is an easy decision to make to discontinue it. If it does work, you can then choose to work on treating the sexual side effects. Alternatively, you could then try switching to desipramine given your positive response to nortriptyline.
Out of curiosity, what other drugs produced anorgasmia in you?
- Scott
Posted by Lamdage22 on November 19, 2015, at 9:29:36
In reply to Re: HELP sexual dysfunction, posted by SLS on November 19, 2015, at 7:36:29
Scott, sex is the one thing that keeps me from going crazy!
Posted by Lamdage22 on November 19, 2015, at 11:22:02
In reply to Re: HELP sexual dysfunction, posted by SLS on November 19, 2015, at 7:36:29
Cymbalta. Sertraline. Effexor to some extent.
Nardil.
Posted by Lamdage22 on November 20, 2015, at 11:16:52
In reply to Re: HELP sexual dysfunction, posted by Lamdage22 on November 19, 2015, at 11:22:02
Is there a reason to believe Desipramine will not cause these sexual side effects?
Posted by SLS on November 20, 2015, at 23:55:05
In reply to Re: HELP sexual dysfunction, posted by Lamdage22 on November 20, 2015, at 11:16:52
> Is there a reason to believe Desipramine will not cause these sexual side effects?
Not really.
I'm going to think about this some more.
Desipramine is more selective for norepinephrine reuptake than is nortriptyline. I don't know how this relates to your case specifically, though. Anorgasmia is usually associated with serotonin reuptake inhibitors, including clomipramine and, to a lesser extent, imipramine. There is an interesting report of anorgasmia resolving once a patient was switched from imipramine to desipramine. The patient was female.
Perhaps NE reuptake inhibitors are problematic for you, though, so I won't make any guarantees. Before committing to making a switch to desipramine, you should wait for more opinions.
Are you totally incapable of achieving orgasm? If you can achieve orgasm at all, perhaps there is a chance that it will improve over time. This is what happened to me with Nardil. It took three months before orgasm approached normalcy.
If you were to switch to desipramine immediately, would you return to nortriptyline if it didn't work?
If it were me, I would continue to test nortriptyline at higher dosages, despite the presence of anorgasmia. I guess it depends upon how many options you have left. Of course, you can always stop taking it whenever you want. I would want the information, though. Most people with severe depression need a minimum of 75 mg/day of nortriptyline. You are almost there. It seems like a waste of the time you have already invested to quit now. I think it makes sense to find out whether or not nortriptyline improves your condition first before switching to another drug. If the anorgasmia begins to improve as nortriptyline begins to work, switching drugs would not be necessary.
It would be interesting to explore the capacity for Remeron to:
1. Reverse anorgasmia via 5-HT2a/c blockade
2. Enhance the antidepressant effects of Effexor or TCA.Good article:
http://www.medscape.com/viewarticle/430614_5
- Scott
Posted by Lamdage22 on November 21, 2015, at 10:55:25
In reply to Re: HELP sexual dysfunction, posted by SLS on November 20, 2015, at 23:55:05
Life is very uncomfortable right now
Posted by Christ_empowered on November 21, 2015, at 12:18:50
In reply to 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 13, 2015, at 10:38:10
can you take wellbutrin?
Posted by SLS on November 21, 2015, at 12:32:09
In reply to Re: HELP sexual dysfunction, posted by Lamdage22 on November 21, 2015, at 10:55:25
> Life is very uncomfortable right now
Upon further thought, I am not convinced that it makes sense for you to switch to desipramine at this juncture. I'm afraid that you might be overly sensitive to NE reuptake inhibitors with respect to anorgasmia. This would be unusual compared to SSRIs, but it is listed as a side-effect of both tricyclics. However, this might be a standard listing for all tricyclics as a class-effect.
It does happen that someone will respond to nortriptyline and not to desipramine. The converse is also true. If you are indicating here that your discomfort is due to your illness, you might as well resume increasing the dosage of nortriptyline. You really do need to find something that helps you immediately. Give nortriptyline more time to see how well it works and then evaluate its side effects. Side effects that appear very early often disappear with continued treatment. Hopefully, your ability to orgasm will return.
- Scott
Posted by SLS on November 21, 2015, at 13:29:26
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Christ_empowered on November 21, 2015, at 12:18:50
> can you take wellbutrin?
That's a great thought.
If it were me, I would continue to explore nortriptyline right now. Using blood tests can save time in determining the ideal dosage. Lamdage may be very close to responding favorably. Unfortunately, it is hard to know in advance.
Interestingly, a recent study indicates that people with the val66val genotype (2/3 of the population) for BDNF respond better to SSRIs while people with met66val or met66met respond better to tricyclics and SNRIs. Soon, there should be more biomarkers to help determine drug choice. One candidate is the gene promoter of the serotonin transporter.
Discipline and patience are difficult to exercise when you don't like the way you react to a drug at first. I have trouble with this. Of course, the emergence of dangerous or counterproductive reactions will indicate stopping the drug immediately.
- Scott
Posted by Lamdage22 on November 22, 2015, at 2:41:21
In reply to Re: 75mg Nortriptyline induces anorgasmia » Christ_empowered, posted by SLS on November 21, 2015, at 13:29:26
wellbutrin was helpful once.
I have doubled the 37.5 mg Effexor for now. Anticipating to try Buspar against anorgasmia!
Effexor gives anorgasmia but no erection problems like Nortriptyline.
Nortriptyline is down to 25mg.
I am 26 year old male, not 80 years old!!?
Posted by Christ_empowered on November 22, 2015, at 9:07:38
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 22, 2015, at 2:41:21
Not sure, but I think Wellbutrin can be used w/ Effexor, too.
Posted by SLS on November 22, 2015, at 9:44:16
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Christ_empowered on November 22, 2015, at 9:07:38
> Not sure, but I think Wellbutrin can be used w/ Effexor, too.
It can, and it makes for a very effective combination for some people.
- Scott
Posted by Lamdage22 on November 22, 2015, at 11:12:36
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by SLS on November 22, 2015, at 9:44:16
thanks guys, i appreciate your support so much.
Wellbutrin sounds like an option. Its not risk free in terms of psychotic symptoms but maybe my doctor (and me) feel its worth taking the risk.
Posted by Lamdage22 on November 22, 2015, at 11:14:47
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 22, 2015, at 11:12:36
few things in life are risk free. I will bring it up.
Posted by Christ_empowered on November 22, 2015, at 15:30:44
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 22, 2015, at 11:14:47
yeah, I really like wellbutrin. I now only very rarely need low dose gabapentin and I almost never need the low dose risperidone I sometimes take/took on top of daily Abilify.
Posted by Lamdage22 on November 23, 2015, at 3:39:42
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Christ_empowered on November 22, 2015, at 15:30:44
So wellbutrin is not pro-psychotic for you at all?
Posted by Christ_empowered on November 23, 2015, at 6:06:52
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Lamdage22 on November 23, 2015, at 3:39:42
no, it isn't. At first there was some jittery-ness, but that subsided. I feel mildly stimulated, but nothing too crazy.
Posted by SLS on November 23, 2015, at 8:31:40
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by Christ_empowered on November 23, 2015, at 6:06:52
> no, it isn't. At first there was some jittery-ness, but that subsided. I feel mildly stimulated, but nothing too crazy.
I wish that I would respond to Wellbutrin that way. Instead, it slows me down and makes me feel significantly more dysphoric. I have taken as much as 900 mg/day. A friend of mine is in remission for having combined Wellbutrin with Pristiq. From what I see in others, Wellbutrin is more of an energizer than it is an anti-anhedonic. I would love to hear from others to see if they report the same thing. I think that's why Wellbutrin can augment SNRIs so well. For the right people, Wellbutrin provides improvements in mental energy and cognition while Effexor/Prisiq/Cymbalta yield a brighter mood with a return of interest, pleasure, and reward in doing things. I don't know if Wellbutrin is as effective when combined with SSRIs. I don't know why it shouldn't be.
A clarification request of Lamdage: Your subject line indicates your concern with anorgasmia, not erectile dysfunction. Your posts indicate otherwise. Which is it? These drugs don't necessarily affect both equally. In my estimation, SSRIs tend to produce more anorgasmia than ED. SNRIs, less so. Nortriptyline and desipramine are less likely to produce anorgasmia than ED. There is a better chance of your recovering erectile function with nortriptyline or desipramine than recovering orgasmic function with SSRIs. With me, Nardil produces anorgasmia for the first 2 - 3 months, whereafter I regain function gradually. I don't recall why you keep your dosage of Effexor so low. Generally speaking, with more severe, non-psychotic depressions, 300 mg/day is often necessary. Does your potential for experiencing psychosis factor into your decision to take only 37.5 mg/day? Side effects? as an aside, Luvox is supposed to be better than the other SSRIs for treating psychotic depression. I don't know what its reputation is for producing sexual side effects. However, adding buspirone might help if necessary.
- Scott
Posted by Lamdage22 on November 23, 2015, at 9:15:05
In reply to Re: 75mg Nortriptyline induces anorgasmia, posted by SLS on November 23, 2015, at 8:31:40
With Nortriptyline the concern is both anorgasmia and ED, with Venlafaxine its only anorgasmia.
I am trying to recover the anorgasmia with buspar if my doctor will let me.
If i can recover it, i would consider dosages above 100mg. If not, i wont do it
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