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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by ben on September 23, 2002, at 3:43:44
I take Effexor 225 mg XR in the morning along with Lithium 900 mg/day and Neurontin 900 mg/day. I developed lack of libido: erectile dysfunction and delayed orgasm when it sometimes comes to a erection. I added Trazodone (Desyrel) up to 200 mg at night without any success (to much sedation). With Nefazodone I am too sedated during the day (at 200 mg per night). Remeron is knocking me out. Bethanechol didnt worked at 20 mg. I dont want to switch to another AD because i tried so much ADs and no one worked as well as Effexor. What about adding acting on dopamine like Bupropion or Methylphenidate ? Do you have ideas , suggestions or experiences with this problems ? I do not think it comes from depression alone - the drugs are involved too - like many pdocs are calling this problems.
Posted by turalizz on September 23, 2002, at 5:32:46
In reply to sex probs coming from Effexor - please help !!, posted by ben on September 23, 2002, at 3:43:44
Adding buproion, or changing your AD to bupropion would help. Also, a vasodilator like gingko biloba is worth a try.
good luck,
cem
Posted by ben on September 23, 2002, at 13:17:06
In reply to Re: sex probs coming from Effexor - please help !!, posted by turalizz on September 23, 2002, at 5:32:46
> Adding buproion, or changing your AD to bupropion would help. Also, a vasodilator like gingko biloba is worth a try.
>
> good luck,
>
> cemThanks !
How much Ginkgo biloba extract is recommended ? And how long does it take to feal a difference ? Any experiences with yohimbine ?
ben
Posted by turalizz on September 23, 2002, at 14:01:54
In reply to Re: sex probs coming from Effexor - please help !! » turalizz, posted by ben on September 23, 2002, at 13:17:06
> Thanks !
>
> How much Ginkgo biloba extract is recommended ? And how long does it take to feal a difference ? Any experiences with yohimbine ?
>
> ben
>I was not on an SSRI while I tried gingko. It was a small dose, something like 40-50 mg, I don't remember exactly, but I remember that I felt a positive effect on my erections. You probably would need a higher dose.
Sorry, no expeerience with yohimbine, but as it is an alpha2 antagonist, I'd expect a similar effect to Remeron in terms of sexual arousal without the sedation.
cem
Posted by jrbecker on September 23, 2002, at 16:02:23
In reply to Re: sex probs coming from Effexor - please help !!, posted by turalizz on September 23, 2002, at 14:01:54
Had the same problem. Was completely anorgasmic, even at 37.5 mg. Ironically, Effexor increased my libido, so this was even more frustrating. I just didn't have as much sensitivity down there on the drug.
I also tried yohimbe, buspar, viagra, l-arginine (a supplement), ritalin as well as wellbutrin. Mostly, they helped with erection (which was not my problem) but only had a small to moderate effect on anorgasmia. The best out of them all was Wellbutrin or a stimulant (i.e., ritalin). I think a component for me was also a sense of distraction I got during sex so whatever helped me focus as well as reducing SSRI-induced anorgasmia was the best treatment for me.
If this is still a major problem after trying these options, you might want to decrease or even stop the dosage a few days around a planned day of sexual activity. Many older couples do this (for instance, only take it Mon-Thursday, then try sex on Sat/Sunday). For some people this has worked, with usually no problems from drug withdrawl in that short interim. I'd discuss with your pdoc if this is a viable option when other strategies fail.
For me, despite all these tactics, the problem still persisted and I just learned to live with it, knowing that I was greatly benefiting from the med depsite this dabilitating side effect. I was also being open with my partners and working through it. And remember, a lot of the problem remains psychological, e.g., performance anxiety in the wake of knowing you already have a problem. So you gotta try not to hyper-focus on it as well.
In the end, you might just have to switch meds. It all depends on priorities and what you can live with. I myself end up switching to Celexa, more for other reasons than just the sexual dysfunction. It has less of a sexual side effect but it was still apparent. Another potential option for the near future is Gepirone (brand name: Ariza). Gepirone is very much like Buspar but with more of an AD effect, and it's close to getting approved for early '03 release. It is supposed to be good for improving sexual dysfunction in depressive sufferers NOT taking a med to begin with. (http://www.pslgroup.com/dg/217266.htm). So, I guess it would be a win-win situation if a medication had good antidepressant qualities as well increasing sexual functioning. Can't wait to see if this is true.
Good luck.
Posted by vince on September 24, 2002, at 20:29:29
In reply to sex probs coming from Effexor - please help !!, posted by ben on September 23, 2002, at 3:43:44
Try this link. I've posted it quite a few times here.
http://www.dr-bob.org/babble/20020914/msgs/120396.html
One thing that has worked for me before that I didn't mention in the previous post is Buspar taken about an hour before sexual activity.
Good Luck, Vince
Posted by sleepy lizard on September 26, 2002, at 18:57:48
In reply to sex probs coming from Effexor - please help !!, posted by ben on September 23, 2002, at 3:43:44
First I'll say sorry to hear about your difficulties. I hope you can get some relief. I wonder what is worse now, the depression/anxiety or the side effects. I don't want to give you false hope, since one solution may work for your sexual side effects, however my experience on Effexor XR with sexual side effects is not good. You said "I developed lack of libido: erectile dysfunction and delayed orgasm when it sometimes comes to a erection." This is exactly what happened to me on Effexor XR 75 mg (also up to 225 mg). I tried adding Wellbutrin SR 150 mg. and I began to panic and become emotionally unstable, and the side effects did not lift. I was on Effexor a total of 13 weeks but had previously been on Paxil and Celexa. The total time was 7 months. I have been off of Effexor XR/Wellbutrin SR combo for 3 weeks now. I get some erections at night, but have not got the libido back. I normally have a very strong sex drive so this is very abnormal for me (male, age 49). I have read much on the subject, almost an obsession with me, and have concluded that nothing works consistently to reverse the dysfunction. However, one scientific study showed the Viagra works. (I tried Yohimbe/Butcher's Broom, Horny Goat Weed/Velvet bean, Wellbutrin, L-Arginine/L-Cystine.) It is really depressing not being able to enjoy sex. I have read that the side effects lift sometimes with lower dosage, and I was able to get orgasms with a two day drug holiday, complete with nightmares and shocks and insomnia as a bonus (being sarcastic). The only thing I did not try that looked promising was Remeron or Serzone. The cause of the sexual side effects is in the inhibitory effect of the 5ht2 receptors. The effects incerease body heat and decrease libido. (I noticed that I am colder now that I am off of Effexor for 3 weeks.)
Posted by Vince on September 26, 2002, at 21:46:31
In reply to Re: sex probs coming from Effexor - please help !! » ben, posted by sleepy lizard on September 26, 2002, at 18:57:48
If you're on an SSRI and having sexual side effects why not switch to a TCA?
25 years of ssri twiddling and what has it accomplished. Unless you take into account the extra side effects, little or nothing! TCA's are just as good or better and they usually don't have sexual side effects and they are probably not as addictive.
But pharmaceutical companies unfortunatly measure progress in dollars.
Vince
Posted by ben on September 27, 2002, at 4:40:59
In reply to Why the H don't most people just use imipramine? , posted by Vince on September 26, 2002, at 21:46:31
I am not able to tolerate TCAs - tried several ones for several weeks ! But theres some folk who find them better than SSRIs. Everyone is different.
> If you're on an SSRI and having sexual side effects why not switch to a TCA?
>
> 25 years of ssri twiddling and what has it accomplished. Unless you take into account the extra side effects, little or nothing! TCA's are just as good or better and they usually don't have sexual side effects and they are probably not as addictive.
>
> But pharmaceutical companies unfortunatly measure progress in dollars.
>
> Vince
Posted by ben on September 27, 2002, at 4:43:52
In reply to Re: sex probs coming from Effexor - please help !!, posted by jrbecker on September 23, 2002, at 16:02:23
Did you tried apomorphine as well as viagra ? That could be an option for you ?!
> Had the same problem. Was completely anorgasmic, even at 37.5 mg. Ironically, Effexor increased my libido, so this was even more frustrating. I just didn't have as much sensitivity down there on the drug.
>
> I also tried yohimbe, buspar, viagra, l-arginine (a supplement), ritalin as well as wellbutrin. Mostly, they helped with erection (which was not my problem) but only had a small to moderate effect on anorgasmia. The best out of them all was Wellbutrin or a stimulant (i.e., ritalin). I think a component for me was also a sense of distraction I got during sex so whatever helped me focus as well as reducing SSRI-induced anorgasmia was the best treatment for me.
>
> If this is still a major problem after trying these options, you might want to decrease or even stop the dosage a few days around a planned day of sexual activity. Many older couples do this (for instance, only take it Mon-Thursday, then try sex on Sat/Sunday). For some people this has worked, with usually no problems from drug withdrawl in that short interim. I'd discuss with your pdoc if this is a viable option when other strategies fail.
>
> For me, despite all these tactics, the problem still persisted and I just learned to live with it, knowing that I was greatly benefiting from the med depsite this dabilitating side effect. I was also being open with my partners and working through it. And remember, a lot of the problem remains psychological, e.g., performance anxiety in the wake of knowing you already have a problem. So you gotta try not to hyper-focus on it as well.
>
> In the end, you might just have to switch meds. It all depends on priorities and what you can live with. I myself end up switching to Celexa, more for other reasons than just the sexual dysfunction. It has less of a sexual side effect but it was still apparent. Another potential option for the near future is Gepirone (brand name: Ariza). Gepirone is very much like Buspar but with more of an AD effect, and it's close to getting approved for early '03 release. It is supposed to be good for improving sexual dysfunction in depressive sufferers NOT taking a med to begin with. (http://www.pslgroup.com/dg/217266.htm). So, I guess it would be a win-win situation if a medication had good antidepressant qualities as well increasing sexual functioning. Can't wait to see if this is true.
>
>
> Good luck.
>
>
Posted by ben on September 27, 2002, at 4:49:40
In reply to Re: sex probs coming from Effexor - please help !! » ben, posted by sleepy lizard on September 26, 2002, at 18:57:48
Hey, Effexor is real bad but we should counteract with something other than going off if it helps ?! Did you tried Sildenafil or Apomorphine ? 200 mg of Serzone at night didnt do anything for me concerning 5HT2 receptors and sexual dysfunction ! Remeron knocked me totaly out at night and for the next day !
> First I'll say sorry to hear about your difficulties. I hope you can get some relief. I wonder what is worse now, the depression/anxiety or the side effects. I don't want to give you false hope, since one solution may work for your sexual side effects, however my experience on Effexor XR with sexual side effects is not good. You said "I developed lack of libido: erectile dysfunction and delayed orgasm when it sometimes comes to a erection." This is exactly what happened to me on Effexor XR 75 mg (also up to 225 mg). I tried adding Wellbutrin SR 150 mg. and I began to panic and become emotionally unstable, and the side effects did not lift. I was on Effexor a total of 13 weeks but had previously been on Paxil and Celexa. The total time was 7 months. I have been off of Effexor XR/Wellbutrin SR combo for 3 weeks now. I get some erections at night, but have not got the libido back. I normally have a very strong sex drive so this is very abnormal for me (male, age 49). I have read much on the subject, almost an obsession with me, and have concluded that nothing works consistently to reverse the dysfunction. However, one scientific study showed the Viagra works. (I tried Yohimbe/Butcher's Broom, Horny Goat Weed/Velvet bean, Wellbutrin, L-Arginine/L-Cystine.) It is really depressing not being able to enjoy sex. I have read that the side effects lift sometimes with lower dosage, and I was able to get orgasms with a two day drug holiday, complete with nightmares and shocks and insomnia as a bonus (being sarcastic). The only thing I did not try that looked promising was Remeron or Serzone. The cause of the sexual side effects is in the inhibitory effect of the 5ht2 receptors. The effects incerease body heat and decrease libido. (I noticed that I am colder now that I am off of Effexor for 3 weeks.)
Posted by ben on September 27, 2002, at 4:52:13
In reply to Re: sex probs coming from Effexor - please help !! » sleepy lizard, posted by ben on September 27, 2002, at 4:49:40
I take Neurontin 900 mg/d and Lithium 900 mg/d along with the Effexor 225 mg/d. What are they doing with sexual desire (libido) and erections ? Any experiences ?
Posted by sleepy lizard on September 28, 2002, at 0:24:35
In reply to Re: sex probs coming from Effexor - please help !! » sleepy lizard, posted by ben on September 27, 2002, at 4:49:40
Yes, probably true, that we should stay on Effexor if it helps, even with side effects and all. But I was just going nuts with the side effects and numb skin, and started to panic. I think it was the combined effect of the Effexor and Wellbutrin...too much Norepinephrine maybe? I'm off of them completely, but taking the horny goat weed/maca/macuna pruriens (L-dopa)/polypodium vulgare compound from www.austinnatural.com. My libido seems to be still low, but coming back. I can orgasm again. I don't know if it would have worked along with the Effexor or not. Since it increases dopamine, maybe I could use an anti-parkinson drug. I did not try Viagra or apomorphine. Do you think that Viagra also increases libido? Thanks for the suggestion.
Posted by Ben Goodman on September 30, 2003, at 10:01:36
In reply to Re: sex probs coming from Effexor - please help !! » ben, posted by sleepy lizard on September 26, 2002, at 18:57:48
Hi,
Ive been on Effexor since December last year and Ive been experiencing a decrease of libido. I go weeks without feeling sexual desire. Just when I started taking Effexor my wife and I took a one week holiday I experienced an increased libido and could make love two to three times a day during that week. Since then, my sexual life has gone down the drain. It has been very painful for both of us. I feel frustrated and my self-confidence is very low at the moment. Is this "normal"? I spoke with my doctor and she reduced the dosage to only 75mg a day and added Lexapro 10mg a day. But the problem still persists. Ive been considering Viagra or any other stimulant to boost my sexual life. Can anyone relate to what Im going through?
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