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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by fairnymph on April 17, 2003, at 0:09:26
My bf has dysthymia...his main symptoms are:
-almost no libido
-lacks interest in life in general
-he has had past issues with drug use ('self-medication')
-doesn't get excited about things; no enthusiasm; feel somewhat numb and dissociated
-constanly tired and lackluster/lacking in energyThese have been problems his entire life, pretty much. He doesn't appear to have major depression or anxiety issues. Just dysthymia.
One particular reason we would like him to be treated is because his lack of libido is causing major problems in our relationship. I get senstive about being rejected and not feeling sexually desired.
I don't know much about dysthymia. I read some really good stuff about amisulpride but we are in the US and I don't know how we'd get some. Would a US dr be able to obtain amisulpride?
How about reboxetine? I found it increased libido for me...and generally had a positive effect on my mood.
Other options? Of course, whatever meds are recommended CANNOT have libido effects...and preferably should have minimal non-libido sexual side effects.
Thanks!
fn
Posted by Caleb462 on April 17, 2003, at 0:40:12
In reply to my boyfriend has dysthymia -- what meds to try?, posted by fairnymph on April 17, 2003, at 0:09:26
> My bf has dysthymia...his main symptoms are:
>
> -almost no libido
> -lacks interest in life in general
> -he has had past issues with drug use ('self-medication')
> -doesn't get excited about things; no enthusiasm; feel somewhat numb and dissociated
> -constanly tired and lackluster/lacking in energy
>
> These have been problems his entire life, pretty much. He doesn't appear to have major depression or anxiety issues. Just dysthymia.
>
> One particular reason we would like him to be treated is because his lack of libido is causing major problems in our relationship. I get senstive about being rejected and not feeling sexually desired.
>
> I don't know much about dysthymia. I read some really good stuff about amisulpride but we are in the US and I don't know how we'd get some. Would a US dr be able to obtain amisulpride?
>
> How about reboxetine? I found it increased libido for me...and generally had a positive effect on my mood.
>
> Other options? Of course, whatever meds are recommended CANNOT have libido effects...and preferably should have minimal non-libido sexual side effects.
>
> Thanks!
>
> fnWell... I can't say I know too much about how dysthimia is generally treated.. but I would assume that the symptoms you listed would be best treated with an activating stimulant type med. Reboxetine is one, yeah... straterra is another. These act primarily on norepinephrine however, and what your boyfriend likely needs is dopaminergic stimulation. Wellbutrin is the obvious choice, particularly if there is a concern that he might abuse his meds as Wellbutrin has very little, if any, abuse potential. Other options are stimulants like Ritalin, Adderall and Dexedrine, plus Parkinson's drugs such as Mirapex.
Fish Oil is another option if he doesn't want to go the pharmaceutical route. There's also SAM-e and St. John's Wort - both can have positive effects on dopamine activity.
Wellbutrin seems like the first-line option to me though.
And of course, he may have deep-seeded issues that needed to be worked out, and that no medication is going to change. So therapy is always an option.
Posted by Ame Sans Vie on April 17, 2003, at 9:10:07
In reply to my boyfriend has dysthymia -- what meds to try?, posted by fairnymph on April 17, 2003, at 0:09:26
I'd say Provigil should maybe be the first thing to try... beyond that, definitely some type of dopaminergic or mixed dopaminergic/noradrenergic: Wellbutrin, Ritalin, Adderall, Dexedrine, Requip, Mirapex, Symmetrel, Sinemet...
Posted by janejj on April 17, 2003, at 13:30:18
In reply to Re: my boyfriend has dysthymia -- what meds to try?, posted by Ame Sans Vie on April 17, 2003, at 9:10:07
Hi,
I have the diagnosis of Dysthymia, the doc just has me one a regular SSRI, Celexa, which works fine. I'm not sure about all these stimulant drugs though, I mean Dythmia is chronic mild depression.
Janejj
Posted by fairnymph on April 17, 2003, at 15:16:33
In reply to Re: my boyfriend has dysthymia -- what meds to try?, posted by janejj on April 17, 2003, at 13:30:18
Oops, i forgot to mention that wellbutrin is the ONE medication he has tried...with no results. It didn't have any effects on him either good or bad! He took it for 3 months, at 300 mg day, at one point as high as 400 mg/day.
The stimulants (ritalin, amphetamines) are not an option. He's abused methamphetamine in the past and is sensitive to amphetamine side effects in general.
As for SSRIs, we've considered those, but they tend to depress the libido, and since my bf is seeking medication to IMPROVE his libido that would be counterproductive wouldn't it?!?
Provigil is something we've been considering; there is even a study being conducted at my university that he could participate in...
I'll look into some of the other meds (some I have never heard of) that were mentioned...thanks. :)
fn
Posted by Eddie Sylvano on April 17, 2003, at 15:45:27
In reply to my boyfriend has dysthymia -- what meds to try?, posted by fairnymph on April 17, 2003, at 0:09:26
> Other options? Of course, whatever meds are recommended CANNOT have libido effects...and preferably should have minimal non-libido sexual side effects.
--------------------If he's tried SSRIs and dopaminergics without success, you might investigate tianeptine, a serotonin reuptake *enhancer*. This should theoretically lower serotonin and increase dopamine. There are some decent studies to be found...
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10598317&dopt=AbstractI've also read that moclobemide has stimulant and pro-sexual effects, though I've never tried it. Hope you guys find something that helps. I'm very similar to your boyfriend, so I can appreciate the frustration you both feel. I'm pretty passsive and meek, and never really dated during my early years, so sexuality always intimidated me. Just talking with my girlfriend helped me a lot to change my perspective, loosen up, and live in the moment. It can be a complex problem, and one that a lot of doctors don't really seem to care about (especially if you're young).
If it's any consolation, I'll wager that it has nothing to do with you, and frustrates him just as much.
Posted by jonh kimble on April 17, 2003, at 15:52:02
In reply to Re: my boyfriend has dysthymia -- what meds to try, posted by fairnymph on April 17, 2003, at 15:16:33
oh horrible dysthymia. i know it all to well (5 years) your right amisulpride would be a great choice and there is a source i know of, but requires a prescription, but other than that is easy to get. it didnt help me though:( dopaminergics in general are a good chioce. yes wellbutrin and also just the plain ol ssri's if he hasnt tried one yet. prozac and zolft are generally considered the most stimulating. i guess rebox could be good but dont know. also provigil and/ or adrafinil could maybe help. but dont know cause none of these helped me. ill tell you if something ever helps me.
if you post your email we could have friendly chat about dysthymia... if you like
Posted by bobby on April 17, 2003, at 15:55:40
In reply to my boyfriend has dysthymia -- what meds to try?, posted by fairnymph on April 17, 2003, at 0:09:26
Hi Fairnyph,
your boyfriend should get a complete check-up to rule out any physical problems first. Then you can go from there. Good luck,
Bobby
Posted by fairnymph on April 17, 2003, at 21:38:19
In reply to Re: my boyfriend has dysthymia -- what meds to try, posted by jonh kimble on April 17, 2003, at 15:52:02
I'd love for you to email me ( fairnymph@collegeclub.com ) -- could you tell me more about your experience with amisulpride?
Posted by fairnymph on April 17, 2003, at 21:46:26
In reply to Re: my boyfriend has dysthymia -- what meds to try? » fairnymph, posted by Eddie Sylvano on April 17, 2003, at 15:45:27
He hasn't actually tried SSRIs, we are just fearful of them because of their known sexual side effects...
I have no faith in tianeptine....I tried that stuff for a while for OCD/depression and I consider it useless...I know that is just my personal experience but I don't know a single person who has actually had any response to it!
The only dopaminergic he has tried was Wellbutrin...I definitely think that other dopaminergic meds would be worth pursuing.
I've been thinking about the MAOIs too...they seem worth looking into...
Thanks for sharing your experience...it sounds quite similar to my bf's. And yeah, we are young, he is in his mid twenties...We have talked about it endlessly and it's pretty obvious that it is something beyond purely psychological stuff (i.e. it's not a matter of him being sexually repressed or undeveloped). I am, not to boast, an extremely attractive young woman. Considering that he is sure of his heterosexuality, there is really no way he could not want to have sex with me and be mentally healthy! (hey, at least I know it's not me, right?) Plus, he gets hard very easily...but still doesn't feel horny...thus I doubt it's a testosterone issue or something along those lines.
Thanks for the advice...
fn
> > Other options? Of course, whatever meds are recommended CANNOT have libido effects...and preferably should have minimal non-libido sexual side effects.
> --------------------
>
> If he's tried SSRIs and dopaminergics without success, you might investigate tianeptine, a serotonin reuptake *enhancer*. This should theoretically lower serotonin and increase dopamine. There are some decent studies to be found...
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10598317&dopt=Abstract
>
> I've also read that moclobemide has stimulant and pro-sexual effects, though I've never tried it. Hope you guys find something that helps. I'm very similar to your boyfriend, so I can appreciate the frustration you both feel. I'm pretty passsive and meek, and never really dated during my early years, so sexuality always intimidated me. Just talking with my girlfriend helped me a lot to change my perspective, loosen up, and live in the moment. It can be a complex problem, and one that a lot of doctors don't really seem to care about (especially if you're young).
> If it's any consolation, I'll wager that it has nothing to do with you, and frustrates him just as much.
>
>
Posted by bookgurl99 on April 17, 2003, at 23:57:55
In reply to my boyfriend has dysthymia -- what meds to try?, posted by fairnymph on April 17, 2003, at 0:09:26
My friend who had similar symptoms responded _really_ well to Effexor. It's not an ssri, so it may not have the same sexual side effects.
Posted by Eddie Sylvano on April 18, 2003, at 11:21:16
In reply to Re: my boyfriend has dysthymia -- what meds to try? » Eddie Sylvano, posted by fairnymph on April 17, 2003, at 21:46:26
> He hasn't actually tried SSRIs, we are just fearful of them because of their known sexual side effects...
-----------------They're no picnic. I've been on several (effexor,paxil,serzone), and the least repressive has been Celexa.
>I know that is just my personal experience but I don't know a single person who has actually had any response to it!
---------------I only mention it as a guess. The most sex-craved I have ever been was a week ago, after a 3 day weekend in which I had forgotten my medication (celexa). I assume it was due to the drop in my serotonin levels.
> The only dopaminergic he has tried was Wellbutrin...I definitely think that other dopaminergic meds would be worth pursuing.
-------------Worth a shot.
>I am, not to boast, an extremely attractive young woman. Considering that he is sure of his heterosexuality, there is really no way he could not want to have sex with me and be mentally healthy!
------------------The hardest time I ever had with sex in a relationship was with the one that most people would identify as the most beautiful (and she *was* stunning). It was intimidating.
> Thanks for the advice...
You're welcome. I'm an odd lot, though, so it may not be of much individual value.
Posted by jemma on April 18, 2003, at 12:44:21
In reply to my boyfriend has dysthymia -- what meds to try?, posted by fairnymph on April 17, 2003, at 0:09:26
I've had lifelong dysthymia, and also had no response good or bad to wellbutrin. After many failed drug trials, I found provigil to work very nicely. By the way, I wouldn't rule out ritalin because of meth abuse - a lot of people with ADD abuse meth because they're self-medicating. A bad idea, because meth is so hard on the heart, liver, and brain chemistry, but ritalin can be a good, safer alternative.
- jemma
Posted by Katia on April 19, 2003, at 3:32:39
In reply to Re: my boyfriend has dysthymia -- what meds to try? » fairnymph, posted by Eddie Sylvano on April 18, 2003, at 11:21:16
Hi,
You said that you tried Serzone? What was your experience like on that? I have a starter pack and should have already been taking it. I'm so fed up with ADs and all their side effects! that I'm hesitant to try another. whatever my other option is....none of course.
I'd appreciate your feedback or anyone else's who has tried Serzone. I, too, have suffered from dyst. since I was ten interspersed with about four major depressions that lasted each min. of a year, some for years.
thanks.
katia
Posted by btnd on April 19, 2003, at 22:24:57
In reply to Re: my boyfriend has dysthymia -- what meds to try?, posted by jemma on April 18, 2003, at 12:44:21
>a lot of people with ADD abuse meth because >they're self-medicating.
I agree completely. And also people with dysthymia use it for self-medication.
>A bad idea, because meth is so hard on the heart, >liver, and brain chemistry, but ritalin can be a >good, safer alternative.
Well, it all comes down to what dosage of the drug someone is taking. It is obvious that Desoxyn (methamphetamine in small 5 mg doses) isn't going to be neurotoxic like studies point on meth generally. The key is to find the right amount working for you and try to keep tolerance low, so that the med won't poop out. Amphetamines have a high tendency for pooping out very quickly; maybe because of their nature - they are chemically very similar to noradrenaline ("fight,run,survive":) hormone which is released in extreme situations, and amphetamines act VERY fast. But they do work extremely well with certain mental problems. My goal right now is to find a substitute for it, to cycle it weekly - 1st week Adderall, 2nd week new working drug ;), 3rd week Adderall, etc.
I'm taking into consideration following drugs:
amisulpride, adrafinil, xyrem (although I know that it won't help with motivation/dysthymia, but can be used as a powerful AD and to boost dopamine which will be later released by Adderall), buspar+klonopin as someone suggested on this board and other combinations of these drugs. I will keep posted if I (hopefully ;) find anything working as good as Adderall.Brad
Posted by Eddie Sylvano on April 21, 2003, at 8:31:33
In reply to Serzone??? » Eddie Sylvano, posted by Katia on April 19, 2003, at 3:32:39
> You said that you tried Serzone? What was your experience like on that?
---------------------I was on it for about 9 months @ 300mg. It took very little time to adjust to, and after that period, I hardly noticed any effects from it (aside from not being so depressed anymore). It detracted from my libidio/orgasm, but not as bad as Effexor, which was like a chastity belt.
The only problem with serzone was my doctor, who was always freaking out about the possible liver problems it causes, and having my blood tested all the time. Bah. Still, aside from Celexa, it's as easy as they come. Withdrawl was also no big deal.
Posted by Hattree on April 21, 2003, at 9:07:52
In reply to Re: Serzone??? » Katia, posted by Eddie Sylvano on April 21, 2003, at 8:31:33
This is the end of the thread.
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