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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Marc Boucher on November 22, 2005, at 17:46:02
Hi all,
I red a lot of posting regarding sexual side-effects of people on medication for ADHD, BUT does ADHD alone adversely effect one's libido/sex drive ?
I've both Dysthymia and ADHD--which is more likely to cause the low sex drive ? I guess both can, but I need some clarification on this, really.
Is Dysthymia more connected with Dopamine than it is to serotonin, OR is it the kind of thing that varies from one individual to another ?
Thanks in advance
P.S. I'm new here--great place !
Posted by Tomatheus on November 25, 2005, at 17:51:18
In reply to Dysthymia and ADHD, posted by Marc Boucher on November 22, 2005, at 17:46:02
Marc,
Thanks for posting. I'm definitely not an expert on the physiology of sexual functioning, but I'll try to help you out as best I can. My responses are below.
> Hi all,
>
> I red a lot of posting regarding sexual side-effects of people on medication for ADHD, BUT does ADHD alone adversely effect one's libido/sex drive ?If your ADHD symptoms are caused (at least in part) by an underlying biochemical abnormality, then I think it is possible that this abnormality could be adversely affecting your sex drive and/or sexual functioning. ADHD is most commonly associated with abnormalities in dopamine transmission, and abnormal variants of genes involved in the functioning of dopamine receptors, dopamine synthesis, dopamine metabolism, and the dopamine transporter have shown statistically significant associations with ADHD (Kirley et al., 2002). However, there is also some evidence that serotonin and norepinephrine may also be involved in the underlying pathology of some -- but not necessarily all -- cases of ADHD. A genetic variant that encodes for the production of abnormally high levels of MAO-A (the enzyme that breaks serotonin and norepinephrine down into inactive metabolites) has also shown statistically significant correlations with ADHD (Domschke et al., 2005; Jiang et al., 2001).
Although I am relatively unfamiliar with the scientific literature on sexual functioning, it is my understanding that dopamine generally tends to be associated with enhanced sexual functioning, while serotonin is often linked with impaired sexual functioning. Indeed, it is the case that sexual dysfunction is a common side effect of the SSRI medications, but not Wellbutrin (bupropion), an inhibitor of dopamine and norepinephrine. But even though elevated levels of serotonin seem to be clearly associated with decreased sexual *functioning*, the relationship between serotonin and sex *drive* is less clear. Even though Nardil (phenelzine), a highly serotogenic MAOI, tends to produce anorgasmia as a side effect (I am on Nardil but have yet to experience this because the medication has not fully "kicked in"), it is my impression from reading posts on this board that a person's sex drive can actually be enhanced by taking Nardil. This could be because Nardil is not just serotogenic -- it also leads to increased levels of synaptic dopamine and norepinephrine via MAO-A and MAO-B inhibition. However, it is my understanding from the research that I've done that Nardil is more serotogenic than it is dopaminergic or noradregenic, so I think it's likely that Nardil's serotogenic effects actually do play a role in the sex-drive enhancement.
So, if a genetic variant resulting in an abnormally low level of synaptic dopamine is at the root of your ADHD symptoms (at least in terms of your illness' biological causes), I do think that this abnormality could be adversely affecting your sexual functioning (remember that high dopamine levels are genrally associated with enhanced sexual functioning) and possibly your sex drive, as well. But even though impaired sexual *functioning* may be associated with low dopamine (and high serotonin, as well), impairments in your sex *drive* could be the result of either abnormally low dopamine or abnormally low serotonin -- at least based on my understanding of things. So, to answer your question in short, I would say that yes, the underlying pathology of your ADHD symptoms (assuming that such a pathology exists) is probably adversely affecting your sex drive. But it's hard to say whether the most likely underlying pathology involves abnormally low serotonin or abnormally low dopamine.
> I've both Dysthymia and ADHD--which is more likely to cause the low sex drive ? I guess both can, but I need some clarification on this, really.
In terms of understanding the connection between your illness and the problems with your sex drive, I would focus more on the underlying cause of your illness than on the exact diagnosis. As I mentioned in my response to your first question, ADHD is most commonly associated with abnormally low levels of synaptic dopamine, but evidence from the two MAO-A gene linkage studies that I cited suggests that both serotonin and norepinephrine may also be involved in certain cases of ADHD. Like ADHD, dysthymia is also believed to be heterogenic, consisting of at least two-subtypes. In a report on dysthymia, Niculescu et al. (2001) described two sub-types of dysthymia: anxious dysthymia (hypothetically associated with low serotonin levels) and anergic dysthymia (hypothetically associated with low dopamine levels). In their conclusion, the researchers even suggested that their classification of two distinct endophenotypes was somewhat oversimplistic, which suggests that both of the dysthymic subtypes could probably be subdivided further into even more subtypes (or perhaps I should say sub-subtypes) with their own distinct biochemical pathologies. To read the entire Niculescu et al. (2001) report (it's highly interesting, but also simple and to the point for a report in a scientific journal), follow this link:
http://neurophenomics.info/MolPsych.pdf
So, to answer your question about whether your impaired sex drive is more likely a manifestation of dysthymia or one or ADHD, I'd say it's probably a manifestation of the biochemical abnormality (once again, assuming that ther is one) that underlies your illness. Whether this illness is called dysthymia or ADHD is less relevant, in my opinion. Your low sex drive could be the result of a genetic variant that results (at least in part) in low synaptic dopamine or a variant that results (at least in part) in low synaptic serotonin. Based on my limited knowledge of sexual physiology, it's hard to say which neurotransmitter is more likely to be involved.
> Is Dysthymia more connected with Dopamine than it is to serotonin, OR is it the kind of thing that varies from one individual to another ?
I'm sure you can tell by now that my response to this question is that it's the kind of thing that varies from one individual to another. See my response to question No. 2.Once again, thanks for your post. Let me know if I could be of further help.
Tomatheus
==
REFERENCES
Domschke, K., Sheehan, K., Lowe, N., Kirley, A., Mullins, C., O’Sullivan, R., et al. (2005). Association analysis of the monoamine oxidase A and B genes with attention deficit hyperactivity disorder (ADHD) in an Irish sample: Preferential transmission of the MAO-A 941G allele to affected children. American Journal of Medical Genetics Part B (Neuropsychiatric Genetics), 134B, 110-14.
Jiang, S., Xin, R., Lin, S., Qian, Y., Tang, G, Wang, D., et al. (2001). Linkage studies between attention-deficit hyperactivity disorder and the monoamine oxidase genes. American Journal of Medical Genetics (Neuropsychiatric Genetics), 105, 783-88.
Kirley, A., Hawi, Z., Daly, G., McCarron, M., Mullins, C., Millar, N., et al. (2002). Dopaminergic system genes in ADHD: Toward a biological hypothesis. Neuropsychopharmacology, 27, 607-19.
Niculescu, A. B., & Akiskal, H. S. (2001). Proposed endophenotypes of dysthymia: Evolutionary, clinical, and pharmacogenomic considerations. Molecular Psychiatry, 6, 363-66.
Posted by Marc Boucher on November 25, 2005, at 22:33:32
In reply to Re: Dysthymia and ADHD » Marc Boucher, posted by Tomatheus on November 25, 2005, at 17:51:18
Thank you very much Tomatheus, I really find your post to be a good one--the article is indeed an interesting read, although I haven't gone through it all yet--I'll finish reading it tomorrow.
I'll think about what other points I'd like to know about and will let you know, and again thank you.
Marc
Posted by Marc Boucher on November 29, 2005, at 16:46:39
In reply to Re: Dysthymia and ADHD, posted by Marc Boucher on November 25, 2005, at 22:33:32
I'd like to know whether anyone knows if low LH and FSH can be tied to Dysthymia ?
LH 2 Ref. range for men (2-9 U/L)
FSH 2 '' '' '' '' (2-12 U/L)My libido has improved a bit, but it's still on the low side. Low libido can definately be tied to Dysthymia, however I don't know if low LH/FSH can be a result of Dysthymia ? I've read that in major depression LH pulses can be less strong, but nothing about LH/FSH and Dysthymia.
Marc
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