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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Dave954 on May 31, 2006, at 22:00:14
I'm looking for a way to remedy the sexual side effects of my current medication regimen: 10 mg Lexapro (taken in the am), 200 mg Seroquel and 900 mg Neurontin (both taken at bedtime). Having been on each of these medications by themselves, I can say that Seroquel contributes the most to my loss of libido, followed closely by Lexapro, with Neurontin causing the least effect. I know that a lot of doctors RX Wellbutrin as a way to overcome sexual side effects, but I am unable to tolerate any stimulants (after one cup of coffee I went to the emergency room and had to stay overnight for observation b/c of a sustained heart rate of 160 bpm ... which lasted for hours ... the same thing also happened when I took a caffeine supplement called Redline at a local gym ... a second hospital stay - this time they kept me overnight for two nights in a row - these serious reactions to stimulants only started in the past two years). I am extremely frustrated because this is the most helpful combination of medication that I have ever been on thus far (I have been on all of the atypical antidepressants including Wellbutrin, Remeron and Serzone as well as Effexor and Strattera - I have never been on the MAOIs or tricyclics - I have also been on benzos i.e. Klonopin and the sedative hypnotics i.e. Ambien/Lunesta). The Wellbutrin made me very anxious before and made my depression worse (I was taking it by itself mind you - and this was several years ago). I sleep perfectly at night now thanks to the Seroquel and the Lexapro works great for my depression. I wish I could take something in place of Seroquel for my chronic insomnia (while only on Lexapro and Neurontin I have a much better sex drive), but I know that I need to be on it b/c it works better than benzos/hypnotics and also augments the Lexapro quite well (it takes away my irritability). It is extremely frustrating to feel like I am doomed to be asexual the rest of my life in order to function as a normal person. I am only 25 and feel that I am missing out on a significant aspect of life. I imagine it is quite a task to overcome sexual dysfunction from an SSRI combined with an antipsychotic since antipsychotics antagonize dopamine, which is the main component that influences libido (among other things). Cialis and Viagra only help me get an erection (which is not my issue), but don't increase libido at all (which IS my issue). Natural supplements have been marginally effective. I fear that in the end, my only option for getting my libido back will be to switch to a medication that is less effective or one that doesn't work at all (it seems that the only truly effective medications are the ones that destroy it all together). Anyone who has a helpful suggestion, please post!
Posted by yxibow on June 1, 2006, at 3:02:08
In reply to Need help w/ SSRI + antipsychotic sexual SEs, posted by Dave954 on May 31, 2006, at 22:00:14
Its not only the antagonism of dopamine, but also prolactin levels that cause sexual side effects with antipsychotics, though Seroquel I believe has a lower amount of that issue. Sheer sedation from the above medications is another reason why you could be experiencing sexual side effects. I would place the SSRI ahead of the Seroquel, which is a fairly low dose of that neuroleptic.
I don't remember whether Cymbalta is sexually stimulating, neutral, or inhibiting, but have you tried that medication or looked into it?
I also take Seroquel and I think the sheer groggy factor and the fact that it lowers blood pressure (you can do the math with where blood pressure is important....) may be a greater factor.
I don't have any great solutions as you said you cannot tolerate Wellbutrin... I assume you used XR or SR, because Wellbutrin by itself can cause greater heart factors as it is immediate release. The only other thing would be to go out on a total limb and say take a small amount of Wellbutrin SR with a beta blocker like atenolol -- of course, beta blockers will also mess with your blood pressure.
Just my 2c
-- Jay
Posted by Dave954 on June 1, 2006, at 6:14:03
In reply to Re: Need help w/ SSRI + antipsychotic sexual SEs » Dave954, posted by yxibow on June 1, 2006, at 3:02:08
> Its not only the antagonism of dopamine, but also prolactin levels that cause sexual side effects with antipsychotics, though Seroquel I believe has a lower amount of that issue. Sheer sedation from the above medications is another reason why you could be experiencing sexual side effects. I would place the SSRI ahead of the Seroquel, which is a fairly low dose of that neuroleptic.
>
> I don't remember whether Cymbalta is sexually stimulating, neutral, or inhibiting, but have you tried that medication or looked into it?
>
> I also take Seroquel and I think the sheer groggy factor and the fact that it lowers blood pressure (you can do the math with where blood pressure is important....) may be a greater factor.
>
> I don't have any great solutions as you said you cannot tolerate Wellbutrin... I assume you used XR or SR, because Wellbutrin by itself can cause greater heart factors as it is immediate release. The only other thing would be to go out on a total limb and say take a small amount of Wellbutrin SR with a beta blocker like atenolol -- of course, beta blockers will also mess with your blood pressure.
>
>
> Just my 2c
>
>
> -- Jay
I am aware that Seroquel elevates prolactin levels the least amount compared to the other APs (except maybe Abilify, which is not good for insomnia) - however it still impairs my libido way more than Lexapro (I have been on each medication by itself - even 25 mg of Seroquel by itself causes worse sexual dysfunction for me than 10 mg of Lexapro by itself - go figure). I have read that Cymbalta's sexual side effects are very similar to Effexor's - hence why I wasn't interested in it (besides, my main issue at this point is the sexual dysfunction from the Seroquel). I considered asking my psychiatrist if he could try me on 150 mg of Wellbutrin XL with a beta blocker, but am not sure if this is a good idea? I question if this approach would even work as I've tried Wellbutrin with a combination of Effexor and Risperdal in the past and I had a lot of anxiety with no increase in sexual desire - though Wellbutrin by itself increased sexual desire big time. I wonder if Lexapro and Seroquel combined with Wellbutrin would have a more favorable effect ...
Posted by flip_flop on June 1, 2006, at 7:31:37
In reply to Need help w/ SSRI + antipsychotic sexual SEs, posted by Dave954 on May 31, 2006, at 22:00:14
Perhaps cabergoline (Dostinex, Cabaser) would help?
Posted by ed_uk on June 2, 2006, at 16:31:46
In reply to Re: Need help w/ SSRI + antipsychotic sexual SEs, posted by Dave954 on June 1, 2006, at 6:14:03
Hi
>I considered asking my psychiatrist if he could try me on 150 mg of Wellbutrin XL with a beta blocker, but am not sure if this is a good idea?
Beta blockers sometimes cause impotence.
Regards
Ed
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