Psycho-Babble Medication Thread 229226

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Can anyone get this article?- Thanks

Posted by Jaynee on May 26, 2003, at 12:44:41

: Brubaker RV. Related Articles, Links
Fluoxetine-induced sexual dysfunction reversed by loratadine.
J Clin Psychiatry. 2002 Jun;63(6):534. No abstract available.
PMID: 12088167 [PubMed - indexed for MEDLINE]


 

Re: Can anyone get this article?- Thanks

Posted by djmmm on May 26, 2003, at 18:51:12

In reply to Can anyone get this article?- Thanks, posted by Jaynee on May 26, 2003, at 12:44:41

> : Brubaker RV. Related Articles, Links
> Fluoxetine-induced sexual dysfunction reversed by loratadine.
> J Clin Psychiatry. 2002 Jun;63(6):534. No abstract available.
> PMID: 12088167 [PubMed - indexed for MEDLINE]
>
>
>

here ya go:

Fluoxetine-Induced Sexual Dysfunction Reversed by Loratadine

Sir: Sexual dysfunction as a side effect of antidepressant treatment occurs at a rate of roughly 50% of treated patients.1 Fluoxetine is no exception. Attempts at reversing sexual side effects in selective serotonin reuptake inhibitors (SSRIs) have included dosage reduction, change to a different SSRI or non-SSRI, and adding bupropion, Ginkgo biloba, cyproheptadine, yohimbine, trazodone, and sildenafil, all with varying degrees of success.2 In this study, loratadine, a long-acting tricyclic antihistamine with selective peripheral histamine H1 receptor antagonistic activity, appeared to be very helpful in reversing fluoxetine-induced sexual dysfunction.

About 12 months ago, one of my male clients with major depression who previously had experienced sexual dysfunction with fluoxetine, 5 mg/day, restarted taking fluoxetine, 5 mg/day, while also taking loratadine, 2.5 mg/day, for allergic rhinitis. The patient was taking these low doses because of being a slow metabolizer of medication in general. Whereas before with fluoxetine he had reported dulling of penile sensation and delayed erection and ejaculation, in the presence of loratadine none of these side effects were present and he reported normal sexual function, which continued at last report.

Due to this initial success with loratadine, over the next 9 months I prescribed, with informed consent, loratadine for fluoxetine-induced sexual dysfunction in 9 additional patients (5 men and 4 women) with a diagnosis of major depression. No sexual dysfunction assessment scales were employed, just the verbal report of each patient within the confines of a typical 15-minute medication review. Before-and-after reports were noted concerning level of sexual interest, delay or absence of erection, and delay or absence of orgasm. Two male patients reported delayed or absent erection and orgasm; 1 male patient reported impotence, anorgasmia, and no sexual interest; 2 male patients had anorgasmia and low sexual interest; 3 female patients reported anorgasmia and no sexual interest; and 1 female patient experienced anorgasmia only. No change in general or psychiatric medications was made. Dosage of loratadine ranged from 2.5 to 15 mg, depending on side effects and efficacy. Most patients were started on 10 mg/day. Seven of 9 patients had complete reversal of sexual dysfunction within 2 days, and the other 2 experienced significant improvement of sexual side effects. One male patient, who had partial impotence and low libido, had function restored to a prefluoxetine state by taking loratadine, 10 mg, 1 day before planned sexual activity. Side effects of loratadine ranged from none to mild-to-moderate dry mouth and sedation, which responded to bedtime dosing or reduction in dose. No change was seen on effectiveness of fluoxetine for depression, although the patients were happy to have their sexual function restored.

Furthermore, a female patient taking nefazadone and sertraline responded nicely to the addition of loratadine for low sexual interest and anorgasmia. I also prescribed loratadine for low sexual interest and anorgasmia to a female patient taking paroxetine and a male patient experiencing impotence who was being treated with citalopram, but neither had a positive response. I have no explanation for this lack of efficacy.

It appears from this small open study that loratadine is a promising agent for reversing fluoxetine-induced sexual dysfunction. These results are subject to the limitations of a retrospective report and the possibility of a placebo-like effect. A larger double-blind controlled study could confirm a generalization of these findings. If confirmed, these findings could prompt an investigation into the mechanism of action of loratadine in reversing sexual dysfunction in patients treated with fluoxetine and possibly lead to development of antidepressants without this side effect. Whether loratadine could be useful for sexual dysfunction induced by other SSRIs awaits further study.


Dr. Brubaker reports no financial affiliation or other relationship relevant to the subject matter of this letter.

References

1. Labbate LA, Lare SB. Sexual dysfunction in male psychiatric outpatients. Psychother Psychosom 2001;70:221-225

2. Woodrum ST, Brown CS. Management of SSRI-induced sexual dysfunction. Ann Pharmacother 1998;32:1209-1215


Russel V. Brubaker, M.D.
Michigan State University
Alto, Michigan

 

Truly fascinating for me, since Claritin .....

Posted by Jaynee on May 26, 2003, at 23:22:31

In reply to Re: Can anyone get this article?- Thanks, posted by djmmm on May 26, 2003, at 18:51:12

I find this study truly fascinating for me, since Claritin has really helped me energy wise, sexually, just all-round better since adding it to my Celexa. I don't know if the depression has lifted, and that is why I feel better or if it is the Claritin, but I am going to continue taking Claritin. I really believe there is something to study with adding claritin to AD's. It is just too bad it is OTC and expensive.

I wouldn't have said this a few weeks ago, but I am glad I got the weird rash and started taking Claritin.

I hope it can help others..........

Thanks again.

 

DOES anyone know the mechanism behind this?

Posted by Caleb462 on May 27, 2003, at 3:04:21

In reply to Truly fascinating for me, since Claritin ....., posted by Jaynee on May 26, 2003, at 23:22:31

I know H1 antagonists induce dopamine release, but I didn't think the effect was very strong - also, claritin is not a centrally acting drug, right? so I don't see how this would work. Anyone know??

 

Re: DOES anyone know the mechanism behind this?

Posted by djmmm on May 27, 2003, at 9:58:16

In reply to DOES anyone know the mechanism behind this?, posted by Caleb462 on May 27, 2003, at 3:04:21

> I know H1 antagonists induce dopamine release, but I didn't think the effect was very strong - also, claritin is not a centrally acting drug, right? so I don't see how this would work. Anyone know??

Well, If it is Clairtin D, it contains pseudoephedrine (a stimulant, with similar pharmacology as amphetamines)

 

Re: DOES anyone know the mechanism behind this?

Posted by Caleb462 on May 27, 2003, at 12:51:33

In reply to Re: DOES anyone know the mechanism behind this?, posted by djmmm on May 27, 2003, at 9:58:16

> > I know H1 antagonists induce dopamine release, but I didn't think the effect was very strong - also, claritin is not a centrally acting drug, right? so I don't see how this would work. Anyone know??
>
> Well, If it is Clairtin D, it contains pseudoephedrine (a stimulant, with similar pharmacology as amphetamines)


Hmm... I see. Well, from my experience, pseudoephedrine would certainly not be strong enough to correct sexual dysfumction.

 

Re: DOES anyone know the mechanism behind this?

Posted by Jaynee on May 27, 2003, at 14:41:34

In reply to Re: DOES anyone know the mechanism behind this?, posted by Caleb462 on May 27, 2003, at 12:51:33

It's not Claritin-D. My doc told me that Claritin does cross the brain barrier.

 

Re: DOES anyone know the mechanism behind this? Jaynee

Posted by Larry Hoover on May 27, 2003, at 15:33:42

In reply to Re: DOES anyone know the mechanism behind this?, posted by Jaynee on May 27, 2003, at 14:41:34

> It's not Claritin-D. My doc told me that Claritin does cross the brain barrier.

I'm not meaning to be contrary here, but the drug monograph for loratadine says:

"Whole body autoradiographic studies in rats and monkeys, radiolabeled tissue distribution studies in mice and rats, and in vivo radioligand studies in mice have shown that neither loratadine nor its metabolites readily cross the blood-brain barrier."

Loratidine is thought to be incapable of crossing the blood-brain barrier because it is not lipid-soluble, and has no affinity for any of the known transporters.

The tricyclic antidepressants, as a class, arose from the accidental discovery that tricyclic hayfever meds had antidepressant effects. Loratadine is classed as a tricyclic antihistamine. Without getting into a detailed analysis of the structure-activity relationship, I have no idea if there's any substantial similarity between loratadine and tricyclic antidepressants, but you're not supposed to use them together (nor with nefazodone).

Now, just what's going on with loratadine is anybody's guess. There have been reports of weird stuff going on with it (including fatal cardiac arrhythmias). The real test is, "Does it help (or not)?", which is only answerable by doing the (personal) experiment.

Lar

 

Re: DOES anyone know the mechanism behind this?

Posted by djmmm on May 27, 2003, at 15:41:35

In reply to Re: DOES anyone know the mechanism behind this?, posted by Jaynee on May 27, 2003, at 14:41:34

> It's not Claritin-D. My doc told me that Claritin does cross the brain barrier.

I'm not a Dr. but I think your Dr. may have mispoken. The reason why the second generation antihistamines are non-sedating, is because they act on peripheral H1 rather than central H1 receptors.

From what I understand (I may be wrong) the positive anti-allergy effects from Claritin (loratadine) may actually be from its metabolites, primarily desloratadine, which also does not cross the BBB, thus the lack of sedation, etc.

Desloratadine may be what is contributing the positive response you are experiencing, since desloratadine has a myriad of effects (anti-inflammatory , and inhibition of superoxide--often associated with male sexual dysfunction).

 

Thanks for the input...........

Posted by Jaynee on May 27, 2003, at 19:03:11

In reply to Re: DOES anyone know the mechanism behind this?, posted by djmmm on May 27, 2003, at 15:41:35

I never take anything a GP says at face value, I just repeated what he said without looking it up myself. I know better than that.

Larry you mentioned Claritin causing heart problems, are you sure it is Claritin and not Claritin-D? Since they keep telling me I may have had a heart attack, which I don't believe, since my research shows that the extra iron in my system can screw up the electrical readings of my heart, but no-one listens to me. I have Hemochromatosis.But my point is, I hope it is not Claritin that is causing the problems with the heart. But now that I think about it, I don't give a shit, because this is the best I've felt in years. I am getting to the point that quality of life is better than quantity.

djmmm.......I believe desloratadine is Clarinex, which is different than loratadin or Claritin, but correct me if I am wrong. I know people who have tried Clarinex and they say they feel like they are on speed, so they end up going back on Claritin.

Thanks again for your input. I am going to definitely keep my eyes open for more studies on Loratadin.

 

Re: Thanks for the input...........

Posted by djmmm on May 27, 2003, at 22:02:13

In reply to Thanks for the input..........., posted by Jaynee on May 27, 2003, at 19:03:11

> I never take anything a GP says at face value, I just repeated what he said without looking it up myself. I know better than that.
>
> Larry you mentioned Claritin causing heart problems, are you sure it is Claritin and not Claritin-D? Since they keep telling me I may have had a heart attack, which I don't believe, since my research shows that the extra iron in my system can screw up the electrical readings of my heart, but no-one listens to me. I have Hemochromatosis.But my point is, I hope it is not Claritin that is causing the problems with the heart. But now that I think about it, I don't give a shit, because this is the best I've felt in years. I am getting to the point that quality of life is better than quantity.
>
> djmmm.......I believe desloratadine is Clarinex, which is different than loratadin or Claritin, but correct me if I am wrong. I know people who have tried Clarinex and they say they feel like they are on speed, so they end up going back on Claritin.
>
> Thanks again for your input. I am going to definitely keep my eyes open for more studies on Loratadin.

You aren't wrong, but desloratadine is just the active metabolite of loratadine (Claritin)...it's just clever marketing, like Sarafem for PMS, which is just fluoxetine (Prozac)...

 

Re: DOES anyone know the mechanism behind this?

Posted by jemma on May 28, 2003, at 10:12:58

In reply to Re: DOES anyone know the mechanism behind this?, posted by djmmm on May 27, 2003, at 15:41:35

I wonder if part of the answer isn't very simple. Seratonin is a vasoconstrictor, and inhibits the vasodilation needed for optimal sexual performance. Antihistamines are vasodilators. Just a thought.

- Jemma

 

Re: DOES anyone know the mechanism behind this?

Posted by Caleb462 on May 28, 2003, at 22:22:16

In reply to Re: DOES anyone know the mechanism behind this?, posted by jemma on May 28, 2003, at 10:12:58

> I wonder if part of the answer isn't very simple. Seratonin is a vasoconstrictor, and inhibits the vasodilation needed for optimal sexual performance. Antihistamines are vasodilators. Just a thought.
>
> - Jemma

Hmm... well, I believe most of the sexual problems from SSRIs arise from overactivity at 5-HT2c receptors, which inhibits dopamine release and thus blunts the sexual response. Not that vasoconstriction doesn't play a part, I just can't say... as I'm not very knowledgeable on the subject. Also... the only anti-histamine I've read about being able to revere SSRI sexual dysfunction is Claritin. Diphenhydramine, promethazine, hydroxyzine... there are no reports of these having a pro-sexual effect, and in my experience, none of them have helped. I haven't tried Claritin yet either.


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