![[dr. bob]](/dr-bob-sm.gif)
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 BeachGuy on August 17, 2003, at 19:52:48
Patient suffers from lifelong low level depression and anxiety...
low level depression and anxiety causes
retarded ejaculation/inhibited orgasm
(patient unable to achieve climax with
partner)after a number of years this situation aggravates
patient's dysthymia and amplifies it into a
full scale depressive episodepatient seeks treatment for depression
patient prescribed SSRI (Paxil)
patient suffers sexual side effect of SSRI....
Retarded Ejaculation/Inhibited OrgasmPatient considers suicide.
Posted by Dragonslayer on August 18, 2003, at 11:03:33
In reply to SSRI's and R.E. Dark Irony, posted by BeachGuy on August 17, 2003, at 19:52:48
"Patient considers suicide."
Sorry for your problems, but not a good option and causes much pain and suffering. Hope you can come up with another idea. Talk to somebody.
Posted by Susan J on August 18, 2003, at 14:55:07
In reply to SSRI's and R.E. Dark Irony, posted by BeachGuy on August 17, 2003, at 19:52:48
> patient seeks treatment for depression
>
> patient prescribed SSRI (Paxil)
>
> patient suffers sexual side effect of SSRI....
> Retarded Ejaculation/Inhibited Orgasm
>
> Patient considers suicide.<<No, suicide's not the answer... :-( I suffered the same types of sexual side effects on Paxil. Switching to Wellbutrin made them go away entirely. Please talk to your doctor about this. It's a very legitimate complaint. I'm not a doc, but perhaps they can prescribe Wellbutrin along with the Paxil. Or perhaps they can lower the dose of Paxil.
Paxil sucks. Please talk to your doc about modifying your meds.....
There's hope. :-) Good luck with everything.
Posted by BeachGuy on August 18, 2003, at 15:54:25
In reply to Re: SSRI's and R.E. Dark Irony, posted by Dragonslayer on August 18, 2003, at 11:03:33
Suicide?... actually doing it? No. Considering it because I have found myself with an incurable dysfunction that has already cost me one marriage and alot of relationships? Yes...often.
Wellbutrin?....ah the miracle drug for the cure
of SSRI sexual dysfunction. Raises dopemine....good. Depression....taken care of.
Sexual desire....heightened,,,,and the nightly dreams?...like going to the movies...full color widescreen with great storylines! Weightloss....such a great little bonus...15 lbs in 6 weeks...wow. Effect on RE? None, but none expected.Raises noreoinphrine (the fight or flight hormon) ...very bad. Preexisting low level anxiety is supercharged and the patient constantly feels like he is being chased through the woods by a pack of hungry wolves even though he is doing nothing more dangerous than reading the newspaper. Even at the lowest dose the anxiety and panic attacks are debilitating.
The irony is the irony..... a cruel cosmic joke.
But the patient rfuses to give up and considers
the following:No SSRI
Wellbutrin SR
Clonazepam to take the edge off the heavy
anxiety attacks that occur a few times a week.
Low level anxiety now heightened?...get used to it.And the sexual dysfunction? Well that's a whole other story.
BG
Posted by Susan J on August 18, 2003, at 16:08:44
In reply to SSRI's and R.E. Dark Irony, posted by BeachGuy on August 18, 2003, at 15:54:25
> Suicide?... actually doing it? No.
<<Good. Don't.>>Considering it because I have found myself with an incurable dysfunction that has already cost me one marriage and alot of relationships? Yes...often.
<<I'm sorry that you are in that much pain. I wish I could say something to help, but as a female, I guess I am not really qualified to speak on this subject too much.Do the adverse sexual side effects kill your libido? If not, is Viagra an option?
As far as going off meds totally, this is what my therapist told me. Don't know if it's true or not, I haven't tested it.
Many things cause depression, either situational issues or chemical imbalance in the brain. Regardless, the situational issue "creates" the chemical imbalance.
Remove the situation, and the brain might be able to return to "normal." Sometimes, taking antidepressants for a while "teaches" the brain how to function properly, and you can wean yourself off of ADs. Sometimes, you need ADs for life.
If there is no combination of meds that can help your adverse sexual side effects, if I were you, I'd try going off the meds and see what happens. I'd stay in contact with a doc while doing this though.
Also, Paxil made me suicidal and I've never been suicidal before. Something to think about.
And I'm going to ask the obvious, so forgive me. But have you been to a urologist to check for any physical causes of sexual disfunction? Is the sexual disfunction caused, even in part, by a low self-esteem (this was my boyfriend's problem).
I'm sorry, I really am. I really empathize with what you are going through. Sometimes I think it's much harder for men to deal with this type of issue than it is for women. Not saying women's sex drives don't matter as much, because they do, but I don't think women's self-worth depends so much on their sexuality (especially sexual performance, while men's self-worth can.
You deserve a full and satisfying sex life, just like anyone. I wish you the best.
Susan
Posted by BeachGuy on August 18, 2003, at 18:22:37
In reply to Re: SSRI's and R.E. Dark Irony » BeachGuy, posted by Susan J on August 18, 2003, at 16:08:44
Hi susan
...hehe...this little story is kinda complicated so forgive me if I wasn't clear in my original post. I tend to forget what others don't know. The cruel irony here is not the fact that SSRI's cause sexual dysfunction...I mean yes that's part of it but the irony is I had the exact same sexual dyfunction caused by the SSRI's BEFORE I ever swallowed my first antidepresent.According to the various sex therpists I have visited over the years the problem has a number of deep dark psychological causes- anxiety and it's best buddy, low self esteem being just two.
It was the sexual dysfunction that CAUSED the depression. And the irony is that the treatment for the depression causes the sexual dysfunction that caused the depression in the first place. Now psychologists and sex therapists believe than you can juggle chainsaws and if you do it right, you won't chop your hand off. In other words....you have to treat the depression first or any sex therapy is useless. In my case this thinking is insane. Oh they say...we'll just keep modifying and combining the med suntil you can be a happy ejaculator. But hard fact is you can't treat inhibited male orgasm with SSRI's and you cannot treat someone suffering from anxiety with Wellbutrin...so...as you can see.....
Told ya it was complicated...but hey...I'm a complicated guy :-)
Women don't hang around long with a guy who can't
ejaculate no matter how cute and charming he is! LOLFix the sexual dysfunction and the pills go in the garbage...don't need em. But since I have begun to realize the problem can't be fixed....well, you can't blame me for feeling a little down in the dumps!
BG
> > Suicide?... actually doing it? No.
> <<Good. Don't.
>
> >>Considering it because I have found myself with an incurable dysfunction that has already cost me one marriage and alot of relationships? Yes...often.
> <<I'm sorry that you are in that much pain. I wish I could say something to help, but as a female, I guess I am not really qualified to speak on this subject too much.
>
> Do the adverse sexual side effects kill your libido? If not, is Viagra an option?
>
> As far as going off meds totally, this is what my therapist told me. Don't know if it's true or not, I haven't tested it.
>
> Many things cause depression, either situational issues or chemical imbalance in the brain. Regardless, the situational issue "creates" the chemical imbalance.
>
> Remove the situation, and the brain might be able to return to "normal." Sometimes, taking antidepressants for a while "teaches" the brain how to function properly, and you can wean yourself off of ADs. Sometimes, you need ADs for life.
>
> If there is no combination of meds that can help your adverse sexual side effects, if I were you, I'd try going off the meds and see what happens. I'd stay in contact with a doc while doing this though.
>
> Also, Paxil made me suicidal and I've never been suicidal before. Something to think about.
>
> And I'm going to ask the obvious, so forgive me. But have you been to a urologist to check for any physical causes of sexual disfunction? Is the sexual disfunction caused, even in part, by a low self-esteem (this was my boyfriend's problem).
>
> I'm sorry, I really am. I really empathize with what you are going through. Sometimes I think it's much harder for men to deal with this type of issue than it is for women. Not saying women's sex drives don't matter as much, because they do, but I don't think women's self-worth depends so much on their sexuality (especially sexual performance, while men's self-worth can.
>
> You deserve a full and satisfying sex life, just like anyone. I wish you the best.
>
> Susan
Posted by Susan J on August 19, 2003, at 9:02:29
In reply to SSRI's and R.E. Dark Irony, posted by BeachGuy on August 18, 2003, at 18:22:37
> According to the various sex therpists I have visited over the years the problem has a number of deep dark psychological causes- anxiety and it's best buddy, low self esteem being just two.
<<Yeah, I read up on it a bit after I posted my last post and I see it's caused a lot by anxiety. That totally sucks. :-( But I, ever the optimist (at least when it comes to other people, not myself) think there HAS to be a solution, albeit a difficult one to find.Are you going to a regular therapist? Is he/she supportive? This post will probably get redirected somewhere since it's not about drugs.
> Women don't hang around long with a guy who can't ejaculate no matter how cute and charming he is! LOL
<<This is bothersome, to say the least. :-) My ex-boyfriend had anxiety issues too, but it worked in the reverse. Too early. Always. I tried to be very supportive and NEVER critical, but no matter how supportive I was, or how good our relationship was, I couldn't crack his low self-esteem. Only he could do it.>But since I have begun to realize the problem can't be fixed....well, you can't blame me for feeling a little down in the dumps!
<<Please don't think a solution doesn't exist. It does. Losing hope just makes that evil cycle keep spinning, it'll kill your self esteem, make you lose hope again....etc.Is there any way to work on those "deep dark psychological issues?" They've got to be surmountable. And if they go away, shouldn't the anxiety follow?
And really, this works. Keep saying to yourself you are a good man, a valuable man, smart, funny, open-minded, ethical, good looking, whatever. Even if you "don't" believe it now, if you repeat it in your head a million times you brainwash yourself! Trust me on this, please.
Good luck. :-)
Posted by BeachGuy on August 19, 2003, at 11:33:15
In reply to Re: SSRI's and R.E. Dark Irony » BeachGuy, posted by Susan J on August 19, 2003, at 9:02:29
Susan...just the fact you are taking an interest is a pretty big boost to self esteem.
So your Ex was a premature ejculator? The PE's and the RE's or so jealous of each other!lol But in truth both probs can destroy a relationship. Although, as a true RE guy I do think PE is better because you DO orgasm so at least you're satisfied...frustrated maybe, but satisfied physically so much better than being horny as hell with no payoff.
Yes I do go to a regular therapist...one of the top sex therapists in the country. I have spent over $18,000 so far trying to get this fixed with a number of therapists over the last 15 years.
There are two kinds of self esteem: core self esteem and exterior self esteem. I have exterior self esteem to burn. If you met me at a party you would have no clue there were problems. I have a very successful career and work very hard on this "shield" of exterior self esteem.
But core self esteem? forget it....it's lower than a snake's belly and has been since I was a baby.
It's probably causes by the low level anxiety and depression which in turn runs in my family.You are what your brain chemicals dictate. Therapy can uncover the causes of problems...but fix them? It's doubtful. My subconcious core says I don't deserve an orgasm and that's that.
The therapists always rub their hands tgether in glee when they first hear my story because most of them love a challenge and I'm a change from the "hubby won't have sex with me anymore boo hoo" that these therapists usually deal with day to day.
But a few months later....after trying everything, I know the signs...they start taking off their glasses and rubbing their eyes and sighing....that's when I know they are starting to give up. I've seen it a least a half dozen times.
Their is no drug to treat this...Viagra is for plumbing probs only and believe me erections are no problem for me. Like most guys suffering from RE I can hold mine for over an hour sometimes longer. Many think this would be an advantage...to be able to give a woman as many orgasms thru intercourse that she can handle. But I stoped having sex years ago because the stress of the RE is just too much to bear.
BG
Posted by Susan J on August 19, 2003, at 12:07:15
In reply to SSRI's and R.E. Dark Irony, posted by BeachGuy on August 19, 2003, at 11:33:15
> Susan...just the fact you are taking an interest is a pretty big boost to self esteem.
<<I hate it when people hurt. I really do. I hate it when I hurt too. :-) And I admire you a lot for trying to fix it. So, so many people never face a problem, let alone try to fix it. The strength is in the attempt. Always. You should value yourself for that. Who is more admirable? The guy who plays shortstop effortlessly because he was lucky enough to inherent physical prowess? Or the kid who tries and tries and practices at night, and comes out as an adequate shortstop?>
> But core self esteem? forget it....it's lower than a snake's belly and has been since I was a baby. It's probably causes by the low level anxiety and depression which in turn runs in my family.You are what your brain chemicals dictate.
<<Nope. Too easy. :-) This world belongs not to those who adapt to it, but to those who adapt the world to themselves. People overcome paralysis. People overcome mental retardation. People overcome being uglier than socially acceptable. People overcome being boring, being a drunk, having terminal cancer. I believe everyone is born with a disability, some just more apparent or more disabling than others.Heck, I'm overweight. I look very similar to Emme on Style channel. Ever seen her? I think "she" is beautiful....why don't I think "I" am? Sounds stupid and pointless, but it's crippling to my self-esteem....I don't think I can turn on a guy sexually because of it. Doesn't help that ex-boyfriend with PE blamed his lack of sex drive on me and my appearance when it was really all him, his lack of self-esteem, and his own depression.
I think I'm the opposite of you. I have decent, not perfect, core self-esteem. I do generally like myself. But my exterior self-esteem lacks some grit. Do I fit into society? Am I this culture's standard of beauty? I don't know. I'm great at sports, very athletic. Men tell me this "intimidates" them. ??? I'm successful in my job and make decent money, more than most people around here. Again, this "intimidates" men. But I'm not willing to change any of those things I care about to please others. I like them too much.
>>Therapy can uncover the causes of problems...but fix them? It's doubtful. My subconcious core says I don't deserve an orgasm and that's that.
<<I'm not a huge believer in the subconcious...only what we think here and now. BUT. Why do you think you don't "deserve" it? That, I don't get.You are a human being. I assume you try to be a good and kind person. You have value just being "you." Period. And as such, you deserve a happy and productive life. Can you accept others warts and all? If so, why can't you accept yourself? Why do you hold yourself to a higher standard than others? We are ALL flawed.
This is from an on-line self-help book:
"Several examples of a destructive internal critic will be given later in this method. But, it is important to note that the internal critic is often seen as doing good too.... the critic says, "You can't do that," it is helping you avoid a situation in which you might fail... Thus, we often tolerate and even welcome the internal critic as a necessity."
Is "accepting" RE a way to rationalize avoiding intimacy? Has it truly been years since you've tried? If so, how do you know it won't be OK now?
>> Many think this would be an advantage...to be able to give a woman as many orgasms thru intercourse that she can handle.
<<Nah, it's just like a woman who has sex all the time but never achieves orgasm...was socially accepted forever. Not a good thing. Not for a man either.>>But I stoped having sex years ago because the stress of the RE is just too much to bear.
<<When you had sex successfully, what was going on in your life? What was different? Can you get back to that place?Part of you lack of self-esteem is because you don't feel like you've got any control over your situation. That's VERY understandable, since you've been struggling with this at least 15 years. I'm not trying to be patronizing here, really. I've been struggling with depression for about that long, and sometimes I think I'll have it the rest of my life and that just is almost more than I can bear. But just "thinking" it's a life-long problem adds to the problem. So I'm sure your just "thinking" you've got something incurable just compounds the problem.
We live in four dimensions, you know, and time is the most pliable, the one that brings surprises. As long as you are alive, there's the possiblility for change.
Posted by BeachGuy on August 19, 2003, at 15:08:39
In reply to Re: SSRI's and R.E. Dark Irony » BeachGuy, posted by Susan J on August 19, 2003, at 12:07:15
thanks for the link. I'm always trying always hoping.
I haven't given up even though I am also rational and believe nothing until I have concrete proof. I believe damage done to you as a child gets deeply rooted inside you. So far that you can't remember it.
All the things people tell children which lowers their self esteem roll off the backs of some, in others every comment, every slight, is stored away--this part of what cases low core self esteem. It can maifest itself in many ways as adults. Some to daredevil things, some become sexually promiscuous, some do drugs or drink too much. With me it was sex. Every therapist has a slightly different take on it but I have managed to see a thread moving through all their observations. It is something I am not aware of when it happens but apparently it is some kind of inner core conciousness (or subconcious) dialogue that goes something like this: why is this woman here with you? There must be something wrong with her. What does she want? What the hell does she see in a loser like you? Can you give her what she wants...what all women demand? Probably not because you are a wimp, a loser, stupid and selfish and this woman will get dissapointed in you and leave sooner or later. You don't dederve her and you don't derserve any sexual pleasure with this kind of woman.Now of course in my day to day life and I don't think any of this. And it took 15 years of therapy to unearth that conversation with myself that happens every time I get intimate with a woman.
These thought s are like footprints made in cement that has dried hard. You can't get them out.You asked me if I had "tried" lately. This is a bit of a tricky question. Let me put it this way....I can function with no problem with a certain type of woman but they are really not the type you want to spend anymore than about an hour with. With anyone else-- anyone nice, anyone I might want to have a relationship with....same old same old.
But none of this is my priority now. I can't take medication and work on this problem at the same time so what I am now trying to decide to do is just forget sex and lose myself in an SSRI even steven bliss where all interest in sex is lost,
or try to continue on in therapy with the high anxiety of Wellbutrin.I THINK I answered most of your questions.
As for you. Well if things can be fixed then it's great to set goals an attain them. It gives meaning to your life. Don't let the guys get you down. There are tons of guys who like active, smart girls. If men are intimidated by you then that is their problem, you probably don't want to be with a guy like that anyway.
Posted by Susan J on August 19, 2003, at 15:37:09
In reply to SSRI's and R.E. Dark Irony, posted by BeachGuy on August 19, 2003, at 15:08:39
> I haven't given up even though I am also rational and believe nothing until I have concrete proof. I believe damage done to you as a child gets deeply rooted inside you. So far that you can't remember it.
<<Yeah, I agree to a certain extent. There's no one who can make me feel uglier than my mother. She made a concerted effort when I was a kid to NEVER tell me I was pretty because she didn't want a girl who traded solely on looks. And she started putting me on diets when I was 10. But I *remember* every single hurt, every single slight as a child. I *know* what's hurt me. I look back at pictures of myself then I was NORMAL, not overweight at all! She still reduces me to tears, though.I *can* get my self-esteem boosted, temporarily, by a sexy guy who finds *me* sexy and beautiful. I know it's not the best way to get higher self-esteem, but it *does* work. Works for as long as the guy's around, and then of course it comes crashing down. Does a woman's attention to you boost your self esteem at all, or do you end up thinking *less* of her because she's interested in you?
>why is this woman here with you? There must be something wrong with her. What does she want? What the hell does she see in a loser like you? Can you give her what she wants...what all women demand? Probably not because you are a wimp, a loser, stupid and selfish and this woman will get dissapointed in you and leave sooner or later. You don't dederve her and you don't derserve any sexual pleasure with this kind of woman.
<<<<Arrrgh. That's terrible. Kind of reminds me of the last guy I was *involved* with. A guy who flirted outrageously with me, actually (I believe) fell in love with me, but would never date me because he thought I was too good for him and would leave him, like everyone else had. I'll tell you what I told him. Shouldn't it be up to *me* to decide if you're worth dating? :-) And if a (nice) woman's in bed with you, isn't that per se proof she likes you?
>I can function with no problem with a certain type of woman but they are really not the type you want to spend anymore than about an hour with. With anyone else-- anyone nice, anyone I might want to have a relationship with....same old same old.
<<Wow, so it really does come down to self-esteem. These women are *low* enough to *want* to be with you so you know you can please them?
A *normal* woman wouldn't find you attractive?
Not true. First of all, you are very self-aware, understand your feelings and insecurities, and I hope your strengths. Ummm, in *my* experience, men like that are few and far between. Do you have female friends in your life with whom you are close? Good ones that compliment you, boost your self-esteem? Are reliable, dependable, fun, sexy, bright?>
> But none of this is my priority now. I can't take medication and work on this problem at the same time so what I am now trying to decide to do is just forget sex and lose myself in an SSRI even steven bliss where all interest in sex is lost, or try to continue on in therapy with the high anxiety of Wellbutrin.
<<I'm sorry it's rough. Only you know what's best for you. I hope (and think) you can conquer both. :-)> As for you. Well if things can be fixed then it's great to set goals an attain them. It gives meaning to your life. Don't let the guys get you down. There are tons of guys who like active, smart girls. If men are intimidated by you then that is their problem, you probably don't want to be with a guy like that anyway.
<<No, I don't want to be with that type of guy. I feel ugly and can't even get myself to the *date* stage with someone who really intrigues me. Much less have a satisfying physical relationship. It has, and still is, taking some serious work on my part to make myself believe I'm at least attractive. And I kind of know what you feel -- almost everyone I come in contact with thinks I'm beautiful. I think they really have a skewed way of looking at things. :-) But I know it's me who's really warped. It's all inside of me.For both of us: I really truly believe there is a partner out there, for each of us, who is understanding and committed and can offer unconditional love. Unconditional love is a *powerful* thing, and can sometimes overcome our own self-hatred.
One thing I know about my own depression is that a supportive person in my life is so incredibly valuable. My ex is still my best friend, and he sits there and listens to me cry hysterically for what seems to be no reason. He tells me I'm a great person, and he really means it. If not, he'd be gone long, long ago. We broke up almost 2 years ago.
And if you need support, this board is a great place for it. And you can always e-mail me if you want:
sdj at justice dot com.
Good luck. :-)
Posted by Dr. Bob on August 19, 2003, at 17:40:37
In reply to Re: SSRI's and R.E. Dark Irony » BeachGuy, posted by Susan J on August 19, 2003, at 15:37:09
> Yeah, I agree to a certain extent. There's no one who can make me feel uglier than my mother...
This discussion seems to have moved beyond SSRIs, so I'd like to redirect it to Psycho-Social-Babble. Here's a link:
http://www.dr-bob.org/babble/social/20030818/msgs/252249.html
Bob
Posted by KimberlyDi on August 20, 2003, at 17:24:34
In reply to SSRI's and R.E. Dark Irony, posted by BeachGuy on August 17, 2003, at 19:52:48
Why would patient consider suicide from SSRI side effect when patient already experienced that problem before the SSRI? Patient may have *continued* to consider suicide. Very likely, patient seeks treatment because of suicidal thoughts in the first place. Patient needs to be encouraged to have patience... Anti-Depressants don't cure depression overnight, and many unpleasant side effects fade away. Patient should also be encouraged to stop the black/white way of thinking. Life will not end if you sacrifice a few pleasures during treatment. The final goal is an emotionally stable and happy individual who feels self-confident enough to seek out healthy relationships, which will include fantastic sex.
KDi in Texas
Poster is very likely patient because the side effects of SSRI's would be well known to any doctor, having long lost any (if there was any) irony about the situation.
> Patient suffers from lifelong low level depression and anxiety...
>
> low level depression and anxiety causes
> retarded ejaculation/inhibited orgasm
> (patient unable to achieve climax with
> partner)
>
> after a number of years this situation aggravates
> patient's dysthymia and amplifies it into a
> full scale depressive episode
>
> patient seeks treatment for depression
>
> patient prescribed SSRI (Paxil)
>
> patient suffers sexual side effect of SSRI....
> Retarded Ejaculation/Inhibited Orgasm
>
> Patient considers suicide.
Posted by BeachGuy on August 21, 2003, at 7:28:07
In reply to SSRI's and R.E. Dark Irony » BeachGuy, posted by KimberlyDi on August 20, 2003, at 17:24:34
KD...of course I'm the patient. Read every message in the thread and you'll understand the situation.
This is the end of the thread.
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