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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by SPhobia on January 31, 2004, at 16:34:14
Hello,
I think the SSRI's might be helping my SAD, but having trouble with anorgasmia. Are there some good meds I could suggest to my doc that would help this, w/out increasing my anxiety?PS: I am male (in case that matters with the options)
Posted by krybrahaha on January 31, 2004, at 22:08:10
In reply to Any good meds for combatting SSRI sexual effects??, posted by SPhobia on January 31, 2004, at 16:34:14
i take 300 mgs of Luvox daily and i have the same problem you do. My p-doc added Buspar to the Luvox. I have only been on it for a couple days but well see. If you dont want something to make your anxiety worse --go for buspar, becaues it is also prescribed for anxiety. Alot of people use Wellbutrin, but that will make your anxiety worse, dont do it
Posted by SPhobia on January 31, 2004, at 22:19:39
In reply to Re: Any good meds for combatting SSRI sexual effects??, posted by krybrahaha on January 31, 2004, at 22:08:10
Thanks for the reply. Do you take Luvox for SAD? I haven't heard much about Luvox. Also, how much Busbar are you taking? Please let me know if it starts working...
> i take 300 mgs of Luvox daily and i have the same problem you do. My p-doc added Buspar to the Luvox. I have only been on it for a couple days but well see. If you dont want something to make your anxiety worse --go for buspar, becaues it is also prescribed for anxiety. Alot of people use Wellbutrin, but that will make your anxiety worse, dont do it
Posted by Chairman_MAO on February 1, 2004, at 10:55:37
In reply to Any good meds for combatting SSRI sexual effects??, posted by SPhobia on January 31, 2004, at 16:34:14
Ropinirole for antidepressant-induced sexual dysfunction
by
Worthington JJ, Simon NM, Korbly NB,
Perlis RH, Pollack MH;
For the Anxiety Disorders Research Program.
Int Clin Psychopharmacol 2002 Nov;17(6):307-10ABSTRACT
Sexual dysfunction is a relatively common side-effect of antidepressants, occurring in approximately one-half of patients, and is associated with significant distress and treatment non-compliance. Dopaminergic agents have been reported to be helpful for the treatment of antidepressant-induced sexual dysfunction and, in this report, we examined the efficacy of the dopamine agonist ropinirole for this indication. Thirteen patients (three women, 10 men), aged 42.6 +/- 7.7 years, who reported sexual dysfunction on a stable dose of antidepressant, were treated openly with ropinirole initiated at 0.25 mg/day and titrated up to 2-4 mg/day over 4 weeks, as tolerated. Ten of the 13 took ropinirole for at least 4 weeks, one discontinued due to an adverse event and two because of lack of response. Sexual dysfunction, as assessed by the Arizona Sexual Experience Scale scores, was reduced from 18.8 +/- 3.6 to 13.8 +/- 4.3 after 4 weeks on ropinirole at a mean dose of 2.1 mg/day. Overall, seven of 13 patients (54%) were rated as responders on the Clinical Global Impression of Improvement Scale. The addition of ropinirole may represent a potentially useful treatment strategy for antidepressant-induced sexual dysfunction.
Anxiolytic profile of ropinirole in the rat,
mouse and common marmoset
by
Rogers DC, Costall B, Domeney AM, Gerrard PA,
Greener M, Kelly ME, Hagan JJ, Hunter AJ.
Neuroscience Research,
SmithKline Beecham Pharmaceuticals,
Harlow, Essex, UK.
Derek_C_Rogers@sbphrd.com
Psychopharmacology (Berl)2000 Jul;151(1):91-7ABSTRACT
RATIONALE: Some features of Parkinson's disease are exacerbated by stress and anxiety and it is important to understand the effects of dopamine receptor agonists on measures of anxiety. The aim of this study was to assess the effects of the dopamine D2/D3 receptor agonist ropinirole in models of anxiety and depression in the rat, mouse and marmoset. RESULTS: In the rat elevated plus-maze test, ropinirole (0.01- 1 mg/kg, i.p.) produced an inverted-U dose-response curve in the percentage time spent in the open arms. Compared with vehicle, ropinirole (0.1 mg/kg) had a significant anxiolytic-like effect, which was similar to that observed with 1.5 mg/kg diazepam. This effect was found at doses that did not affect motor behaviour or induce stereotypy. In the mouse black and white box test of anxiety, ropinirole (0.1-10 mg/kg, i.p.) increased both the rearing time and number of line crosses in the white section. This effect reached statistical significance for both measures at a dose of 0.1 mg/kg and suggests an anxiolytic-like action of the compound. By contrast, the dopamine agonist bromocriptine (0.1-10 mg/kg, i.p.) did not produce significant changes in these behaviours. In the marmoset human threat test, ropinirole (0.01-10 microg/kg, s.c.) reduced the number of postures at all doses tested and this reached statistical significance at 10 microg/kg. Ropinirole did not compromise the effect of amitriptyline in the Porsolt test of depression and in itself produced antidepressant-like effects. CONCLUSIONS: These data demonstrate that systemic administration of ropinirole produces anxiolytic-like effects in three separate models in the mouse, rat and marmoset. This may predict an action of ropinirole in man that would provide a superior profile of action over other presently available anti-parkinsonian agents.
Posted by KathrynLex on February 1, 2004, at 16:04:08
In reply to Any good meds for combatting SSRI sexual effects??, posted by SPhobia on January 31, 2004, at 16:34:14
Hi SPhobia,
I suggest Wellbutrin. A lot of people I know have taken it for anoragasmia. But it's possible that it will increase your anxiety. Keep in mind that it doesn't have this effect on everyone. You might add it to your list of options and try it if others don't work. Best of luck to you.
K.
Posted by JonW on February 1, 2004, at 16:08:07
In reply to Any good meds for combatting SSRI sexual effects??, posted by SPhobia on January 31, 2004, at 16:34:14
> Hello,
> I think the SSRI's might be helping my SAD, but having trouble with anorgasmia. Are there some good meds I could suggest to my doc that would help this, w/out increasing my anxiety?
>
> PS: I am male (in case that matters with the options)I have severe social anxiety myself, and have been on many many different meds for it. It's been my experience that the most effective meds for social anxiety have some of the worst sexual side-effects. I'm currently taking Lexapro which, to my surprise, has not had a major impact on sexual function. I found Paxil more effective for SP, but I like the side-effects of Lex a lot better :) Anyway, as far as antidotes go... I've found the herbal product Muira Puama the best remedy for sex side-effects. Unfortunately, it seemed to worsen my depression and anxiety a bit. But fortunately, Lexapro for the most part has been kind to me in the side-effect department.
Good Luck,
Jon :)
Posted by SPhobia on February 1, 2004, at 17:26:41
In reply to Re: Any good meds for combatting SSRI sexual effects?? » SPhobia, posted by JonW on February 1, 2004, at 16:08:07
Jon,
How is the Lexapro working for your SA? I started Lex just recently and was thinking of switching to Zoloft b/c I have heard so many good things about that med with respect to SA. Lexapro is giving me anorgasmia (unfortunately) and Paxil certainly did, so I expect the same from Zoloft if I go there. But since I expect I will have this effect from each of these meds (hence the post), I am also trying to find the most effective SSRI for SA, and one that won't heavily sedate me and kill my motivation. You seem like you may have a lot of experience with them, so any thoughts would be very helpful.> > Hello,
> > I think the SSRI's might be helping my SAD, but having trouble with anorgasmia. Are there some good meds I could suggest to my doc that would help this, w/out increasing my anxiety?
> >
> > PS: I am male (in case that matters with the options)
>
> I have severe social anxiety myself, and have been on many many different meds for it. It's been my experience that the most effective meds for social anxiety have some of the worst sexual side-effects. I'm currently taking Lexapro which, to my surprise, has not had a major impact on sexual function. I found Paxil more effective for SP, but I like the side-effects of Lex a lot better :) Anyway, as far as antidotes go... I've found the herbal product Muira Puama the best remedy for sex side-effects. Unfortunately, it seemed to worsen my depression and anxiety a bit. But fortunately, Lexapro for the most part has been kind to me in the side-effect department.
>
> Good Luck,
> Jon :)
Posted by Ame Sans Vie on February 1, 2004, at 19:32:35
In reply to Re: Any good meds for combatting SSRI sexual effects?? » JonW, posted by SPhobia on February 1, 2004, at 17:26:41
Prozac can be great for social anxiety, and (especially in males) it is the least likely of all the SSRIs to cause sexual side effects. I've tried all five other SSRIs and experienced anorgasmia from all of them, even at the lowest doses. Not so with Prozac.
Just a little warning -- some people experience increased anxiety on Prozac, but this is usually transient and subsides within a few weeks. On the other hand, statistically speaking, Prozac isn't any more likely to cause anxiety than any of the other similar drugs.
Posted by JonW on February 1, 2004, at 23:12:28
In reply to Re: Any good meds for combatting SSRI sexual effects?? » JonW, posted by SPhobia on February 1, 2004, at 17:26:41
> Jon,
> How is the Lexapro working for your SA? I started Lex just recently and was thinking of switching to Zoloft b/c I have heard so many good things about that med with respect to SA. Lexapro is giving me anorgasmia (unfortunately) and Paxil certainly did, so I expect the same from Zoloft if I go there. But since I expect I will have this effect from each of these meds (hence the post), I am also trying to find the most effective SSRI for SA, and one that won't heavily sedate me and kill my motivation. You seem like you may have a lot of experience with them, so any thoughts would be very helpful.Everyone is different, but I think most people would say that Paxil is the best SSRI for SP. The impression one gets from reading the literature and individual posts on the internet is that Paxil is the best SSRI for most anxiety disorders. The other SSRIs don't seem to stand out as much, but all of that may be more a result of marketing than anything else... who knows. As for Zoloft, I think it's definitely worth a shot. Dr. Liebowitz of Columbia thinks well of Zoloft for SP. It's the least selective of the SSRIs, and effects more than just serotonin. I'll tell you that, ironically, zoloft gave me very few sex side-effects. I say ironically, because it seems that most people do have problems with zoloft, but I did not and you may not. It did make me sweat way too much, though. All other SSRIs gave me intollerable anorgasmia. As for Zoloft's effect on social anxiety, I personally clump it with the rest of the SSRIs. Just reporting my own experience, but it was one that really killed my motivation. Here's how I would rate the SSRIs in terms of efficacy for SP: Paxil > Luvox or Zoloft > Celexa, Lexapro, Prozac. I also found Zoloft and Prozac more likely to make me agitated, irritable, etc. I found Paxil, Luvox, and Celexa to be the gentlest and kindest to my anxiety while starting them. Zoloft, Lexapro, and Prozac were really tough on my anxiety in the begining. It's interesting that Celexa was easier to adjust to than Lexapro. I like Lexapro the best because it is comparable to the other SSRIs, but has fewer side-effects for me. So basically, everyone's different, but that's been my experience and my impression. Are side-effects the only thing limiting you??? I mean, are the SSRIs effective for you? If not, look to other classes of meds. Are you involved with CBT? CBT has changed everything for me. Search this site for CBT and my name if you want to read my thoughts on that. In any event, don't stop searching for a solution. Persistence pays very well!
Jon :)
Posted by theo on February 1, 2004, at 23:43:51
In reply to Re: Any good meds for combatting SSRI sexual effects??, posted by Ame Sans Vie on February 1, 2004, at 19:32:35
I've read from several sources that Zoloft is the least to cause sexual sides in men. Also if one does have sexual sides from Prozac it takes at least a week to get better because of its long half life.
Posted by krybrahaha on February 2, 2004, at 0:42:33
In reply to Re: Any good meds for combatting SSRI sexual effects?? » krybrahaha, posted by SPhobia on January 31, 2004, at 22:19:39
> Thanks for the reply. Do you take Luvox for SAD? I haven't heard much about Luvox. Also, how much Busbar are you taking? Please let me know if it starts working...
>
> > i take 300 mgs of Luvox daily and i have the same problem you do. My p-doc added Buspar to the Luvox. I have only been on it for a couple days but well see. If you dont want something to make your anxiety worse --go for buspar, becaues it is also prescribed for anxiety. Alot of people use Wellbutrin, but that will make your anxiety worse, dont do it
>
>
I take Luvox for SAD, OCD, and GAD. I just started on Buspar. I take 20 mgs daily for now. Just to battle the sexual side effects. I take 10 mgs in morning and 10 mgs at night. If that dont work, Ill probably raise the dose. My p-doc absolutely refused Wellbutrin because I have anxiety as it is and he said it will make it worse and can also cause tics. I dont think he is a big fan of wellbutrin. I dont recommend it. There are also other meds out there that help.
Posted by krybrahaha on February 2, 2004, at 0:45:49
In reply to Re: Any good meds for combatting SSRI sexual effects??, posted by Ame Sans Vie on February 1, 2004, at 19:32:35
> Prozac can be great for social anxiety, and (especially in males) it is the least likely of all the SSRIs to cause sexual side effects. I've tried all five other SSRIs and experienced anorgasmia from all of them, even at the lowest doses. Not so with Prozac.
>
> Just a little warning -- some people experience increased anxiety on Prozac, but this is usually transient and subsides within a few weeks. On the other hand, statistically speaking, Prozac isn't any more likely to cause anxiety than any of the other similar drugs.For me, Prozac had the worst Sexual side effects, but i guess it varies person to person. Luvox is my SSRI of choice
Posted by terrics on February 2, 2004, at 15:10:25
In reply to Any good meds for combatting SSRI sexual effects??, posted by SPhobia on January 31, 2004, at 16:34:14
Try wellbutrin...I am female, had the same problem with SSRIs.The wellbutrin works great. Can cause other problems though. Ask your MD. good luck. terrics
Posted by SPhobia on February 2, 2004, at 18:28:34
In reply to Re: Any good meds for combatting SSRI sexual effects?? » SPhobia, posted by JonW on February 1, 2004, at 23:12:28
Jon,
Thanks for the info. I am not entirely sure if SSRI's are effective for my SA yet b/c I have not been on one long enough to tell. I'm going to get off Lexapro I think, b/c it's giving me chronic headaches (and kills my libido and gives me anorgasmia just like the others), and giving Paxil a full chance. I was going to do Zoloft, but maybe I'll go Paxil instead. But on another note, what are your feelings on Effexor for SA? Also, I posted this question below, but do you know anything about using Tegretol for SA?
Thanks Jon!
Posted by theo on February 2, 2004, at 19:56:59
In reply to Re: Any good meds for combatting SSRI sexual effects?? » JonW, posted by SPhobia on February 2, 2004, at 18:28:34
I loved Paxil but it seems to produce the most sexual dysfunction among all SSRI's (especially in men) because of its selectivity of serotonin reuptake. It actually not only killed my libido but also caused erectile dysfuntion. I'm a healthy 39 year old male and erections have never been a problem. The Paxil did work so good but I gotta be able to perform. I'm currently taking Wellbutrin XL and Xanax XR and if I add an SSRI I've read Zoloft to be the least to produce these problems and might try it.
Posted by JonW on February 2, 2004, at 22:55:15
In reply to Re: Any good meds for combatting SSRI sexual effects?? » JonW, posted by SPhobia on February 2, 2004, at 18:28:34
> Jon,
> Thanks for the info. I am not entirely sure if SSRI's are effective for my SA yet b/c I have not been on one long enough to tell.I think for a number of reasons it takes considerably longer for social anxiety to improve than it does to simply feel less depressed. Paxil, in particular, has clinical trials to support this idea.
>I'm going to get off Lexapro I think, b/c it's giving me chronic headaches (and kills my libido and gives me anorgasmia just like the others)
That's probably best if it doesn't agree with you.
>and giving Paxil a full chance. I was going to do Zoloft, but maybe I'll go Paxil instead.
I had slightly less sexual side-effects with Paxil CR than Paxil, but not a huge difference. Anyway, it seems correct to place value in staying on a drug for a time. Check this abstract out:
Here's an excerpt: "RESULTS: Only duration of treatment was a statistically significant predictor of treatment response. Further analysis demonstrated that, in paroxetine-treated patients in particular, many nonresponders at week 8 (46/166; 27.7%) were responders at week 12."
>But on another note, what are your feelings on Effexor for SA?
I was only briefly on Effexor at a very young age, but don't remember my experience. Maybe someone else here can share their experience with it. It often gets a bad rap, but I'm sure it's a miracle drug for many.
>Also, I posted this question below, but do you know anything about using Tegretol for SA?
I know it's thought to be the drug of choice for TLE (Temporal Lobe Epilepsy), which shares the symptoms of many of the psychiatric illnesses. Trileptal has fewer side-effects, but I've been told it's less potent and not as effective against depression. I like Trileptal a lot. I've never taken Tegretol, though. I didn't consider Trileptal a solution to social anxiety, though. As far as anti-convulsants go, high-dose Neurontin would probably be a better choice than Tegretol.
I'd consider CBT in addition to the meds... it's a kick ass combo and meds can only do so much by themselves. At least in my experience.
Hang in there,
Jon :)
Posted by Sad Panda on February 3, 2004, at 4:47:18
In reply to Any good meds for combatting SSRI sexual effects??, posted by SPhobia on January 31, 2004, at 16:34:14
> Hello,
> I think the SSRI's might be helping my SAD, but having trouble with anorgasmia. Are there some good meds I could suggest to my doc that would help this, w/out increasing my anxiety?
>
> PS: I am male (in case that matters with the options)
>
>Adding Remeron works for me.
Cheers,
Panda.
Posted by PoohBear on February 5, 2004, at 12:22:14
In reply to Re: Any good meds for combatting SSRI sexual effects??, posted by Sad Panda on February 3, 2004, at 4:47:18
I use half a 75mg Wellbutrin SR daily... Works for me.
Tony
Posted by Questionmark on February 6, 2004, at 14:07:04
In reply to Re: Any good meds for combatting SSRI sexual effects??, posted by Sad Panda on February 3, 2004, at 4:47:18
> > Hello,
> > I think the SSRI's might be helping my SAD, but having trouble with anorgasmia. Are there some good meds I could suggest to my doc that would help this, w/out increasing my anxiety?
> >
> > PS: I am male (in case that matters with the options)
> >
> >
>
> Adding Remeron works for me.
>
> Cheers,
> Panda.What dose of Remeron were you on? Or what dose helped you the most with that, and overall?
i still don't understand how anyone can benefit from Remeron with those outrageous antihistaminic effects it has (and i could even affORD to gain a good deal of weight).... If for depression: the antihistaminic ultra-ultra-dumbed-down drowsiness makes me a **** of alot more depressed than normal even-- regardless of the adrenergic effects it has. For anxiety (SA): i'm too stupid to even talk coherently, so socializing is more difficult than usual and just sucks. For anorgasmia: i'm too f***ing tired to even move or THINK, let alone have satisfying sexual relations. i don't get it. i've heard so many good things about Remeron, but i cannot fathom how it could ever be worth it at all for me. It's weird.
Posted by theo on February 8, 2004, at 9:22:16
In reply to Re: Any good ***s for combatting...?? » Sad Panda, posted by Questionmark on February 6, 2004, at 14:07:04
Posted by Draisy on March 28, 2004, at 12:43:22
In reply to Re: Any good meds for combatting SSRI sexual effects??, posted by PoohBear on February 5, 2004, at 12:22:14
I couldn't come last night! I wanted to so bad it hurt! I've been on 5mg celexa for the past 3 days. do anti-anxiety meds have these kind of side effects? i'm done with celexa.
Posted by mrsrjv on June 29, 2006, at 13:00:30
In reply to Re: Any good meds for combatting SSRI sexual effects??, posted by theo on February 1, 2004, at 23:43:51
has anyone experienced ejaculation problems with Wellbutrin and if so do they dissapte with time
Posted by jedi on July 3, 2006, at 1:37:10
In reply to Wellbutrin and delayed or no ejaculation??, posted by mrsrjv on June 29, 2006, at 13:00:30
> has anyone experienced ejaculation problems with Wellbutrin and if so do they dissapte with time
Hi,
Generally Wellbutrin is known for very few sexual side effects. Some people even claim it helps reduce the sexual side effects caused by other antidepressants. If you really want to see some ejaculation delay, try the MAOI phenelzine(Nardil). In my opinion it is the best medication for treatment resistant atypical depression and social anxiety, but the delay in ejaculation can be incredible; at least for the first few months.
Be Well,
Jedi
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