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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by iforgotmypassword on June 24, 2005, at 10:32:03
this is NOT directed at anyone in particular, but why is sex such a big issue with people taking antidepressants? if you find something that works, isn't that a hell of a lot better than some useless sex drive or ability to have an orgasm/erection?! day to day, i can only function minimally and i have to pull teeth to get any doctor to take me seriously. how come people who can function well enough to care about their sexual performance/desire are taken so much more seriously than i am? i'm sorry to sound abrasive but do i have to kill myself in order for a doctor to take me seriously? i guess this is just my self-pity, but can you make any more sense out of this than i can? thankyou.
Posted by cybercafe on June 24, 2005, at 10:45:53
In reply to sex and ADs?!?! okay, honestly..., posted by iforgotmypassword on June 24, 2005, at 10:32:03
> this is NOT directed at anyone in particular, but why is sex such a big issue with people taking antidepressants? if you find something that works, isn't that a hell of a lot better than some useless sex drive or ability to have an orgasm/erection?! day to day, i can only function minimally and i have to pull teeth to get any doctor to take me seriously. how come people who can function well enough to care about their sexual performance/desire are taken so much more seriously than i am? i'm sorry to sound abrasive but do i have to kill myself in order for a doctor to take me seriously? i guess this is just my self-pity, but can you make any more sense out of this than i can? thankyou.
i used to feel totally the same way. Now that I have found something that works, I am almost ashamed that I barely remember what depression was like. So of course once you feel 100%, you start focusing your attention on other things.
Again, even if I had zero libido, there is no way I'm going off my anti-depressants. YMMV.
Posted by ed_uk on June 24, 2005, at 11:09:15
In reply to sex and ADs?!?! okay, honestly..., posted by iforgotmypassword on June 24, 2005, at 10:32:03
Hi!
>why is sex such a big issue with people taking antidepressants? if you find something that works, isn't that a hell of a lot better than some useless sex drive or ability to have an orgasm/erection?!
I understand you well! I would much rather have no sex drive than spend 8 hours a day obsessing (I have OCD).
Once people start to recover from their depression/anxiety/whatever, their sex life starts to become a lot more important, especially if they're their wife/husband/whatever feels rejected because they no longer have sex.
Kind regards
~Ed
Posted by Emily Elizabeth on June 24, 2005, at 11:32:06
In reply to sex and ADs?!?! okay, honestly..., posted by iforgotmypassword on June 24, 2005, at 10:32:03
I'm with you. I wish that lack of sex drive were my biggest problem. For that matter, I wish that I had a husband so that I had a reason to worry about sex drive!
EE
Posted by Nezirov on June 24, 2005, at 14:44:29
In reply to sex and ADs?!?! okay, honestly..., posted by iforgotmypassword on June 24, 2005, at 10:32:03
I'm sorry that you feel so bad. I can imagine that if you feel badly enough, sex is the last thing on your mind. But in other cases, such as mine, people are sometimes prescribed SSRIs when they don't really need them. IMO they are vastly overprescribed.
I wanted to just stick with valium when I had anxiety back in 2001. But, to cut a long story very short, my psychiatrist coerced me into taking celexa. I took the drug for two years until my sexual functioning totally collapsed in 2003. Now I have no libido to speak of with weak orgasms.
Sex had always been extremely important to me and I loved it. Now that part of my life is apparently gone for good. It's amazing to me that a so-called "antidepressant" can do this. It basically ripped out part of my personality and destroyed my life. I will go to the courts eventually. So, I can see things from your perspective, try to see them from mine.N
Posted by Nezirov on June 24, 2005, at 14:53:43
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 14:44:29
To follow on from my lst message. I feel pretty much as though the celexa caused a sexual lobotomy in my brain, a sort of chemical castration. It has been two years since I stopped taking it, and my sexual functioning has not returned at all. Considering that I used to have a very robust sexuality before I took it,and lead pretty much a normal life with occasional anxiety, I paid a *very* heavy price for having taken it. As I said before, it basically destroyed my life.
N
Posted by Emily Elizabeth on June 24, 2005, at 15:17:25
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 14:44:29
I'm sorry to hear what has happened to you. (And thanks for understanding the other side of it.) Docs should never coerce people into taking a med that they don't feel comfortable with. I hope that something can be figured out to make you feel like yourself again.
EE
> I'm sorry that you feel so bad. I can imagine that if you feel badly enough, sex is the last thing on your mind. But in other cases, such as mine, people are sometimes prescribed SSRIs when they don't really need them. IMO they are vastly overprescribed.
> I wanted to just stick with valium when I had anxiety back in 2001. But, to cut a long story very short, my psychiatrist coerced me into taking celexa. I took the drug for two years until my sexual functioning totally collapsed in 2003. Now I have no libido to speak of with weak orgasms.
> Sex had always been extremely important to me and I loved it. Now that part of my life is apparently gone for good. It's amazing to me that a so-called "antidepressant" can do this. It basically ripped out part of my personality and destroyed my life. I will go to the courts eventually. So, I can see things from your perspective, try to see them from mine.
>
> N
Posted by ed_uk on June 24, 2005, at 15:27:16
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 14:44:29
Hi Nezirov,
What treatments have you tried to increase your libido?
I have a very low libido these days. I've been on SSRIs since I'm 14, I'm 21 in a few days time. I used to think about sex all the time when I was 14! When I stop an SSRI, my libido comes back slowly but it's never very strong. I'm taking Celexa at the moment for obsessive-compulsive disorder.
~Ed
Posted by Nezirov on June 24, 2005, at 18:35:19
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Emily Elizabeth on June 24, 2005, at 15:17:25
Thanks for your sympathy, Elizabeth. Yeah, my pscyh. basically said that if I didn't take the SSRI he wouldn't continue with the psychotherapy. Pretty strange when you consider that I was improving on diazepam and talk therapy. I was under time constraints (new job), so didn't have the luxury of looking elsewhere to get better. I'm looking into a lawsuit.
Posted by Nezirov on June 24, 2005, at 18:41:52
In reply to Re: sex and ADs?!?! okay, honestly... » Nezirov, posted by ed_uk on June 24, 2005, at 15:27:16
Hi Ed,
It appears that the celexa may have dirupted my hypothalamus-pituitary-testicular axis and given me low testosterone. So I'm trying to get that fixed. But I think it may be more complicated than that. I'm also looking into the possibility that SSRIs cause long-term depletion of major neurotransmitters, such as serotonin, dopamine, and norepinephrine long-term in some people. I'm afraid that for some people, once you take an SSRI, you are never the smae again. Or at least it will take a *very* long time to get back to normal - if yu're lucky.
When you think about it, it's a miracle that some people seem to get almost no side effects from SSRIs. Most likely they are very fast metabolizers of the drug in the first place, or are hardly absorbing it and getting a placebo effect. Plus the chemical signature of a brain is probably far more unique to each individual than a fingerprint could ever be.
Basically you're taking the most complex thing in the known universe, the human brain, and artificially raising (or lowering, as some people believe) a major neurotransmitter for months or years at a time. You are inducing a chemical state in the brain that was never supposed to exist in nature, something totally unnatural. And then on top of that you have hormonal alterations like reduced testosterone. I wish I'd thought more deeply about this before I took celexa. I think the artificially induced chemical landscape is so foreign that for some people like me the brain can't find it's was back.
Posted by Phillipa on June 24, 2005, at 19:07:40
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 18:41:52
I remember when I first started dating my husband he was on paxil. It came back when he stopped. Myself gone forever. Fondly, Phillipa
Posted by Nezirov on June 24, 2005, at 19:09:47
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Phillipa on June 24, 2005, at 19:07:40
Really? You're sex drive never came back? When was the last time you took an SSRI?
N
Posted by Nezirov on June 24, 2005, at 19:18:44
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Phillipa on June 24, 2005, at 19:07:40
Hi again Philippa,
Didn't you say in an earlier post to linkadge that you believe once you're off SSRIs sexual functioning should return to normal? I guess you weren't refering to your own case? Not trying to put you on the spot, BTW.
Nezirov
Posted by ed_uk on June 24, 2005, at 19:50:52
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 18:41:52
Hi N,
>It appears that the celexa may have dirupted my hypothalamus-pituitary-testicular axis and given me low testosterone.
Have you had your testosterone level measured? If so, were you prescribed testosterone replacement therapy? Did it help?
>When you think about it, it's a miracle that some people seem to get almost no side effects from SSRIs.
I've taken various SSRIs.....
Celexa 60mg
Paxil 60mg
Prozac 20mg etc.They do reduce my anxiety and OCD which I why I continue to take them. My side effects......
Low libido, drowsiness, reduced motivation and profuse sweating.
So....what have you tried to increase your libido??
Wellbutrin?
Cabergoline?~Ed
Posted by Nezirov on June 24, 2005, at 20:11:42
In reply to Re: sex and ADs?!?! okay, honestly... » Nezirov, posted by ed_uk on June 24, 2005, at 19:50:52
I'm thinking about wellbutrin and cabergoline. More so cabergoline. Have you ever tried either of them? I'm wary of wellbutrin because my major complaint has always been anxiety, rather than depression, and I've heard that wellbutrin causes anxiety. Not sure it would be a good idea. I just wish I knew what the heck was going on. I'm furious that a so-called "antidepressant" could do this. Talk about having something to be depressed about...
I'm seeing a specialist in male TRT next month and hopefully we can restart my HPTA and get my T up to were it used to be. If T is the only thing causing my reduced libido, it must have been very high before, maybe around 1000 ng/dl. Right now its 375.
Posted by Nezirov on June 24, 2005, at 20:18:57
In reply to Re: sex and ADs?!?! okay, honestly... » Nezirov, posted by ed_uk on June 24, 2005, at 19:50:52
I'm also thinking about trying aurorix (moclobemide). I'd rather not try any more psch. drugs at this point. I think they do me *way* more harm than good. For a lot of people they are also very addictive. Once you've been on an SSRI for a while,, well, you know the rest.
Celexa was enough. But if this is the only way to get my sex drive back...I'll reluctantly try somenthing else.
Posted by Maximus on June 24, 2005, at 20:43:58
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 18:41:52
> It appears that the celexa may have dirupted my hypothalamus-pituitary-testicular axis and given me low testosterone.
You are absolutely right :-( *sigh* Long term SSRI's treatment lowers dramatically the testosterone level...
Posted by ed_uk on June 24, 2005, at 20:56:38
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 20:11:42
Hi N,
>More so cabergoline. Have you ever tried either of them?
No. Chairman_MAO currently takes cabergoline for sexual dysfunction associated with various medications: opioids and MAOIs. He has found it helpful. You might want to search from some of his posts.
>I've heard that wellbutrin causes anxiety.....
It often does...but not always.
~Ed
Posted by Chairman_MAO on June 25, 2005, at 12:41:47
In reply to Re: sex and ADs?!?! okay, honestly..., posted by Nezirov on June 24, 2005, at 14:44:29
You should get a doctor to prescribe you a DA agonist. The two most pro-sexual ones are Uprima (apomorphine, used as-needed) and cabergoline (as needed, but takes hours to work, or all the time). Others that have good track records are ropinirole, lisuride, bromocriptine, and probably pergolide and pramipexole (just dont remember). Oh yeah, and amantadine, but that makes some people feel downright strange and is not as strong as the rest of them.
Let me just stress something again: for such an anhedonic state, you need a dopaminergic drug. Parnate would probably also work, as might wellbutrin or a psychostimulant.
Posted by Chairman_MAO on June 25, 2005, at 12:57:48
In reply to Calling Chairman_MAO » Nezirov, posted by ed_uk on June 24, 2005, at 20:56:38
Actually, cabergoline is not working as well in that department as it once did. There is a possibility, however, that the reason for this is that I started taking Nardil with bioperine, a bioavailability enhancer (to see if it would work better). I forgot the bioperine a few times in a row, and notice that I'm starting to feel the serotonergic-agent-withdrawal "brain zaps" every once and a while, so it most likely did increase plasma levels of it. Thus, it's possible that the increase was drastic enough that I was effectively taking too much for my body weight.
Also, opioids have an endocrinological effect (GnRH release inhibition) that also is detrimental to sexual functioning; that cabergoline would not address. Last weekend I found that if I took a LOT of it (6-8mg, I forget which) I was able to orgasm after an absurd amount of stimulation. I was astounded at how low a side effect profile cabergoline has, as with many other DA agonists there'd be a high probability that I'd get really nauseous, my sinuses would stuff up, I'd get really tired, hypotensive, etc. Instead I felt NO side effects.
As of now I am looking to add another agent to supplement the cabergoline, possibly something androgenic; I need to consult with my doctor. Another option is apomorphine, either by injection or sublingual tablet. That is a D1 and D2 agonist and very pro-sexual.
I also should add that if I weren't on 90mg of Nardil AND an opioid, the cabergoline might still be working. I will also talk to my doctor about slowly reducing the dosage of the Nardil perhaps to 75mg/day and the bupe to 8mg/day instead of 16 with the hope of things getting a lot better. That choice is DEAD LAST, as everything else besides the libido is great!
Posted by SLS on June 25, 2005, at 14:51:53
In reply to Re: Calling Chairman_MAO » ed_uk, posted by Chairman_MAO on June 25, 2005, at 12:57:48
Hi CM.
First of all, good luck with your treatment plan.
> Actually, cabergoline is not working as well in that department as it once did. There is a possibility, however, that the reason for this is that I started taking Nardil with bioperine
How does bioperine work?
If I need to go back on Nardil, I will simply titrate up clinically and not set target dosages based on the old preparation. So what if I would need 90mg this time and only 75mg last time? At least this way, there would be consistency without need of bioavailability enhancing strategies.
DA agonists increase the release of GH. Perhaps that contributes to an increase in libido. Do you think DHEA would be of any help?
- Scott
Posted by ed_uk on June 25, 2005, at 20:31:26
In reply to Re: Calling Chairman_MAO » ed_uk, posted by Chairman_MAO on June 25, 2005, at 12:57:48
Hi CM,
>I was astounded at how low a side effect profile cabergoline has.......
Have you tried any other D2 agonists?
>possibly something androgenic.......
I think testosterone injections are quite cheap.
>Another option is apomorphine, either by injection or sublingual tablet. That is a D1 and D2 agonist and very pro-sexual.....
We've got Uprima in the UK. Is it approved in the US yet? I don't think it is.
Kind regards
~Ed
Posted by Declan on June 25, 2005, at 23:27:36
In reply to Re: Calling Chairman_MAO » Chairman_MAO, posted by ed_uk on June 25, 2005, at 20:31:26
Hi Ed
This is rather off topic, but since you mentioned Uprima.....What do you think of the use of apomorphine for opioid addiction? Was it Dr Dent in the UK? He treated William Burroughs....Can you see any rationale for it?
Declan
Posted by ed_uk on June 26, 2005, at 7:53:27
In reply to Re: Calling Chairman_MAO, posted by Declan on June 25, 2005, at 23:27:36
Hi Declan,
Well.....AFAIK, dopamine release is reduced during opioid withdrawal. Since apomorphine stimulates certain dopamine receptors, it might be expected to reduce craving and/or the severity of the withdrawal syndrome. What do you think?
~Ed
Posted by Chairman_MAO on June 26, 2005, at 9:59:06
In reply to Re: Calling Chairman_MAO » Chairman_MAO, posted by SLS on June 25, 2005, at 14:51:53
AFAIK, bioperine has several different mechanisms. One of them is to inhibit p-glycoprotein in cells in the intestinal walls, thereby allowing more drugs and nutrients to make it into systemic circulation instead of being allowed to efflux back into the small intestine.
For some things the bioavailability increase is drastic, up to around 2000% (for curcumin(sp?)).
You know, I never thought about DHEA or other GH releasers. I'll have to look into that. THe biggest problem is anorgasmia, however, as when I am actually with my g/f, my libido usually does return to an acceptable level. Like I said, the cabergoline IS doing SOMETHING, it just doesn't seem able to push me "over the edge". Apomorphine might work because it is a D1 agonist as well.
I don't have that much money, though, and will go broke simply trying to get normal! argh!
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