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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by d0pamine on August 3, 2007, at 19:41:02
I've switched from EMSAM to Parnate and having been on 60mg for 2 weeks now have zero depression and for the first time in my whole life am very outgoing and conversational to the extent that people around me are amazed. I enjoy this however there are two down sides that I just don't know if I can deal with or not. 1 I've become so sleepy that I've had to take time off work and can't do anything for any length of time without taking a nap, even after sleeping 12 hours / night. (typically I require about 4 hours / night and never get tired or sleepy)..That is my BIG problem, however secondarily I have also developed the complete inability to have an orgasm and I can assure you it's not simply delayed but utterly impossible as my very patient wife and I have spent many hours the past few nights trying EVERYTHING we could come up with and while it's all quite pleasant I simply never get off. Will these things go away and if so, when? I really don't want to quit parnate as I am really enjoying being conversational, but the sleep thing will ruin my life and I suspect the other part will get to me eventually as my libido is through the roof. Thanks for any suggestions.
Posted by Jedi on August 3, 2007, at 22:52:12
In reply to Parnate Love / Hate : sleep, orgasms - help please, posted by d0pamine on August 3, 2007, at 19:41:02
Hi,
When I was on Parnate, it took almost eight weeks for the daytime
somnolence to go away. If the med is helping the depression, I would find a way to tough it out. Maybe a couple of cups of coffee in the mid afternoon.Parnate is noted for lack of sexual side effects. Are you sure they didn't slip you some Nardil? Everyone is different, but I bet the ejaculation delay will go away soon.
When you find something that works for depression and social anxiety, stick with it. The side effects will go away or can be treated.
Good Luck,
Jedi> I've switched from EMSAM to Parnate and having been on 60mg for 2 weeks now have zero depression and for the first time in my whole life am very outgoing and conversational to the extent that people around me are amazed. I enjoy this however there are two down sides that I just don't know if I can deal with or not. 1 I've become so sleepy that I've had to take time off work and can't do anything for any length of time without taking a nap, even after sleeping 12 hours / night. (typically I require about 4 hours / night and never get tired or sleepy)..That is my BIG problem, however secondarily I have also developed the complete inability to have an orgasm and I can assure you it's not simply delayed but utterly impossible as my very patient wife and I have spent many hours the past few nights trying EVERYTHING we could come up with and while it's all quite pleasant I simply never get off. Will these things go away and if so, when? I really don't want to quit parnate as I am really enjoying being conversational, but the sleep thing will ruin my life and I suspect the other part will get to me eventually as my libido is through the roof. Thanks for any suggestions.
Posted by OzLand on August 3, 2007, at 23:25:50
In reply to Parnate Love / Hate : sleep, orgasms - help please, posted by d0pamine on August 3, 2007, at 19:41:02
Gosh I am surprised to hear you are on 60 mg. after just two weeks. When I started Parnate, I started at 20 mg. and up to 30 mg. after almost a week and then up to 40 mg. I had the same problem with being so tired in the middle of the day, I thought I was not going to be able to do my job. That eventually went away and after I devised a schedule that seemed to fit for me like dividing the does to part in the morning and part in the early evening.
RE orgasms; well I am a female, but it does seem harder. I would ask the pdoc about this. Out of curiosity, why were you put on so high a dose so fast? I am thinking the orgasm problem will get better as the sleepiness gets better too. I think it took me at least a month and maybe longer to get past the wish to take a nap in the middle of the day. It can take a month or longer for the body to get used to the medication.
OzLand
Posted by d0pamine on August 4, 2007, at 7:44:45
In reply to Re: Parnate Love / Hate : sleep, orgasms - help please » d0pamine, posted by Jedi on August 3, 2007, at 22:52:12
That is super encouraging, thanks. I can tough though about anything if I know it will end and end well.
Posted by d0pamine on August 4, 2007, at 7:52:30
In reply to Re: Parnate Love / Hate : sleep, orgasms - help please » d0pamine, posted by OzLand on August 3, 2007, at 23:25:50
> Gosh I am surprised to hear you are on 60 mg. after just two weeks. When I started Parnate, I started at 20 mg. and up to 30 mg. after almost a week and then up to 40 mg. I had the same problem with being so tired in the middle of the day, I thought I was not going to be able to do my job. That eventually went away and after I devised a schedule that seemed to fit for me like dividing the does to part in the morning and part in the early evening.
>I was started on 30mg, but the sleepiness was even worse, when the level was upped to 60 some of the sleepiness abated and I actually felt better, but it's still very difficult to tolerate but the difference is napping a couple times / day as opposed to sleeping all day long. I even tried 90mg, but at that dose the sleepiness got worse instead of better so the optimal starting dose for me seems to be around 60mg.
> RE orgasms; well I am a female, but it does seem harder. I would ask the pdoc about this. Out of curiosity, why were you put on so high a dose so fast? I am thinking the orgasm problem will get better as the sleepiness gets better too. I think it took me at least a month and maybe longer to get past the wish to take a nap in the middle of the day. It can take a month or longer for the body to get used to the medication.
>
> OzLand
The orgasm thing is just insane I've never experienced anything like this before. I mean my super trooper of a wife and I have tried EVERYTHING and nothing does it. I'm like a superhero now Anorgasmia Man or something.
Posted by steel on August 4, 2007, at 8:46:52
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » OzLand, posted by d0pamine on August 4, 2007, at 7:52:30
I dont know about the posting parnate is without sexual side effects.
Parnate is a double edged sword my friend,it as you prob know increases sex drive,keeps an erection so there is no problem there,HOWEVER the delayed ejaculation is very real,and a MAJOR MAJOR MAJOR MAJOR issue with me as well.
I pretty much tend to my lady friend which makes for a good parnter in there eyes,this is because i all but gave up on myself.
Whats worse is not being able to with a parnter is one thing,however not trying to be graphic but even alone is impossable,ive had nights where i drove myself half insane sweating like a dog trying to allieviate to go to sleep.
Its beyond annoying,and simply scary,it has to do i believe with prolactin,and while im grateful there is no erectile dysfunction issues,i like u really need to resolve this issue.
Sorry i have no remedy,just offering understanding and the fact that as much as i wish i could tell u different,being on it a few years now its only gotten worse,im sorry to be the bearer of bad news.
Posted by d0pamine on August 4, 2007, at 10:13:54
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by steel on August 4, 2007, at 8:46:52
> I dont know about the posting parnate is without sexual side effects.
>
> Parnate is a double edged sword my friend,it as you prob know increases sex drive,keeps an erection so there is no problem there,HOWEVER the delayed ejaculation is very real,and a MAJOR MAJOR MAJOR MAJOR issue with me as well.
>Thanks for your honest candid response that's good to know as I am still at a bit of a deciding point. I've read some things about possible chemical solutions to this and may give one of those a try, as this inability simply can't be healthy for a marriage relationship.
Posted by Oppycat on August 4, 2007, at 11:12:09
In reply to Parnate Love / Hate : sleep, orgasms - help please, posted by d0pamine on August 3, 2007, at 19:41:02
> I've switched from EMSAM to Parnate and having been on 60mg for 2 weeks now have zero depression and for the first time in my whole life am very outgoing and conversational to the extent that people around me are amazed. I enjoy this however there are two down sides that I just don't know if I can deal with or not. 1 I've become so sleepy that I've had to take time off work and can't do anything for any length of time without taking a nap, even after sleeping 12 hours / night. (typically I require about 4 hours / night and never get tired or sleepy)..That is my BIG problem, however secondarily I have also developed the complete inability to have an orgasm and I can assure you it's not simply delayed but utterly impossible as my very patient wife and I have spent many hours the past few nights trying EVERYTHING we could come up with and while it's all quite pleasant I simply never get off. Will these things go away and if so, when? I really don't want to quit parnate as I am really enjoying being conversational, but the sleep thing will ruin my life and I suspect the other part will get to me eventually as my libido is through the roof. Thanks for any suggestions.
Since I was on Parnate for most of 18 years, I can sympathize with your difficulty in reaching orgasm. That was the only reason that I tried other meds several times during that period. However, I always came back to Parnate.Fortunately, all is not bad. As another poster pointed out, you did move up to 60mg very rapidly. Your body will adjust to a degree. You will be able to achieve orgasm, at least some of time. Some of your orgasms won't be too great, either, but many of them will. Your stamina will be great, which you mentioned. A little viagra can also do wonders, not so much for orgasm as for performance. Some variety and imagination also helps.
One thing that I found that worked very well was to concentrate on pleasing my partner one night and having her work to please me the next. I also learned to enjoy sex without getting an orgasm. There's much to be said for prolonged lovemaking. I just wish that it hadn't taken me so long to learn all this.
As far as the sleep goes, I never had the problem with daytime somnolence. I found Parnate to be enervating, especially when I first started taking it. My problem was getting to sleep, but that was solved with Trazodone.
I hope you can solve the orgasm thing. If so, you will find that Parnate is a very effective drug. Best of all, you probably won't gain weight on it. Good luck.
Posted by d0pamine on August 4, 2007, at 19:32:10
In reply to Re: Parnate Love / Hate : sleep, orgasms - help please » d0pamine, posted by Oppycat on August 4, 2007, at 11:12:09
> You will be able to achieve orgasm, at least some of time. Some of your orgasms won't be too great, either, but many of them will. Your stamina will be great, which you mentioned.
Thank you for the encouraging post. I had all but decided to switch back to emsam this evening until I read your hopeful response. Given that it should be at least possible at some point I think I'll stick it out a little bit longer and see where things go.
Posted by Sigismund on August 4, 2007, at 21:36:19
In reply to Re: Parnate Love / Hate : sleep, orgasms - help please » d0pamine, posted by Oppycat on August 4, 2007, at 11:12:09
Maybe my standards are lowish, but I think sex without orgasm is quite OK.
You could just pretend you were being tantric.
Posted by yznhymer on August 5, 2007, at 2:19:42
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by Sigismund on August 4, 2007, at 21:36:19
I had the same response to MAOI Nardil many years ago. It turned me from a depressed introvert into a positively happy and gregarious individual almost overnight. I LOVED finally being connected with that aspect of myself. I've been searching for a similar AD response ever since.
I don't recall how it affected sleep/alertness, etc. But I did gain 20 lbs the first month and orgasms went out the window within a few days. Over time, I eeked out one or two miserable approximations but things seemed to be getting worse rather than better. My pdoc said based on his experience he wouldn't expect it to improve. Still, that's not true for everyone, I understand. Anyway, I had similar reactions to SSRI's and Tricyclates and other AD's. I actually had retrograde ejaculations on one AD - very unpleasant.
Fortunately, things always resolved when I stopped the culprit meds, until I took a 3 month course of phentermine at the beginning of this year. While things have improved, reaching that point where things click in my head and the orgasm ensues remains a difficult point to reach. Its frustrating and the fact that things haven't snapped back to normal is a little unnerving.
Ultimately, the anorgasmia issue with Nardil was the deal breaker for me. I would have been willing to work with the weight gain, food restrictions, and even the one hypertensive crisis I experienced. Under the combined circumstances, I couldn't see Nardil as a long-term therapy for me.
I haven't had a good antidepressant response since, though EMSAM seems to be doing some good things for me. I've been optimistic because its an MAOI and I have atypical depression features. I'm at about 6 weeks, still on 6mgs. It remains to be seen whether I'll go up, but I think my pdoc can be persuaded to let me try a higher dose. I'm still hoping for that Nardil response without the side effects. Honestly, I'm amazed EMSAM hasn't put the "equipment" out of commission.
I guess you'll know soon enough whether the anorgasmia will pass. At least you have a good experience with EMSAM to fall back on. The EMSAM side effects - was it afternoon drowsiness? - might be easier to alleviate than anorgasmia.
By the way, I responded to one of your other posts wondering what you were doing post-EMSAM before I read this post of yours.
Y
Posted by d0pamine on August 5, 2007, at 19:43:09
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by yznhymer on August 5, 2007, at 2:19:42
Yeah you may have a point about the EMSAM's evening fatigue being easier to get rid of, but since that wasn't the way emsam had been working for me for the past year, it looked to me like maybe I was on what had become a sinking ship and being a programmer that's currently working 12 hours days trying to catch up, this is a very bad time to have my ship sink so I was hoping to jump ship before the real issues began to show.
Posted by Quintal on August 5, 2007, at 23:14:31
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » yznhymer, posted by d0pamine on August 5, 2007, at 19:43:09
The anorgasmia might be due to the serotonergic effects of Parnate. SSRIs do the same thing. It's not usually a problem with Parnate, but I suspect the high dose and rapid titration has something to do with that. There's an antihistamine called cyproheptadine that blocks 5-HT2A receptors which can temporarily reverse serotonin-induced anorgasmia. You take it an hour or so before sexual activity a bit like Viagra etc. Being an antihistamine it also makes you sleepy, so probably best to time sex when you're already ready for bed. I suppose it might also be an effective sleep aid.
Q
Posted by Quintal on August 6, 2007, at 6:05:48
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by steel on August 4, 2007, at 8:46:52
You might find extra glans stimulation will help you achieve orgasm more easily. I've used a fleshlight for this purpose with success. I take the 'flesh' part out of the plastic casing and sandwich it between two pillows then hump it. The stamina training unit might also come in useful. Also, I use a lube called 'ID Pleasure Sensual Lubricant' which contains L-arginine, menthol, ginkgo biloba and red clover extracts to heighten sensation and arousal - very effective.
http://www.fleshlight.com/main/index.php?It's strange because I don't remember having any sexual problems on Parnate despite reaching the 120mg mark in the first month. Maybe it has something to do with the different formulation between brands like it is with Nardil? I was using the Goldshield brand while I think most people in the US get the GSK brand.
Q
Posted by steel on August 6, 2007, at 9:32:02
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » steel, posted by Quintal on August 6, 2007, at 6:05:48
Thanks,ill check out the link info.Your right we get gsk,which i believe isnt what it was,OR we have a choice of the U.S based generic.
I also have used Link and it is a milder smoother parnate,i found personaly both gsk/link were best used at different intervals depending on desired effect.
But link is in my opinion definalty different,also on all parnate,working or not,ive had the ejac/delay issue,ive also added ghb which also effect PROLACTIN which i was told were the culprit in both cases.
Appearently prolactin,inhibited or not,not sure exactly,is a factor in the mix.
Posted by Quintal on August 6, 2007, at 10:16:00
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by steel on August 6, 2007, at 9:32:02
I've heard of prolactin being implicated in SSRI-induced sexual dysfunction too. I thought it took a few weeks or months for prolactin to build up to levels that caused sexual dysfunction though, whereas serotonin-induced sexual dysfunction is more or less immediate. Have you tried adding a dopamine agonist? They are used to lower prolactin levels and also to treat drug-induced sexual dysfunction. It would be interesting to see if anyone responded to cyproheptadine, I keep suggesting it but nobody ever seem to try it for some reason.
If you're considering a Fleshlight I'd recommend either the 'Lady' or the 'Mouth' models with the speed bump insert. The super ribbed and wonder wave are very intense, eye-wateringly so. Speed bump has a more natural, massaging feel. I'd steer away from the 'Butt' model too (unless that's what floats your boat) as it takes great force to penetrate and tends to nip the shaft.
Q
Posted by d0pamine on August 6, 2007, at 10:16:34
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » steel, posted by Quintal on August 6, 2007, at 6:05:48
You guys are great! I really appreciate all of the suggestions and ideas and will certainly be giving them a try.
Posted by cactus on August 7, 2007, at 3:14:03
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by d0pamine on August 6, 2007, at 10:16:34
Look this happens to me on SSRI/SNRI's and TCA's. I just started Zoloft and thought here we go, no more orgasms for me, not true. I'm on ropinirole(requip/repreve) for restless leg syndrome. There have been studies done on AD's and sexual dysfunction with adding a dopamine agonist such as ropinirole. And it work's really well. I don't know if you can take it on Parnate though, you'll have to check on a drug interaction checker. I got a big thankyou from this thread, so look into it because it works for SSRI's. Link credit- http://www.dr-bob.org/babble/20070730/msgs/772986.html Good luck I hope you have a happy ending!!!!
Posted by d0pamine on August 7, 2007, at 4:08:30
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » d0pamine, posted by cactus on August 7, 2007, at 3:14:03
Thanks. I asked my dr about dopamine agonists just yesterday to see if he would work with me on that and it was a no go. He really wasn't even comfortable leaving me on an MAOI as he wants to push the newer stuff to me. But I'll keep on trying. Thanks for the tip.
Posted by Quintal on August 7, 2007, at 4:25:08
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » cactus, posted by d0pamine on August 7, 2007, at 4:08:30
It's safe to take dopamine agonists with MAOIs (some people with Parkinson's Disease need to take them with selegiline anyway), so I'm guessing this was the pdoc's own prejudice against combining things with MAOIs in general. I suppose cyproheptadine was a no-no as well?
Q
Posted by d0pamine on August 7, 2007, at 19:36:01
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » d0pamine, posted by Quintal on August 7, 2007, at 4:25:08
> It's safe to take dopamine agonists with MAOIs (some people with Parkinson's Disease need to take them with selegiline anyway), so I'm guessing this was the pdoc's own prejudice against combining things with MAOIs in general. I suppose cyproheptadine was a no-no as well?
>
> Q
I didn't even try for cyproheptadine because I'm pretty sure this is a prolactin and not a serotonin issue since my libido hasn't decreased ANY.
Posted by Quintal on August 7, 2007, at 21:02:17
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by d0pamine on August 7, 2007, at 19:36:01
Well that would be more consistent with serotonin-induced anorgasmia. Prolactin suppresses sex drive and causes loss of libido and impotence, whereas with excess serotonin men still often have libido and can get an erection, but suffer ejaculatory delay or anorgasmia. That's why SSRIs like paroxetine are prescribed off-label for premature ejaculation and drugs that raise prolactin are not. The fact that Parnate is a powerful dopamine elevator might be one reason why your sex drive is still so high.
http://en.wikipedia.org/wiki/Prolactin#EffectsQ
Posted by cactus on August 8, 2007, at 2:46:47
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by d0pamine on August 7, 2007, at 19:36:01
> > It's safe to take dopamine agonists with MAOIs (some people with Parkinson's Disease need to take them with selegiline anyway), so I'm guessing this was the pdoc's own prejudice against combining things with MAOIs in general. I suppose cyproheptadine was a no-no as well?
> >
> > Q
> I didn't even try for cyproheptadine because I'm pretty sure this is a prolactin and not a serotonin issue since my libido hasn't decreased ANY.
>
Well it sounds like he is being an *ss, if you can take it and it doesn't interact then maybe you need to find a more sympathetic doctor. Maybe he suffers from premature ejaculation and is jealous. Big sorry to all the guys out there that do!!!!!!!! But people don't understand how frustrating it is when you can't get there, it just drives you crazy. Can you print out some info about it to show him????????
Posted by d0pamine on August 8, 2007, at 4:17:57
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl » d0pamine, posted by cactus on August 8, 2007, at 2:46:47
Well I've already pushed him into what is really a very uncmofortable area for him just with first being his only patient on EMSAM and now his only patient on Parnate. He didn't argue that it might be a good solution but said that he simply wasn't comfortable enough with it to prescribe it and offered to suggest the name of another doctor. I certainly can't fault a doctor for actually being cautious with stuff when I've had others that I could have swore were trying to kill me. In the end I'll likely just end up giving parnate an 8 week trial and when I still can't orgasm, just switching back to my beloved EMSAM. I'm really not comfortable with taking a dopamine agonist just for that one purpose anyway when it seems they can have nasty long term heart valve effects and such. I guess my hope is that somehow in another 5 weeks I'll be able to orgasm...Is that realistic? If it isn't then I'll just save myself the torture and switch back now.
Posted by Quintal on August 8, 2007, at 4:36:49
In reply to Re: Parnate Love / Hate : sleep, orgasms - help pl, posted by d0pamine on August 8, 2007, at 4:17:57
You could still try for cyproheptadine. Mirapex (pramipexole) isn't associated with heart valve defects as far as I know, nor is Requip (ropinirole). It's the ergot-derived dopamine agonists bromocriptine, cabergoline, lisuride, and pergolide that are the problem.
Q
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