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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Trevpr on October 7, 2012, at 16:26:17
So ever since the depression I've had basically no sex drive, but before the depression it really felt amazing. I mean, it was something I was driven towards, like I had a healthy interest in the opposite sex.
Its been over 11 months now and I'm not seeing any improvements, is it likely to never be the same again? I've refused taking serotonergic drugs since the beginning, and whether I'm on meds or off them doesnt seem to matter, both ways it is just dead.
I've tried maxing out NRIs such as wellbutrin without any success. I've also tried abilify. I tried stimulants, but they werent sustainable, wore off quickly, gained a tolerance, etc.I cant imagine it just coming back all the sudden. Its not happening gradually...so does that mean it isnt coming back?
What is everyone elses experience with this?
Posted by ChicagoKat on October 7, 2012, at 16:38:19
In reply to Sexual Problems - Permanent or Not?, posted by Trevpr on October 7, 2012, at 16:26:17
> So ever since the depression I've had basically no sex drive, but before the depression it really felt amazing. I mean, it was something I was driven towards, like I had a healthy interest in the opposite sex.
> Its been over 11 months now and I'm not seeing any improvements, is it likely to never be the same again? I've refused taking serotonergic drugs since the beginning, and whether I'm on meds or off them doesnt seem to matter, both ways it is just dead.
> I've tried maxing out NRIs such as wellbutrin without any success. I've also tried abilify. I tried stimulants, but they werent sustainable, wore off quickly, gained a tolerance, etc.
>
> I cant imagine it just coming back all the sudden. Its not happening gradually...so does that mean it isnt coming back?
>
> What is everyone elses experience with this?Damn! I was gonna recommend wellbutrin, but looks like you've already tried it. Did you stay on it long enough, ie a couple of months, to be sure it didn't help? And did it help your depression?
It does sound like this is just another awful side effect of the big D, which sucks. The only thought I can offer is that if you can get your depression improved - without SSRIs and related drugs, obvviously - this awful side effect will clear up. Do you see a therapist? I mean a really, really, really good one?
Oh, and how old are you? Have you had your testosterone levels checked? Low levels of testosterone can contribute to depression and a lower sex drive.
Sorry I can't offer more suggestions in the way of meds, but I'm sure some of the resident experts will chime in and they may well have an answer for you. I wish you the best of luck
Kat
Posted by Trevpr on October 7, 2012, at 17:48:04
In reply to Re: Sexual Problems - Permanent or Not? » Trevpr, posted by ChicagoKat on October 7, 2012, at 16:38:19
Thanks for the post! Yeah this has really been the most confusing symptom of mine. My Testosterone is fine, I'm healthy, young, and everything appears to be okay. I tried Wellbutrin at the max dose, 450mg, for a whole 2 months. It seemed to help lift symptoms such as anxiety, focusing issues, etc., but did not touch my anhedonia or sex drive. I also tried Adderall, Mirapex, Desipramine, Abilify, and now Vivactil without any positive effect. I've also tried the gambit of supplements such as DLPA, L-tyrosine, L-Theanine, Rhodiola Rosea, SAM-E, etc.
Ritalin helped a very small amount, but for reasons discussed before, it was not a sustainable solution and quickly formed a tolerance.
I'm just at a loss here because I've lost all interest in everyone and I'm still single! I kind of wanted to date and marry, but now it seems that I won't be able to.
The low libido problems have been literally constant and I haven't gotten a break from them since the beginning of the depression. So far no libido and anhedonia/apathy/lack of emotional responsivity have been my only symptoms.
From my research, I've compiled a list of meds that seem to be best at helping to alleviate these issues:
THE MEDICATION ROUTE
NOTES ON MEDICATION STRATEGIES
Now, there is a sort of catch-22 situation with anhedonia because serotonergics can blunt hedonic response, but the administration of dopaminergic agents also can worsen the problem. Downregulation, desensitization, or tolerance may develop. In addition, many dopaminergic/norepinepheric agents have many side effects such as elevated blood pressure or heart rate (such as Ritalin) and may produce chemical dependency or addiction. Many available drugs that modulate hedonic response are not available in the United States. Not all drugs work the same way for different people. Many people find relief from more activating SSRIs such as Prozac or Zoloft, others may find relief with SNRIs like Pristiq or Effexor, while still others may find relief from stimulants. There is no universal cure, because each brain has different metabolism and chemistry.STIMLANTS
Stimulants are drugs that force the release of catecholamines (neurotransmitters like dopamine and norepinepherine). Stimulants usually work very quickly, usually within an hour, but their effects do not usually last very long. Extended release versions of stimulants exist, but the amplitude of the response is spread over a longer time duration, thus making it lower. Stimulants like Ritalin usually take around 20 minutes to start working, but only last from an hour and thirty minutes to three hours. Adderall is stronger and can last longer, so dosages are correspondingly lower. The main disadvantages to using stimulants is the building of tolerance, a crash after the effect wears off, insomnia, high heart rate, stress on the cardiovascular system, high blood pressure, psychosis at high doses, and short duration of response. Stimulants may also be addicting.Ritalin (Methylphenidate), Dextroamphetamine, Adderall (mixed amphetamine salts), Focalin (Dextromethylphenidate), Modafinil, Mazindol
DOPAMINE AGONISTS
Dopamine agonists are dopamine substitutes which bind to specific dopamine receptors like dopamine. Dopamine agonists are typically prescribed for Parkinsons Disease or Restless Leg Syndrome patients, but many studies have shown efficacy in treating depression. Dopamine agonists have the potential to cause compulsive habits or addictions or make a person tired. Dopamine agonists may lower prolactin levels, cause hypersexuality, compulsive gambling, or even psychosis. These drugs are typically thought of as nonaddicting, but a withdrawal syndrome may occur.Mirapex (Pramipexole), Requip (Ropinirole), Dostinex (Cabergoline), (Apomorphine), (Bromocriptine), (Rotigotine), (Amantadine)
ANTIPSYCHOTICS
Antipsychotics antagonize certain dopamine receptors and may bind to others or leave extra free dopamine somewhere else. This may be useful for depression, but some dopamine agonists increase prolactin or can cause Tardive Dyskenesia, restlessness, or agitation.Abilify (Aripiprazole), Amisulpride, Sulpride, Zyprexa
SEROTONIN RECEPTOR ANTAGONISTS
Serotonin receptor antagonists may disinhibit dopamine which is normally inhibited by certain serotonin receptors. These medicines may even be used in some cases to ward of SSRI induced sexual dysfunction.Buspar (Busiprone), Low dose Prozac (Fluoexitine), Remeron, Periactin (Cyproheptadine)
DOPAMINE REUPTAKE INHIBITORS
DA reuptake inhibitors do just what their name suggests, though they may be addicting in some cases.(Amineptine), To a small extent Wellbutrin (Bupropion)
NOREPINIPHERINE REUPTAKE INHIBITORS
Norepinepherine reuptake inhibitors inhibit norepinepherine which may increase alertness or feelings of stimulation or wakefulness. These drugs may have an indirect effect on dopamine. These drugs may cause tachycardia or blood pressure problems.(Desipramine), (Atomoxetine), Vivactil (Nortryptaline), Wellbutrin (Bupropion)
MAOIs
MAOIs inhibit monoamine oxidase, which normally breaks down neurotransmitters. The inhibition of MAO means that more neurotransmitters will be left floating around, improving mood. MAO-B inhibitors work primarily to increase dopamine, while MAO-A inhibitors work to increase all monoamine neurotransmitters. These medications typically work quickly; within a day to a week or two. MAOIs are not typically considered a first line of treatment due to a large number of side effects including dangerous side effects. There are also food restrictions with these medications.Parnate, Nardil, Selegiline, Marplan
MOOD STABILIZERS
Mood stabilizers help keep mood at a normal level, and thus help with depression in many cases.
Lithium, LamactilSUPPLEMENTS
Supplements may include monoamine precursors or other items which improve neurotransmission.L-Tyrosine, L-Theanine, L-Glutamine, Saint Johns Wort, Phenylethylamine, Levodopa, SAM-E, Saffron, Fish Oil, Magnesium, Zinc, Calcium, Vitamin B Complex, Multivitamins, Vitamin D
SELECTIVE SEROTONIN-NOREPINEPHERINE REUPTAKE INHIBITORS
Effexor, Cymbalta, Strattera, Savella, AnafranilOTHER
Testosterone, Exercise, ETC, rTMs
Posted by Trevpr on October 7, 2012, at 17:50:16
In reply to Re: Sexual Problems - Permanent or Not?, posted by Trevpr on October 7, 2012, at 17:48:04
Any thoughts? What meds seem to work? Did you recover from your sexual problems after a really long depression? I feel so stuck >.<
Posted by jono_in_adelaide on October 7, 2012, at 18:16:48
In reply to Re: Sexual Problems - Permanent or Not?, posted by Trevpr on October 7, 2012, at 17:50:16
Have you tried Ropinirole - I've heard anacdotal evidence that this can help, either taken regularly, or as a signle dose when you think somthings likely to happen.
My gut feel given everything you've tried would be Parnate + Welbutrin, with a PRN dose of Ropinirole if it seemed likely that you were gonna get some.
Posted by schleprock on October 7, 2012, at 18:45:48
In reply to Re: Sexual Problems - Permanent or Not?, posted by jono_in_adelaide on October 7, 2012, at 18:16:48
Would Ropinirole be effective as an adjunctive to a tricyclic? What are its side effects?
Posted by phillipa on October 7, 2012, at 19:15:20
In reply to Re: Sexual Problems - Permanent or Not? » jono_in_adelaide, posted by schleprock on October 7, 2012, at 18:45:48
Even when young I never had a really high sex drive. So it meant less to me. As a female I prefer cuddling and snuggling. Now don't get me wrong I desired and had lots of sex when younger but meds didn't change this was menopause and anxiety/depression. Phillipa
Posted by jono_in_adelaide on October 7, 2012, at 19:54:06
In reply to Re: Sexual Problems - Permanent or Not? » jono_in_adelaide, posted by schleprock on October 7, 2012, at 18:45:48
From Wiki:
Medical usesRopinirole is prescribed for mainly Parkinson's disease, restless leg syndrome, and extrapyramidal symptoms. It can also reduce the side effects caused by selective serotonin reuptake inhibitors, including Parkinsonism syndrome as well as sexual dysfunction and erectile dysfunction caused by either SSRIs or antipsychotics.[edit] DosageRopinirole in the Requip form is available in various preparations, ranging from a 0.25 mg tablet to a 5 mg tablet. The primary reason is dose titration. This implies that the person taking Requip has to closely interact and communicate with the primary care physician with regard to how much should actually be taken by the patient.
For restless leg syndrome (RLS), the maximum recommended dose is 4 mg per day, taken 1 to 3 hours before bedtime. A 52-week open label study had a mean dosage of 1.90 mg, once daily 1 to 3 hours before bedtime.[4]
For Parkinson's disease (PD), the maximum recommended dose is 24 mg per day, taken in three separate doses spread throughout the day. The maximum dose recommendations of ropinirole for subjects with End Stage Renal Disease (ESRD) should be reduced by 25% compared with those recommended for subjects with normal renal function. A 25% dose reduction represents a more straightforward dosage regimen in terms of available tablet strength, compared with a 30% dose reduction.[5]
[edit] PharmacologyRopinirole acts as a D2, D3, and D4 dopamine receptor agonist with highest affinity for D2. It is weakly active at the 5-HT2, and α2 receptors and is said to have virtually no affinity for the 5-HT1, benzodiazepine, GABA, muscarinic, α1, and β-adrenoreceptors.[6]
Ropinirole is metabolized primarily by cytochrome P450 CYP1A2 to form two metabolites; SK&F-104557 and SK&F-89124, both of which are renally excreted[5], and at doses higher than clinical, is also metabolized by CYP3A4. At doses greater than 24 mg, CYP2D6 may be inhibited, although this has only been tested in vitro.[1]
[edit] Side effectsRopinirole can cause nausea, dizziness, hallucinations, orthostatic hypotension, and sudden sleep attacks during the daytime. Common and more unusual side effects specific to D3-preferring agonists such as ropinirole and pramipexole can include hypersexuality and compulsive gambling, even in patients without a prior history of these behaviours.[7]
Posted by Trevpr on October 7, 2012, at 20:56:28
In reply to Sexual Problems - Permanent or Not?, posted by Trevpr on October 7, 2012, at 16:26:17
Unfortunately along with the loss of my libido is the loss of all romantic desire, including nonsexual bonding such as snuggling, etc.
I looked into ropinirole and considering my failed pramipexole trial, I dont think it will do much. The binding profiles of requip and mirapex are similar, so if I didnt feel ANY difference in libido on pramipexole, chances are I wont on ropinirole.
I am beginning to think that parnate is my best shot, perhaps with wellbutrin (or maybe just parnate since I felt no difference on wellbutrin alone). Unfortunately I think my doc is gonna want to extend my vivactil trial, then I have to wait for a washout.
Has anyone gotten their libido back after a long period without one? If so, has it been the same or is there residual problems?
Thanks for the suggestions!
Posted by jono_in_adelaide on October 7, 2012, at 21:31:19
In reply to Re: Sexual Problems - Permanent or Not?, posted by Trevpr on October 7, 2012, at 20:56:28
I have gotten mine back, after almost a year with no desire for sex - Sometimes I'd for weeks without even masturbating.
Then, for some reason, I woke up one morning feeling better.....over 3 days the anxiety and depression lessend, and my interest in things (including sex) started to come back
No idea why - nothing had changed, my meds were the same, my living arrangements were the same, my job was the same, mylife circumstannces were the same etc, it just happend. Having said that, I'm not at the point where I was before i had my breakdown by a long shot, but atleast I can feel attraction, enjoy intimate contact, feel sexualy aroused and perform in the sack, and enjoy it.
I'd definatly try Parnate by it self, and if that doesnt get you there, Parnate + Welbutrin.
Dont write any drug off in combination just because it didnt get you where you needed to be singulaly, there is such a thing as a threshold effect, - think of it like Excedrin, it consists of 250mg acetaminophen, 250mg aspirin, and 65mg of caffeine, which when considered singularly are weak analgesics, but when all three are taken together, they form probably the best headache pill out there.
The same might well be true of (say ) regular Parnate and Welbutrin with PRN pramipexole..... or some other such combination
It might also be that you're putting your self under a lot of pressure over this, which might be contributing to some sort of vicious circle - I think I might have been in that cycle, continualy beating my self up for not being "normal" which of course made it even less likely that I would get back to normal.
Posted by Lou Pilder on October 7, 2012, at 21:41:22
In reply to Re: Sexual Problems - Permanent or Not?, posted by Trevpr on October 7, 2012, at 20:56:28
> Unfortunately along with the loss of my libido is the loss of all romantic desire, including nonsexual bonding such as snuggling, etc.
>
> I looked into ropinirole and considering my failed pramipexole trial, I dont think it will do much. The binding profiles of requip and mirapex are similar, so if I didnt feel ANY difference in libido on pramipexole, chances are I wont on ropinirole.
>
> I am beginning to think that parnate is my best shot, perhaps with wellbutrin (or maybe just parnate since I felt no difference on wellbutrin alone). Unfortunately I think my doc is gonna want to extend my vivactil trial, then I have to wait for a washout.
>
> Has anyone gotten their libido back after a long period without one? If so, has it been the same or is there residual problems?
>
> Thanks for the suggestions!
>Trevpr,
I have never known of a person that was healed of sexual loss by taking psychotropic drugs. I have known many that after taking psychotropic drugs, the sexual part of their humanuty was taken away.
So you have come here for finding from others how to get your humanity back and they could tell you to take more drugs here. You see, psychotropic drugs have chemicals in them that effect the nervous system and brain functions. Some of these chemicals are in agents used for mass-murder. Some are in insecticides, worm killers and rat poison, explosives and jet fuel and such. Is this a way to be healed, by taking psychotropic drugs?
You see, the componants in your brain are effected from these chemicals. I know of a way for you t regain your humanity and have healing to those componants in your brain that are damaged from the drugs. But be advised, there are prohibitions posted to me here by Mr Hsiung that prohibit me from posting what I would need to so that you could be healed. Keep on druggin'? Would those drugs not cause other effects from those chemicals that could induce a life-ruining condition or addiction or death?
You have a chance now. You have a head-start. Take this opportunity to learn what these drugs do to you. Take this opportunity to go to the administrative board here and read the posts from me to Mr Hsiung that have outstanding requests that go back years. Ask yourself why these requests remain outstanding. If they were replied to, could lives be saved? Would people have sexual dysfunction? Could people be healed? Would the posts that have statements that could arouse antisemitic feelings that are allowed to stand have the threat to Jews put out if those posts were replied to?
If you read those posts and post from your perspective there, I could post my reply to you there. You see, when one perspective is outlawed, an indoctrination can occur. And what I could tell you would come from a Jewish perspective and there is healing from that perspective. Healing that comes from the rays of a sun. Healing that is by divine accomplishment, by the Sun of rightiousness, the Light of Life, th Prince of Salem. I tell you today, you could be in paradise
Lou
Posted by jono_in_adelaide on October 7, 2012, at 21:49:29
In reply to Lou's response-nowlizdhatym » Trevpr, posted by Lou Pilder on October 7, 2012, at 21:41:22
Lou is right Trev - the answer to your problems is the Church of Scientology
Posted by jono_in_adelaide on October 7, 2012, at 21:51:25
In reply to Re: Lou's response-nowlizdhatym, posted by jono_in_adelaide on October 7, 2012, at 21:49:29
And despite what Lou says, few here would suggest that drugs are the entire solution, counseling/psychotherapy of various types has a big role to play in many psychological disorders
Posted by schleprock on October 7, 2012, at 22:24:49
In reply to Lou's response-nowlizdhatym » Trevpr, posted by Lou Pilder on October 7, 2012, at 21:41:22
>
> Trevpr,
> I have never known of a person that was healed of sexual loss by taking psychotropic drugs. I have known many that after taking psychotropic drugs, the sexual part of their humanuty was taken away.
> So you have come here for finding from others how to get your humanity back and they could tell you to take more drugs here. You see, psychotropic drugs have chemicals in them that effect the nervous system and brain functions. Some of these chemicals are in agents used for mass-murder. Some are in insecticides, worm killers and rat poison, explosives and jet fuel and such. Is this a way to be healed, by taking psychotropic drugs?
> You see, the componants in your brain are effected from these chemicals. I know of a way for you t regain your humanity and have healing to those componants in your brain that are damaged from the drugs. But be advised, there are prohibitions posted to me here by Mr Hsiung that prohibit me from posting what I would need to so that you could be healed. Keep on druggin'? Would those drugs not cause other effects from those chemicals that could induce a life-ruining condition or addiction or death?
> You have a chance now. You have a head-start. Take this opportunity to learn what these drugs do to you. Take this opportunity to go to the administrative board here and read the posts from me to Mr Hsiung that have outstanding requests that go back years. Ask yourself why these requests remain outstanding. If they were replied to, could lives be saved? Would people have sexual dysfunction? Could people be healed? Would the posts that have statements that could arouse antisemitic feelings that are allowed to stand have the threat to Jews put out if those posts were replied to?
> If you read those posts and post from your perspective there, I could post my reply to you there. You see, when one perspective is outlawed, an indoctrination can occur. And what I could tell you would come from a Jewish perspective and there is healing from that perspective. Healing that comes from the rays of a sun. Healing that is by divine accomplishment, by the Sun of rightiousness, the Light of Life, th Prince of Salem. I tell you today, you could be in paradise
> LouLou, honestly, when was the last time you've heard from this "Mr Hsiung"? Months? Years? Decades??? I would appreciate a link to the last correspondance that you, or anyone else had with this "Mr Hsiung".
Has it ever crossed your mind that this "Mr Hsiung" Might have abandoned this network? Or died? Or even never existed at all? I say you just forget about this illusive "Mr Hsiung" and just post away. Be a man already Lou (or is it "Mary-lou"?) Let's find out the truth all about this "Herr Hsiung"!
Posted by Trevpr on October 8, 2012, at 0:02:10
In reply to Lou's response-nowlizdhatym » Trevpr, posted by Lou Pilder on October 7, 2012, at 21:41:22
Well I guess if psychotropic meds aren't going to help, I'm basically SOL since I've been in therapy and tried everything I could think of...The reason I'm approaching the problem this way is I'm grasping for straws and these meds appear to be my "last straw."
Ill try parnate next, if that doesnt help, well, I guess I'll have to learn to live like Spock. >__<
Posted by jono_in_adelaide on October 8, 2012, at 0:42:56
In reply to Re: Lou's response-nowlizdhatym, posted by Trevpr on October 8, 2012, at 0:02:10
trev - if Parnate doesnt do it, I'd encourage you to try Parnate + Welbutrin, Parnate + Desipramine, Parnate + etc etc.
Also, you said that you've felt some benifit from psychostimulants - could you keep those on hand and take a dose only when it looks like you're going to get some action, as a sort of psychological Viagra...... take parnate or whatever each day, and take a dose of ritalin or adderal when you were going on a date for example - that should deal with the tolorance issue
Posted by Raisinb on October 12, 2012, at 5:28:13
In reply to Sexual Problems - Permanent or Not?, posted by Trevpr on October 7, 2012, at 16:26:17
I'm late to this thread and haven't read all posts, but it sounds to me like your lack of sex drive is an effect of your illness, not a med side effect. So if you treat the depression and anhedonia, your sex drive will probably come back with it. The question is what med regime to try next since you've been on a lot of things already. If you've exhausted the SSRIs and Wellbutrin, there are a couple of ways to go next: Mood stabilizers that help with depression (Lamictal, primarily, and maybe Lithium or Abilify), MAOIs (help lots of people but you have to be careful with your diet) and/or stimulants like Adderall, Ritalin, Concerta, or Provigil.
Talk with your pdoc about what path is most suited for you. Apologies if I suggested anything you've already tried; I'm up at 5 am and my brain is a little fuzzy.
This is the end of the thread.
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