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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 Sheilac on December 18, 2016, at 16:24:48
I'm on 150 SR Wellbutrin and my desire for sex is gone. No interest whatsoever. Totally dead. Just numb. Plus, I've become irritable and bitchy I've noticed.
I was taking 100 SR Wellbutrin and low dose Seroquel before.
I'm thinking I need to drop my dose of Wellbutrin (I'm very sensitive to meds. Could only take 5mg of Adderall).
I'd like to get my sex drive back, get rid of this increased anxiety/irritability and still get the antidepressant feel I need.
I thought Wellbutrin was supposed to boost your sex drive. A tiny dose of Adderall always did. Maybe I'm on too much Wellbutrin.
Posted by SLS on December 19, 2016, at 8:25:03
In reply to Wellbutrin killed libido!, posted by Sheilac on December 18, 2016, at 16:24:48
I know this is going to sound mean, but I say it out of concern for your future:
You can't have everything.
That doesn't mean that you can't try, but I think you should accept that, for now, it will be necessary to make compromises. You have some hard decisions to make.
How badly do you want to feel well?
What are you unwilling to trade for your mental health?
For me, making the choice between losing my libido or continuing a life of pain and dysfunction was an easy one to make. So, I take 6 medications that produce side effects, one of which is a loss of libido. As important as having a libido is... Well, you get the idea.
One last comment: It may be that your libido will return once the brain accommodates to the new medication. Perhaps you should wait awhile before making any decisions.
Easier said than done.
:-(
I would remain aggressive with medication and dosages if I were in your situation. Don't lower the dosage of anything until you have an honest discussion about this with your doctor.
- Scott
Posted by baseball55 on December 19, 2016, at 19:11:08
In reply to Wellbutrin killed libido!, posted by Sheilac on December 18, 2016, at 16:24:48
you But didn't you just start wellbutrin very recently? It could be a start-up effect or it could be that your depression and anxiety are affecting libido. Give it a chance. I don't want to be critical, but you often freak about side-effects within days of starting something, then stop and don't give new meds a chance.
> I'm on 150 SR Wellbutrin and my desire for sex is gone. No interest whatsoever. Totally dead. Just numb. Plus, I've become irritable and bitchy I've noticed.
>
> I was taking 100 SR Wellbutrin and low dose Seroquel before.
>
> I'm thinking I need to drop my dose of Wellbutrin (I'm very sensitive to meds. Could only take 5mg of Adderall).
>
> I'd like to get my sex drive back, get rid of this increased anxiety/irritability and still get the antidepressant feel I need.
>
> I thought Wellbutrin was supposed to boost your sex drive. A tiny dose of Adderall always did. Maybe I'm on too much Wellbutrin.
Posted by phidippus on October 7, 2017, at 13:40:28
In reply to Wellbutrin killed libido!, posted by Sheilac on December 18, 2016, at 16:24:48
Wellbutrin is more likely to kill your sex drive at low doses than it is at high doses. This is mainly because Wellbutrin stimulates the releas of more norepenephrine than dopamine at a low dose. Too much orepenephrine can mean lower libido.
The anxiety and irritability are not going to go away...
How many meds have you been on?
Eric
Posted by phidippus on October 7, 2017, at 13:43:12
In reply to Re: Wellbutrin killed libido! » Sheilac, posted by SLS on December 19, 2016, at 8:25:03
Scott, I disagree. I hunted down a med regimine that did not disturb my sex drive.
And given the choice between an activity that brings great joy and pleasure and a medication that robs me of that pleasure, I'll choose joy anytime.
Eric
Posted by SLS on October 8, 2017, at 12:12:57
In reply to Re: Wellbutrin killed libido!, posted by phidippus on October 7, 2017, at 13:43:12
Hi Eric.
> Scott, I disagree.
What is it that you disagree with?
> I hunted down a med regimine that did not disturb my sex drive.
As have I in the past. In fact, MAOIs had increased my sex drive beyond what had been my historic normal baseline level. The increased activity that it facilitated gave me great pleasure.
> And given the choice between an activity that brings great joy and pleasure and a medication that robs me of that pleasure, I'll choose joy anytime.
You might not say that if your only source of joy is the lack of depression, regardless of how your treatment affects your libido. Unfortunately, I am currently in a position of having to choose between depression with its attendant diminished libido and a major improvement in depression with no libido at all. It's a hell of a choice to have to make, but I'll choose remission of depression anytime. Perhaps as I approach remission, I will recover some small amount of sex-drive.
- Scott
Posted by phidippus on October 8, 2017, at 12:20:44
In reply to Re: Wellbutrin killed libido! » phidippus, posted by SLS on October 8, 2017, at 12:12:57
I recently had a bad depression (had to end it with ECT) and when I recovered from it, my libido returned. I didn't take any antidepressants.
What's this 'choice' you're facing?
Eric
Posted by SLS on October 8, 2017, at 19:24:06
In reply to Re: Wellbutrin killed libido!, posted by phidippus on October 8, 2017, at 12:20:44
> I recently had a bad depression (had to end it with ECT) and when I recovered from it, my libido returned. I didn't take any antidepressants.
>
> What's this 'choice' you're facing?
>
> EricRightly or wrongly, I believe that my last best chance of achieving remission pharmacologically is my current treatment regime. The trajectory of improvement so far has been the best I've experienced since 1987. I consider this a miracle. I'll know better in 1-2 months whether or not the improvement continues along its current path towards remission. It might stall completely or be unable to maintain a partial improvement. So, the choice becomes whether or not to continue with my current treatment and sacrifice my sex-drive or continue life immobilized by a severe anergic depression with psychomotor retardation. Since depression all but ruins my sex-drive anyway, the decision really is an easy one to make. To be specific, it is the drug prazosin that kills my libido at all dosages. This is unfortunate as prazosin produced such a robust improvement once it was added. I spent the last two months trying to taper and discontinue the prazosin. I deteriorated, so I had to restart it. The improvement I experienced upon its reintroduction was striking. I set myself back a few months by doing this, but I think it was a worthwhile experiment.
By the way, lithium at dosages above 300 mg/day make me more depressed, not less. At 300 mg/day, lithium acts to improve the magnitude of my response to the antidepressants I currently take.
Parnate 80 mg/day
nortriptyline 100 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 15 mg/day
prazosin 20 mg/day (I'm still in the process of finding the optimum dosage of this drug)If this treatment ultimately proves inadequate, I am thinking about discontinuing the Parnate and using either Effexor or Nardil in its place. Beyond that, I will consider brain stimulation techniques. Right now, I am interested in "deep" transcranial magnetic stimulation (dTMS) and transcranial direct current stimulation (tDCS). For now, I have ruled-out DBS. It is far too invasive, and the statistical results seem to me to be rather poor.
Thank you so much for your input. You never know from whom will come healing.
I hope all is well with you.
- Scott
Posted by phidippus on October 8, 2017, at 19:52:41
In reply to Re: Wellbutrin killed libido! » phidippus, posted by SLS on October 8, 2017, at 19:24:06
How did prazosin improve your mood?
Eric
Posted by SLS on October 9, 2017, at 9:37:11
In reply to Re: Wellbutrin killed libido!, posted by phidippus on October 8, 2017, at 19:52:41
> How did prazosin improve your mood?
>
> EricPrazosin acts like a potent antidepressant to improve all of my symptoms of depression when combined with other antidepressant drugs. This includes anergia, depressed mood, anhedonia, psychomotor retardation, cognitive slowing, memory impairments, impaired ability to read, and hyperphagia. Except for the libido issue, prazosin is remarkably clean with regard to side effects. I experienced some initial hypotension, but this wore off quickly. It is recommended that the very first dose be 1.0 mg taken at bedtime to prevent syncope. Thereafter, dosages can be taken b.i.d. or t.i.d. My doctor came up with this brilliant choice of treatment because I reported being repeatedly abused physically and emotionally beginning at a very young age. This was compounded by neglect. My doctor called this scenario "Developmental PTSD". It is now more commonly referred to as Complex Trauma Disorder or Complex PTSD. For someone who finds himself to be treatment resistant and has a history of childhood adversity, I would suggest considering combining prazosin with antidepressant drugs - especially with those that produce a partial therapeutic response.
My pet theory is that prazosin uniquely blocks brain 5-HT1b receptors to modulate dopaminergic neurotransmission.
1. Blocks presynaptic autoreceptors - increased serotonin release.
2. Blocks postsynaptic heteroreceptors - disinhibition of excitatory neurons like dopamine, glutamate, and norepinephrine.http://www.sciencedirect.com/topics/neuroscience/5-ht1b-receptor
- Scott
Posted by phidippus on October 9, 2017, at 13:16:13
In reply to Re: Wellbutrin killed libido! » phidippus, posted by SLS on October 9, 2017, at 9:37:11
alpha 1-adrenoceptors stimulate dopamine release in the caudate putamen as well as in the nucleus accumbens
Maybe its effects on dopamine produce the antidepressaant qualities.
Eric
Posted by Tony P on January 19, 2018, at 2:40:21
In reply to Re: Wellbutrin killed libido!, posted by phidippus on October 9, 2017, at 13:16:13
Back to libido: I've had a similar experience on a lower dose of Wellbutrin. I recently discovered in Wikipedia something I hadn't known before; don't know if it's new research or I just never caught the details. It could account for loss of libido on Wellbutrin, especially at higher doses. This gets a bit technical, so bear with me.
Bupropion itself has a relatively short half-life (7-10 hr). Its principal metabolite, hydroxybupropion, has an appreciably longer half-life (21-27 hr). The result is that over the usual week to ten days startup or dose increase period, the concentration of hydroxybupropion can build up to as much as 1620 times that of bupropion itself. The kicker is that only the native bupropion is a dopamine agonist, i.e. booster (NDRI/NDRA), and it's the dopamine that has the biggest effect on libido. The metabolites are mainly NE agonists (sNRIs), with some nicotinic antagonist effects not sure what effect that latter would have on libido (Scott?) and virtually no effect on dopamine. Dopamine can also "poop out" with heavy doses of an agonist over an extended period, as is only too well known to recreational meth users.
This accounts for my peculiar experience when I started on Wellbutrin 18 months ago. Knowing I was hypersensitive to it, I only took a quarter of a 150 mg XR pill per day for the first few weeks. I had about two weeks of greatly improved mood, sense of well-being, huge positive energy; got chores done I'd been putting off for months if not years. Then it pooped out; I felt the stimulation, but not the well-being or the desire to tackle things I'd been procrastinating on, or even the desire to do pleasurable things such as make music, which I HAD had in that 2-week honeymoon period. Upping the dose to 1/2 tab, then the full 150 mg, just didn't have the same effect as that start-up period, I think from the simple arithmetic of the huge ratio between the bupropion and the metabolites.
I've been tempted to try (and once or twice have done it, with varying success) stopping the WB for 2 weeks or more, then starting up again. But then I started out in bioscience research, and I love to do experiments on myself (with a statistical sample of one). I can't honestly recommend the experimental approach, especially if you're on the full dose, without consulting your doctor; my GP is a bit P.O.'d with me right now for my various "experiments", understandably so.
I've been a good boy (well, with the bupropion anyway) and stayed on my current Rx of 1/2 XR tab (75 mg/day) for 6+ months now, and my libido is considerably worse than ever before (complicated by age & SSRI side-effects). So maybe this is, indeed, a medium- to long-term side effect of Wellbutrin.
Posted by SLS on January 19, 2018, at 10:48:49
In reply to Re: Wellbutrin killed libido! » Sheilac, posted by Tony P on January 19, 2018, at 2:40:21
> ...nicotinic antagonist effects not sure what effect that latter would have on libido (Scott?)
Nice to feel valued...
:-)
My answer to you question is: I have no idea.
- Scott
Posted by Tony P on January 20, 2018, at 1:38:00
In reply to Re: Wellbutrin killed libido! » Tony P, posted by SLS on January 19, 2018, at 10:48:49
> > ...nicotinic antagonist effects not sure what effect that latter would have on libido (Scott?)
>
> My answer to you question is: I have no idea.
>
> - ScottThinking it through...One of Wikipedia's articles on nicotine suggests that nicotine *before* a pleasurable activity such as eating or sex should increase the degree of pleasure since _agonism_ of the nicotinic acetylcholine receptor results in multiple downstream effects such as increase in activity of dopaminergic neurons in the midbrain reward system, as well as the decreased expression of monoamine oxidase. So a nicotinic _antagonist_ might well decrease pleasure, anticipated desire, euphoria etc. that are all part of "libido". In other words, yes, the buildup of the metabolite hydroxybupropion *would* likely decrease libido. However, when it gets into some of the more complex receptor subtypes I lose my thread of thought.
I can vouch for a drop in libido (anecdotally) on my own part after 6 months+, although I may have other factors. Sheilac, your Seroquel could be a contributing factor. So, going back to your original question, Sheilac, "Maybe I'm on too much Wellbutrin.", if you're sensitive like I am, I incline to believe the answer may be "yes, too much for too long" I can also apply that to myself.
There are few other A/Ds that increase the dopamine reward activity safely & without risk of addiction; ropinirole has a mild effect, & buspirone (though some people find it totally ineffective), amd I think tianeptine has now been shown to activate dopamine more than serotonin (only available from Europe & Channel Islands, though). Kava - fast acting, as safe as any med, hopefully available again next month. Nicotine itself, of course, although I'm NOT promoting smoking! But while I have found NRT (nicotine replacement therapy) lozenges first thing in the morning reduce my early-morning depression, I don't find that NRT significantly increases desire or pleasure in the way that (dare I say) methamphetamine or adderall and such direct acting meds do later in the day.
I've almost talked myself into taking a "holiday" from my bupropion again, this time maybe longer than 2 weeks. Then restarting at the lowest dose again. The hydroxybupropion ought to flush out in about 1-2 weeks, but I'm suspicious of the half-life figures; they don't fit with my nefazodone interaction experience. A rollercoaster ride is not the best answer to depression and anhedonia, but hopefully Kava will be available again next month as a second-line backup.
This is the end of the thread.
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