Psychopharmacology Tips for Sexual Dysfunction
JuliaGold9
Those interested in anti-depressants and inability to orgasm will be
interested in an interesting web site I came across recently:
http://uhs.bsd.uchicago.edu/dr-bob/tips/tips.html
This site includes lengthy anecdotal discussions among practitioners about
various drug combinations they have had luck with. The following is an
excerpt from the discussion on SSRIs and sexual dysfunction. There is more
at the web site. It's fun reading.
- Julia G.
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SSRI sexual dysfunction
Date: Wed, 15 Mar 1995 01:10:41 EST
From: MWK...@prodigy.com (Dr Frederick C
Goggans)
Subject: SSRI sexual dysfunction
I have had good experience withe use of buspirone to
reverse SSRI effects on libido and orgasm and find this
method to be more useful than other approaches touted
in the literature.
Date: Wed, 12 Apr 1995 22:47:16 +0059 (EDT)
From: sc...@world.std.com (Stanley Cole)
Subject: Rreversing sexual dysfunction
I haven't had much luck with buspirone reversing sexual
dysfunction (I am having better luck with bupropion).
Date: Sun, 16 Apr 1995 11:30:20 -0700 (PDT)
From: Ivan Goldberg <psy...@psycom.net>
Subject: SSRI retarded ejaculation
On Sun, 16 Apr 1995
pazn...@MCRCR6.MED.NYU.EDU wrote:
He responded very well to Prozac.
Unfortunately he developed intolerable
retarded ejaculation.
Bupropion would be a good choice as it seldom causes
sexual dysfunction. Trazodone can seldom be given in
doses high enough to be effective without being too
sedating. If the bupropion does not help, you might
consider restarting the Prozac and co-administering
buspirone 10-20 mg tid. Buspirone has been reported to
protect some men from the sexual side effects of the
SSRIs.
If the buspirone fails, some other medications that may
help sexual function are: amantadine, bupropion, and
cyproheptadine.
Date: Sun, 16 Apr 1995 16:34:08 -0700 (PDT)
From: "Kristin E. Zethren" <zet...@chaph.usc.edu>
Subject: SSRI retarded ejaculation
I have found a number of strategies useful with this type
of problem but no one panacea. Sometimes, adding 75
mg of bupropion can make a difference. There has been
some success for some of my patients with
cyproheptadine 2-4 mg about an hour before sex
although most of my colleagues have not been
impressed. There is the danger of the anti-serotonin
effect with this drug but I have never encountered it. The
sedation might also be a problem (since about half the
people using antihistamines become sedated). Of course,
sedation would be a big problem with trazodone,
especially for those of us who favor morning sex.
From: "Richard Rubin, MD" <rd...@mindspring.com>
Date: Mon, 17 Apr 1995 00:28:32 -0500
Subject: SSRI retarded ejaculation
Although I haven't had a report from any patients yet,
I've heard that nefazodone (Serzone) is similar to
bupropion in absence of sexual side effects.
Date: Mon, 17 Apr 1995 07:08:56 -0400 (EDT)
From: Charles B. Nemeroff <cne...@emory.edu>
Subject: SSRI retarded ejaculation
Either treat the sexual dysfunction secondary to SSRIs
with one of the anecdotal treatments, e.g. buspirone
10-20 mg po tid, amantidine, or cyproheptidine, or
switch to venlafaxine (in my experience less sexual
dysfunction) or bupropion.
Date: Sat, 13 May 1995 08:49:20 -0400 (EDT)
From: Bill Boyer <wbo...@emory.edu>
Subject: SSRI sexual dysfunction
Dr. John Feighner (creater of the Feighner criteria, which
led to the RDC and then to DSM-III and IV) states that
he has successfully treated SSRI-associated sexual
dysfunction in 3 individuals with methylphenidate
(Ritalin), 10-30 mg/day.
This fits conceptually with reports of the efficacy of
amantadine, another dopamine agonist, and with the idea
that SSRI-associated apathy (including lowered libido)
may be related to dopamine down-regulation.
From: Kevin Miller <Mill...@wpogate.slu.edu>
Date: Fri, 19 May 1995 03:20:36 -0400
Subject: SSRIs and decreased libido in women
I've had fairly good (75%, small n) luck with
cyproheptadine, 2-4 mg several hours before sex or 2-4
mg TID regularly, for sexual dysfunction/loss of interest
with SSRIs. One also can try adding small doses of
bupropion to the SSRI for both depression and loss of
sexual interest.
From: DRJ1...@aol.com (Jim Sterling, Ph.D.)
Date: Sat, 20 May 1995 10:59:45 -0400
Subject: SSRI sexual dysfunction
Three patients on bupropion (Wellbutrin) switched from
Prozac because of sexual side effects reported a return
of sexual function. They functioned without depression
for up to a year. Thereafter depression or in one case
intrusive thoughts resumed, eventually requiring 10 mg of
Prozac every other day in addition to 100 mg of
Wellbutrin tid. All are doing well, for the past four to six
months, on this combination.
Date: Sun, 4 Jun 1995 01:43:54 -0500
From: talm...@Onramp.NET (John M. Talmadge,
M.D.)
Subject: SSRI anorgasmia
Some of us have had success with telling patients to skip
the dose the day of expected sexual acitivity, and that
works pretty well with venlafaxine (Effexor) (not a true
SSRI, but...) in my experience. I have also noticed that
just switching SSRIs can often alleviate the problem. I
seem to be seeing that on the Prozac-Zoloft-Paxil axis I
can just move a patient from one to another and often
clear things up. I'll bet that is a buggy solution and that
my "n" is not large enough to justify any conclusions, but
as long as it works I guess I'll keep going with it.
I have also been disappointed that trying to switch my
patients to Wellbutrin, now touted for its lack of sexual
side effects, doesn't seem to help many of them.
In the really problematic cases, I urge them to give a
TCA a trial, because despite some of the other side
effects those are still very reliable medications. I just
don't like having that lethal overdose potential and I
prefer the rapid onset of action the SSRIs seem to
demonstrate.
<SNIP>
Date: Mon, 20 May 1996 14:30:11 -0700
From: jg...@mindlink.bc.ca (Jane Garland)
Subject: SSRI anorgasmia
Lots of my patients read the articles about nefazodone in
our local press about a year ago because of local release
and research. I switched over quite a number of patients
over. To date, no or marginal improvement in
anorgasmia and relapse of depression have been the
result. I have been much more impressed with bupropion
for reversal of anorgasmia. I have had a few patients
with an antidepressant response (somewhat, not too
impressive) to nefazodone (mostly anxious ones who did
well on trazodone but got too sedated in the past), but
not those I switched for anorgasmia. I am not opposed
to trying a few more, however, in case one of them
reverses, as this side effect is disabling, but nefazodone
has been quite disappointing overall. Perhaps a clearer
profile of potential responders will emerge.
From: Cdbo...@aol.com (Christopher D. Bojrab,
M.D.)
Date: Thu, 27 Jun 1996 22:38:33 -0400
Subject: SSRI anorgasmia
Before trying any of these approaches, I believe that one
should make sure that the depression has resolved to the
point where the patient could realistically expect the
return of his or her normal libido.
P.S. My personal "small n" favorite is bupropion 75-100
mg QPM, which I have had the most reliable luck with,
especially in women.
From: LJG...@aol.com (L.James Grold M.D.)
Date: Thu, 11 Jul 1996 11:30:15 -0400
Subject: SSRI sexual dysfunction
My experience with yohimbine is that it rarely has
worked, however, a patient of mine found yohimbine
chewing gum at a health food store. He chewed 10-15
pieces and had according to him an incredible sexual
time with his girlfriend.
Date: Thu, 11 Jul 1996 10:46:37 -0700 (PDT)
From: Denis Franklin <de...@itsa.ucsf.edu>
Subject: SSRI sexual dysfunction
Success [of yohimbine] in SSRI induced hypo-orgasmia
has been reported to me by a couple of patients.
I recommended use of 0.5 to 1 tab (5.4 mg each) an
hour or so ahead of the event. Yohimbine does also
produce insomnia, so one has to arrange the timing and
titrate the dose to accommodate the circumstances. The
insomnia can actually be an additional benefit to the
romantic, bonding aspects of the relationship, and the
man's status in the eyes of the woman, because he can't
roll over and go to sleep immediately after orgasm.
Date: Wed, 14 May 1997 00:02:00 -0400
From: Ivan Goldberg <Psy...@PsyCom.Net>
Subject: Relative SSRI sexual dysfunction
How does fluvoxamine
compare to the other SSRIs
with respect to sexual
dysfunction?
I have not seen any meaningful differences
between the SSRIs with regard to sexual
dysfunction. But we use very little
fluvoxamine.
--Larry Ereshefsky
Many psychopharmacologists who prescribe a lot of
SSRIs have noted that the incidence of sexual side
effects with fluvoxamine is higher than that of the other
SSRIs. I am unaware of any good data on the topic.
From: jefferso...@ssmhcs.com
Date: Wed, 14 May 97 15:15:33 CST
Subject: Relative SSRI sexual dysfunction
The lore that fluvoxamine has a lower incidence comes
from Nemeroff et al. Depression 3: 163-169, l995. In a
double-blind comparison, "Significantly more patients
reported sexual dysfunction in the sertraline (28%) than
in the fluvoxamine (10%) group." It was not clear if
sexual function was evaluated by specific questioning.
The party line from Solvay to me in a letter dated 2/7/97
was, "Reaching definitive comparative conclusions
regarding SSRIs and incident rates of side effects is
difficult... Overall, SSRIs cause significantly less sexual
dysfunction than tricyclic antidepressants."
Grrlpetal
Wow! Great find, Julia! Thanx for the URL, too :)
Cindy
JuliaGold9
>
>Wow! Great find, Julia! Thanx for the URL, too :)
>
>Cindy
You're welcome, Cindy. And thanks for the smile. It's still the best medicine.
Julia G.