Permanent change in ejaculation - Prozac? Prostate?
john russel
About a year ago a new doctor switched me from Paxil to Prozac,
because the Paxil seemed to have burnt out (after 2 years). After 3
days on Prozac I had an unusual orgasm, where there was a long (4
seconds?) delay after the orgasm started (no pulsing) and before
ejaculation, and then the semen just ran out, it didn't "shoot" as
usual. The next orgasm, 2 days later, was more normal and did not have
the delay, but the semen just ran out again, and the feeling was not
nearly as intense as normal. When the same thing happened again (a
couple days later) I quit taking the prozac. The change in orgasm
didn't go away, and the feeling is still not very intense - it's been
over a year now.
Is there anything I can do to correct this problem and be back to
normal? I cross-posted this to the prostate group, as someone there
may have an answer. There was never any pain during orgasm. I think it
would be quite a coincedence if I actually have a problem with my
prostate.
PS- When I quit taking the Prozac I did not switch to another SSRI.
After a few weeks I was (mentally) back to normal, and wondered if I
should have quit the SSRIs sooner. Paxil did snap me out of it a
couple years back (the main depressive symptom was difficulty in
concentration), but when I tried to quit taking it a couple times the
symptons had returned. In case you are wondering, I never contacted
the new doctor when I quit taking the Prozac.
Thanks for any help.
john russel
Dave Bird
<john...@hotmail.com> writes:
>Hi,
>
> About a year ago a new doctor switched me from Paxil to Prozac,
>because the Paxil seemed to have burnt out (after 2 years). After 3
>days on Prozac I had an unusual orgasm, where there was a long (4
>seconds?) delay after the orgasm started (no pulsing) and before
>ejaculation, and then the semen just ran out, it didn't "shoot" as
>usual. The next orgasm, 2 days later, was more normal and did not have
>the delay, but the semen just ran out again, and the feeling was not
>nearly as intense as normal. When the same thing happened again (a
>couple days later) I quit taking the prozac. The change in orgasm
>didn't go away, and the feeling is still not very intense - it's been
>over a year now.
> Is there anything I can do to correct this problem and be back to
>normal? I cross-posted this to the prostate group, as someone there
>may have an answer. There was never any pain during orgasm. I think it
>would be quite a coincedence if I actually have a problem with my
>prostate.
SSRIs often cause reduced, delayed, or no- orgasm. The effect is
less obvious with paxil than prozac, because paxil clears from the body
in about 2.5 days but prozac in about 21 days.
What you need to do is google something like "SSRI anorgasmia remedies"
Various people's experience has thrown up a zoo of assorted remedies,
mostly aimed at reducing the anorgasmia while continuing the SSRI.
The common thread seems to be either
(a) DOPAMINERGICS: wellbutrin anti-depressant, selegiline used as
anti-depressant, even amantidine which is rather weak. You could
try Ritalin. (b) 5HT2 ANTAGONISTS. Kytrial is effective but costs
about $20 per day.
>
>PS- When I quit taking the Prozac I did not switch to another SSRI.
>After a few weeks I was (mentally) back to normal, and wondered if I
>should have quit the SSRIs sooner. Paxil did snap me out of it a
>couple years back (the main depressive symptom was difficulty in
>concentration), but when I tried to quit taking it a couple times the
>symptons had returned. In case you are wondering, I never contacted
>the new doctor when I quit taking the Prozac.
GOOGLE( ssri sexual dysfunction remedy )
Number one finding was this page:
http://www.dr-bob.org/tips/split/SSRI-sexual-dysfunction.html
Dr. Bob's
Psychopharmacology Tips
SSRI sexual dysfunction
There are dozens of entries so I'll try to summarise.
====================================================================
====================================================================
5HT2 BLOCKERS
ANTI-ANXIETY Busparilone anti-anxiety drug
with 5HT2 blocking effect ###
ANTI-DEPRESSANTS (SEROTONIN) Tradozone / nefadozone, serotonin
anti-depressants with 5HT2 blocking effect.
ANTI-DEPRESSANTS (NORDRENALINE) Remeron / Blovidon , noradrenailne
anti-depressants with 5HT2 blocking effect
PURE 5HT2 BLOCKER Kytril, anti-emetic: about $20 per day.
SEROTONIN BLOCKER Periactin
DOPAMINERGICS
ANTI-DEPRESSANTS Bupropion [wellbutrin] ############
ANTI-TREMOR DRUG Amantidine
STIUMLANT Ritalin [methylphenidate], dopaminergic stimulant
D2 AGONISTS Bromocriptine (, Cabergolene, or Quinagolide);
expensive
CIRCULATORY/ERECTILE BOOSTERS
ERECTILE Viagra
CIRCULATORY Yohimbine
HERBAL BRUG Ginko Biiloba, circulation booster. ###
EXERCISE Vigorous exercise :->
=======================================================================
=======================================================================
Bupropion alone, or with added Busparilone, might be a good 1st choice.
+-----------------------------------------------------------------------
Date: Wed, 15 Mar 1995 01:10:41 EST
From: MWK...@prodigy.com (Dr Frederick C Goggans)
Subject: Adding buspirone for 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.
BUSPIRONE/BUSPAR, anti-axiety drug with 5HT2 blocking effect
+-----------------------------------------------------------------------
Date: Wed, 12 Apr 1995 22:47:16 +0059 (EDT)
From: sc...@world.std.com (Stanley Cole)
Subject: Adding bupropion for SSRI sexual dysfunction
I haven't had much luck with buspirone reversing sexual dysfunction (I
am having better luck with bupropion).
BUPROPION/WELLBUTRIN, dopaminergin anti-depressant. Your best bet.
+-----------------------------------------------------------------------
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 and cyproheptadine.
BUPROPION, BUSPIRONE, AMANTIDINE (dopaminergic), PERIACTIN (5HT2 block)
+-----------------------------------------------------------------------
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.
BUPROPION, PERIACTIN, TRADOZONE [serotonin antidepressant 5HT2 blocker]
+-----------------------------------------------------------------------
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.
NEFADOZONE is no longer available, substitute TRADOZONE; or BUPROPION
+-----------------------------------------------------------------------
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.
BUSPIRONE, AMANTIDINE, PERIACTIN, BUPROPION; switch from SSRIs.
+-----------------------------------------------------------------------
Date: Sat, 13 May 1995 08:49:20 -0400 (EDT)
From: Bill Boyer <wbo...@emory.edu>
Subject: Adding methylphenidate for 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.
RITALIN/METHYPHENIDATE (dopaminergic), AMANTIDINE (dopaminergic)
+-----------------------------------------------------------------------
From: Kevin Miller <Mill...@wpogate.slu.edu>
Date: Fri, 19 May 1995 03:20:36 -0400
Subject: SSRI 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.
PERIACTIN, BUPROPION
+-----------------------------------------------------------------------
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.
DIFFERENT SSRI; BUPROPION didn't help; switch antidepressants---TCA
means the older [noradrenaline based] Tri-Cyclic Antidepressants.
+-----------------------------------------------------------------------
Date: Sun, 4 Jun 1995 10:47:38 -0400
From: Aminada...@brown.edu (Aminadav Zakai)
Subject: SSRI anorgasmia
My 2 cents' worth:
Lower SSRI dose.
Try SSRI vacation on weekends.
Add cyproheptadine 4-28 mg 30-60 min prior to sex (if they can stay
awake).
Add trazodone if problem seems to be erectile failure.
Add bupropion 75-100 mg in AM (adrenergic effect seems to help).
Switch out of class to therapeutic dose of bupropion, nefazodone, etc.
My experience is that switching within class rarely works but is worth
try in some cases.
Re-think if this is medication side effect, consider work with couple.
LOWER DOSE; DOSE HOLIDAY (paxil not prozac); TRADOZONE / NEFADOZONE
+-----------------------------------------------------------------------
Date: Sun, 4 Jun 1995 11:59:23 -0700 (PDT)
From: Ivan Goldberg <psy...@psycom.net>
Subject: SSRI anorgasmia
There are a few more psychopharmacologic interventions that are often
useful:
amantadine 100 mg bid or tid
buspirone 5-10 mg tid or qid (may increase desire too)
dextroamphetamine 5 mg tid or qid
methylphenidate 10 mg tid or qid.
AMANTIDINE; BUSPIRONE; RITALIN.
+-----------------------------------------------------------------------
Date: Sun, 4 Jun 1995 13:00:55 -0700 (PDT)
From: Thomas Lewis <tbl...@itsa.ucsf.EDU>
Subject: Adding yohimbine for SSRI anorgasmia
I've also had good luck adding yohimbine, 5.4 mg bid to tid.
YOHIMBINE, improves circulation
+-----------------------------------------------------------------------
Date: Sun, 4 Jun 1995 13:42:34 -0700 (PDT)
From: Ivan Goldberg <psy...@psycom.net>
Subject: Adding yohimbine for SSRI anorgasmia
Yohimbine is often effective but may precipitate manic episodes in
pholks with bipolar disorder.
YOHIMBINE
+-----------------------------------------------------------------------
From: Fl...@aol.com (Ron Winchel, MD)
Date: Mon, 5 Jun 1995 04:43:29 -0400
Subject: Adding buspirone for SSRI anorgasmia
Try adding buspirone (Buspar). Michael Norden recently reported
benefits. I have been doing the same for about a year with substantial
benefits about 1/2 the time. [8<....]
BUSPARILONE
+-----------------------------------------------------------------------
From: OR...@aol.com
Date: Thu, 8 Jun 1995 01:37:25 -0400
Subject: SSRI anorgasmia
One thing to consider is whether you can lower the dose of the SSRI.
That was helpful for three of my female patients. Another female patient
did well with cyproheptadine (Periactin) though it cut down on
spontaneity.
LOWER SSRI DOSE; PERIACTIN
------------------------------------------------------------------------
From: M112...@aol.com (Michael Friedman, M.D.)
Date: Sat, 17 Jun 1995 09:40:45 -0400
Subject: SSRI sexual dysfunction
My experience with SSRIs is that they [can] cause decreased libido as
well as anorgasmia. Personally, I believe that the problems are rather
difficult to treat. I have had little success with adding Periactin,
Buspar or Wellbutrin. I have found that more often than not I am forced
to lower the SSRI or stop it completely when the patient complains about
these side effects.
PERIACTION or BUSPAILONE or BUPROPION did no good -- cease SSRIs.
+----------------------------------------------------------------------
Date: 18 Jun 95 11:33:33 EDT
From: "Furey A. Lerro" <71544...@compuserve.com>
Subject: SSRI decreased libido
I have found that loss of sex drive in depressed patients often occurs
separately from the symptom of diminished libido that is part of
depression. The majority of my patients do not prefer to stop the
medication for fear of return of symptoms. I've had some success in
lowering the dosage of the SSRI, but have found various remedies for the
problem, e.g., yohimbine and amantadine, not to be helpful. Switching to
trazodone, bupropion, and most recently nefazodone has been quite
successful.
YOHIMBINE or AMANTIDINE did not help; switch to TRADOZONE or BUPROPION
+-----------------------------------------------------------------------
Date: Thu, 13 Jul 1995 22:09:04 -0700 (PDT)
From: Ivan Goldberg <psy...@psycom.net>
Subject: SSRI decreased libido in women
On Thu, 13 Jul 1995 Hot...@aol.com wrote:
Can anyone shed light on management of diminished libido in female
patients on SSRIs? Are there any differential strategies across gender?
Lowering dosage and trying cyproheptadine are two that come to mind.
What about buspirone and bupropion in females vs. males?
While cyproheptadine is often useful in reversing the anorgasmia in both
men and women taking SSRIs, it does not usually have any effect on
desire.
Buspirone, bupropion, and amantadine seem to do the best at restoring
desire in both sexes.
BUSPIRONE, BUPROPION, AMANTIDINE, PERIACTIN
+-----------------------------------------------------------------------
Date: Thu, 13 Jul 1995 22:33:08 -0500
From: gsda...@niagara.com (George Davidson)
Subject: SSRIs and decreased libido in women
In extensive practical but not academic experience, lowering the dose is
effective only when you get close to zero, cyproheptadine may work for
anoragasmia (I haven't had any success with it) but not for libido,
buspirone doesn't seem to work for anyone I've tried it on (small n,
scared off by ineffectiveness or side effects), and you can't use
bupropion in Canada.
If I have a good response to SSRI, but sexual problems become a
nuisance, I have so far had 100% success switching to nefazadone or
moclobemide.
PERIACTIN, BUSPIRONE, switch from SSRIs to TRADOZONE / NEFADOZONE.
+----------------------------------------------------------------------
Date: 15 Jul 95 09:04:01 EDT
From: "Furey A. Lerro" <71544...@compuserve.com>
Subject: SSRIs and decreased libido in women
I can echo Dr. George Davidson's comments regarding buspirone being
unhelpful along with the SSRI. Bupropion has been the best alternative
medication. I've also been able to switch a couple of women to trazodone
with very good success. Additionally, returning to the tricyclics is
often worth considering. Dr. Susan McElroy's article on treating
antidepressant side effects in suppl. 2 of vol. 56 of the Journal of
Clinical Psychiatry this year is excellent and gives many good
references in this area.
BUSPIRONE, BUPROPION, switch to TRADOZONE
+-----------------------------------------------------------------------
From: PMB...@aol.com (Peter M. Brigham, MD)
Date: Fri, 21 Jul 1995 09:22:23 -0400
Subject: Increased sexual function on buspirone
On Jul 20, 1995, JG...@mindlink.bc.ca (Jane Garland) wrote:
no one has mentioned the paradoxical occurrence of increased libido and
increased frequency and intensity of orgasms which one of my patients
had on fluoxetine at 20 mg. She was being treated for OCD, [which]
responded well. She also enjoyed the sexual side effects.
I haven't seen this with SSRIs, but I have a patient on fluoxetine 20 mg
for an atypical anxiety disorder who complained bitterly of anorgasmia,
so I added buspirone 10 mg tid and she got her sexual responsiveness
back. [8<.....]
BUSPIRONE
+-----------------------------------------------------------------------
Date: Sat, 11 Nov 1995 17:10:30 -0500
From: wbr...@mail.aqua.net (Walter A. Brown MD)
Subject: SSRIs and decreased libido
I have heard that for folks with sexual dysfunction on paroxetine or
sertraline (not fluoxetine) that using the med four days a week but not
on Friday-Saturday-Sunday will preserve remission of depression and at
the same time allow unimpaired libido on weekends.
--Jaime Smith
DOSE HOLIDAY (paxil or sertraline, not prozac)
+-----------------------------------------------------------------------
Date: Tue, 14 Nov 1995 22:41:52 -0800 (PST)
From: "J. Wynn" <jdw...@u.washington.edu>
Subject: Bupropion for SSRI sexual dysfunction
Interestingly it seems that bupropion was touted early on as a curative
for low libido in and of itself, i.e., before marketing it as an
antidepressant took off it was discussed by sexologists as a potentially
useful item. I have tried it twice with no luck.
BUPROPION
+-----------------------------------------------------------------------
From: "Richard Rubin, MD" <rd...@mindspring.com>
Date: Tue, 12 Dec 1995 17:20:14 -6
Subject: Bupropion for paroxetine sexual dysfunction
I've tried bupropion 75 mg at 6:00 p.m. in 4 patients who were
complaining of problems with decreased libido as a side effect of
paroxetine. Three of them reported no more side effects when using the
bupropion. They were the women. The one man continued to complain that
he was unable to achieve orgasm.
BUPROPION in females, maybe not in males.
+-----------------------------------------------------------------------
Date: Thu, 16 Nov 1995 08:00:47 -0800 (PST)
From: Thomas Lewis <tbl...@itsa.ucsf.EDU>
Subject: SSRI anorgasmia
For what it's worth, I have a female patient, 40-ish, on 40 mg of
paroxetine for major depression, who fortuitously discovered that her
dense anorgasmia is relieved for a period of several hours after aerobic
exercise (e.g., running).
EXERCISE
+-----------------------------------------------------------------------
Date: Sun, 19 Nov 95 17:49:21 PST
From: "Jim Ellison" <jell...@interserv.com>
Subject: Bupropion for SSRI sexual dysfunction
Clinicians are adding bupropion to SSRIs [to diminish the loss of libido
they sometimes cause], but I'd be more inclined simply to switch to
bupropion if possible (not always possible!). Walker et al (J Clin
Psychiatry 54: 459-465, 1993) found such a switch helpful for patients
with fluoxetine-induced loss of libido, and Gardner and Johnston (J Clin
Psychopharmacol 5: 24-29, 1985) used such a substitution to restore
libido and erectile function to the majority of a group of patients on a
TCA, tranylcypromine, or trazodone. Adding the bupropion makes sense in
some ways, but one might be concerned about additive side effects or a
synergistically lowered seizure threshold.
BUPROPION
+-----------------------------------------------------------------------
Date: Sun, 19 Nov 1995 18:02:15 -0800 (PST)
From: Ivan Goldberg <psy...@psycom.net>
Subject: Bupropion for SSRI sexual dysfunction
While I have occasionally had great success adding bupropion to an SSRI
when the sexual side effects were unacceptable, more often than not, the
depression improves a bit but the sexual problems remain unchanged.
BUPROPTION sometimes works but sometimes doesn't.
+-----------------------------------------------------------------------
Date: Mon, 20 Nov 1995 20:02:04 -0800 (PST)
From: Peter Forster <for...@itsa.ucsf.EDU>
Subject: Bupropion for SSRI sexual dysfunction
I have tried adding bupropion to SSRIs with both men and women with good
results in about 80%. Usually I think about switching to bupropion, but
often I don't because of the very positive response to the SSRI. In
those where adding a second agent doesn't help, I sometimes can get a
response by decreasing the SSRI
BUPROPION works in 80%, and/or REDUCE SSRI DOSE.
+-----------------------------------------------------------------------
Date: Mon, 11 Dec 1995 22:43:14 +0001 (EST)
From: sc...@world.std.com (Stanley Cole)
Subject: Bupropion for SSRI sexual dysfunction
I've used bupropion 75 mg BID (occasionally 75 mg qd will do it,
especially if it is taken in the afternoon) with both fluoxetine and
sertraline. About 80% of people had about an 80% improvement in libido
and delayed orgasm with it. I have tried all the other remedies for this
will rare success (amantadine can help).
BUPROPION works in 80%, less success with AMANTIDINE.
+-----------------------------------------------------------------------
Date: Mon, 11 Dec 1995 19:00:41 -0800 (PST)
From: "J. Wynn" <jdw...@u.washington.edu>
Subject: Bupropion vs. bromocriptine for SSRI impotence
I've added bupropion, in doses up to 325 mg/d, to Paxil, Zoloft and
Prozac, with little benefit. I recently added bromocriptine to
venlafaxine for the same problem with prominent apathy, with very nice
results. I've also been disappointed with cyproheptadine, buspirone and
yohimbine, though not in a large patient sample.
Bromocriptine is very expensive.
BROMOCRIPTINE or other dopamine D2 agonists -- expensive.
+-----------------------------------------------------------------------
Date: Tue, 13 Feb 1996 22:55:46 -0800
From: jg...@mindlink.bc.ca (Jane Garland)
Subject: SSRI sexual dysfunction
At recently attended conferences on SSRIs and sexual dysfunction, the
audience was asked to raise their hands depending on the frequency with
which they had seen this problem in private practice. The % ran between
30 and 50 -- much higher than originally reported. This fits with my
experience also. I think that the under-reporting previously was based
on the fact that severely depressed patients aren't that concerned
initially about sexual dysfunction. It is only later as they begin to
get out of the pit that it becomes an issue. I think psychiatrists
probably also attributed the sexual dysfunction to the depressed state.
[8<...]
SEXUAL DYSFUNCTION VERY FREQUENT
+-----------------------------------------------------------------------
Date: Fri, 3 May 1996 01:17:10 -0300
From: Ivan Luiz de Vasconcellos Figueira <il...@Montreal.com.br>
Subject: Increased sexual function on fluoxetine
I have a woman in her late 20s on fluoxetine 20 mg/day for 2 weeks for
depression (of a mild to moderate severity). She felt it as odd that her
sexual arousal was improved more than she would have thought from her
small improvement in mood.
PROZAC **IMPROVED** LIBIDO
+-----------------------------------------------------------------------
Date: Mon, 20 May 1996 16:19:50 -0400 (EDT)
From: Randi Rubovits-Seitz <rrs...@gwis2.circ.gwu.edu>
Subject: Switching to nefazodone
A couple of people I switched to nefazodone, one each from Prozac and
Paxil, to which they'd had otherwise excellent responses, reported some
improvement in sexual function on nefazodone but were so much less happy
with it as an antidepressant that they requested reinstitution of the
SSRI.
SWITCH TO TRADOZONE / NEFADOZONE but it may be less effective
as an anti-depressant.
+-----------------------------------------------------------------------
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.
TRADOZONE / NEFADOZONE less good, BUPROPION is better.
+-----------------------------------------------------------------------
From: boj...@iquest.net (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.
BUPROPION, especially in females.
+-----------------------------------------------------------------------
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.
YOHIMBINE?
+-----------------------------------------------------------------------
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.
YOHIMBINE
+-----------------------------------------------------------------------
From: CWan...@aol.com
Date: Fri, 8 Nov 1996 23:27:36 -0500
Subject: Ginkgo biloba for SSRI sexual dysfunction
I read about a pilot study by psychiatrist Alan Jay Cohen at the
University of California at San Francisco. It suggests that ginkgo
biloba, an ancient Chinese herbal medicine, may be an antidote to
diminished libido or delayed orgasm. Cohen presecribed a patent-
protected formulation of ginkgo-tree leaf extracts, two 60 mg capsules
qid, to 37 men and women, all of whom experienced diminished libido and
delayed orgasm as a result of Prozac, Zoloft, and Paxil. (The subjects
had tried switching to other antidepressants, taking sexually activating
prescription drugs before bedtime, or avoiding medication on weekends,
all to no avail.) After taking the ginkgo biloba 86 percent reported
substantial improvement in their sexual function, with virtually no side
effects. Cohen says that ginkgo biloba seems to restore blood flow to
the genitalia, which is often blocked by serotonin-enhancing drugs.
GINKO BILOBA (a herbal remedy which improves ciculation)
+-----------------------------------------------------------------------
Date: Fri, 8 Nov 1996 20:55:18 -0800 (PST)
From: Camilla Cracchiolo <cam...@PrimeNet.Com>
Subject: Ginkgo biloba for SSRI sexual dysfunction
Very interesting, especially in light of ginkgo's vasodilating effects.
Two fast comments:
Since Traditional Chinese Medicine uses the seed and not the leaf, the
traditional indications for gingko don't neccessarily apply to this
work.
I don't see any mention of a placebo control group.
GINKO BILOBA
+-----------------------------------------------------------------------
Date: Sat, 9 Nov 1996 04:42:43 -0800
From: "Jim Ellison" <jell...@interserv.com>
Subject: Ginkgo biloba for SSRI sexual dysfunction
I spoke with Dr. Cohen in the course of preparing a talk on this topic
and after reading his New Research Abstract (NR 715) in the 1996 APA
syllabus. He is a UCSF psychiatrist and has had excellent results with
ginkgo -- but his studies are not controlled and must be seen in that
light. The mechanism claimed for ginkgo is enhanced vascular flow, but
that too should be considered tentative.
GINKO BILOBA
+-----------------------------------------------------------------------
Date: Sat, 30 Nov 1996 14:10:34 -0800 (PST)
From: Camilla Cracchiolo <cam...@PrimeNet.Com>
Subject: Ginkgo for SSRI sexual dysfunction
I mentioned using ginkgo to treat SSRI related sexual dysfunction to my
personal physician, who responded that she had been prescribing ginkgo
to treat male erectile difficulties for the past 3 years and found that
it works fairly well. She originally enountered the idea in the Journal
of Urology. Unfortunately, she didn't have the reference at hand.
GINKO BILOBA
+-----------------------------------------------------------------------
From: r...@icu.com (Richard David Brand, MD)
Subject: Bupropion for SSRI sexual dysfunction
Date: Sun, 13 Apr 1997 00:17:40 -0400
Bupropion 75 mg QAM has worked for about half the SSRI related sexual
dysfunction patients I've treated (n about 12-20).
BUPROPION
+-----------------------------------------------------------------------
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?
DO SSRIs DIFFER? FLUVOXAMINE WORST
+-----------------------------------------------------------------------
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.
DO SSRIs DIFFER? FLUVOXAMINE WORST
+-----------------------------------------------------------------------
Date: Thu, 29 May 1997 09:17:11 -0400
From: Jim Ellison MD <jell...@interserv.com>
Subject: Nefazodone for SSRI sexual dysfunction
A recent letter to the editor cited use of nefazodone with sertraline.
The purpose was to block 5HT2 postsynaptic receptors and reduce sexual
dysfunction:
Reynolds RD. Sertraline-induced anorgasmia treated with intermittent
nefazodone [letter]. Journal of Clinical Psychiatry. 58 (2): 89, 1997
Feb.
TRADOZONE / NEFADOZONE as 5HT2 blocker.
+-----------------------------------------------------------------------
Date: Thu, 10 Jul 1997 10:10:38 -0700 (PDT)
From: "J. Wynn" <jdw...@u.washington.edu>
Subject: SSRI sexual dysfunction
Reference for SSRI-induced sexual side effects being even more common
than most of us realize:
Modell JG, Katholi CR, Modell JD, DePalma RL. Comparative sexual side
effects of bupropion, fluoxetine, paroxetine, and sertraline. Clinical
Pharmacology & Therapeutics. 61 (4): 476-87, 1997 Apr.
Of patients given an SSRI, 73% reported at least one type of sexual
dysfunction and 27% reported no problems.
SEXUAL DYSFUNCTION COMMON WITH SSRIs.
+-----------------------------------------------------------------------
Date: Wed, 23 Jul 1997 22:17:35 -0400
From: Ivan Goldberg <Psy...@PsyCom.Net>
Subject: Ginkgo for SSRI sexual dysfunction
Ginkgo has been mentioned on this list a number of times as a possible
treatment for patients with antidepressant-induced sexual dysfunction.
The July issue of Clinical Psychiatry News (p. 5) contains a report on a
presentation by Alan J. Cohen, MD, at the recent San Diego annual
meeting of the APA. Dr. Cohen reported that 60-120 mg twice a day of
ginkgo led to relief of antidepressant-induced sexual side effects in 30
of 33 women and 23 of 30 men. Side effects of ginkgo were reported to
have been minimal.
GINKO BILOBA
+-----------------------------------------------------------------------
From: Cmin...@aol.com
Date: Thu, 24 Jul 1997 17:40:47 -0400 (EDT)
Subject: Ginkgo for SSRI sexual dysfunction
I've tried ginkgo with one man, in his late 50s, after some months on
sertraline with decreased sexual interest, some difficulty in getting an
erection, and prolonged ejaculation. He was taking one aspirin a day,
and after I checked with an internist who knew about ginkgo, who didn't
think the potential interference with platelet aggregation would be much
of an issue, he started at 60 mg qd. At 60 mg bid the above side effects
diminished significantly. (Bupropion hadnn't helped, nor had stopping
the medication for up to 2 days prior to sex.)
GINKO BILOBA; BUPROPION had not helped this man.
+-----------------------------------------------------------------------
From: Tom...@aol.com
Date: Fri, 25 Jul 1997 08:41:43 -0400 (EDT)
Subject: SSRI sexual dysfunction
I haven't seen people develop tolerance to the sexual side-effects of
SSRIs and venlafaxine.
Date: Fri, 25 Jul 1997 16:22:46 -0400
From: Ivan Goldberg <Psy...@PsyCom.Net>
Subject: SSRI sexual dysfunction
I have seen a few people in whom tolerance to the sexual side-effects of
SSRIs seemed to develop... or maybe their compliance decreased and they
failed to report that.
Date: Fri, 25 Jul 1997 23:37:04 -0400
From: William Braden <bra...@brown.edu>
Subject: SSRI sexual dysfunction
Yes, some patients do lose the sexual side-effects (after 2 to 6
months).
SEXUAL DYSFUNCTION REDUCES WITH TIME.
+-----------------------------------------------------------------------
Date: Sat, 26 Jul 1997 06:57:45
From: "Richard David Brand, MD" <r...@icu.com>
Subject: SSRI sexual dysfunction
Several patients of mine have regained sexual normal sexual activity
after 3-6 months on venlafaxine.
SWITCH TO VENLAFAXINE
+-----------------------------------------------------------------------
Subject: Ginkgo for SSRI sexual dysfunction
Date: Mon, 1 Dec 97 19:50:51 -0000
From: Geoff Hyde <geof...@empnet.com>
Ginkgo Biloba for Drug-induced Sexual Dysfunction
Alan J. Cohen, M.D., Department of Psychiatry, University of CA at SF;
Barbara D. Bartlik, M.D.
In an open trial, ginkgo biloba, an herb derived from the bark of the
Chinese ginkgo tree, noted for its cerebral enhancing effects, was found
to be 84% effective in treating antidepressant-induced sexual
dysfunction due predominantly to selective serotonin reuptake inhibitors
(SSRIs) (N = 63). Women (N = 33) were more responsive to the sexually
enhancing effects of ginkgo biloba than men (N = 30), with relative
success rates of 91% versus 76%. Ginkgo biloba generally had a positive
effect upon all four phases of the sexual response cycle: desire,
excitement (erection and lubrication), orgasm, and resolution
(afterglow). This study originated from the observation that geriatric
patients on ginkgo biloba for memory enhancement noted improved
erections. Patients exhibited sexual dysfunction secondary to a variety
of antidepressant medications including SSRIs, SNRIs, MAOIs, and
tricyclics. Dosages of ginkgo biloba extract ranged from 60 mg qd to l80
mg bid (average 200 mg/d). The common side effects were gastrointestinal
disturbances, headache, and general CNS activation.
Cohen A. Treatment of antidepressant-induced sexual dysfunction: a new
scientific study shows benefits of gingko biloba. Healthwatch. 5 (1),
1996 Jan.
Kleijnen J, Knipschild P. Ginkgo biloba. Lancet. 340 (8828): 1136-9,
1992 Nov 7. Comment: 1992 Dec 12; 340 (8833): 1474.
GINKO BILOBA
+-----------------------------------------------------------------------
From: doc...@webtv.net (alan cohen)
Date: Tue, 2 Dec 1997 23:09:01 -0800
Subject: Ginkgo for SSRI sexual dysfunction
Please see my Brief Report on Long Term Safety and Efficacy of Ginkgo
Biloba Extract in the Treatment of Antidepressant-Induced Sexual
Dysfunction.
GINKO BILOBA
+-----------------------------------------------------------------------
Date: Tue, 20 Jan 1998 23:28:41 -0500 (EST)
From: Charles S Berlin <cber...@pitt.edu>
Subject: Granisetron for SSRI sexual dysfunction
Although only a single open use case report, there was a fascinating
letter in the November Journal of Clinical Psychiatry. Drs. Nelson,
Keck, and McElroy note the theoretically inviting view that granisetron,
a 5HT3 antagonist (and sexual stimulant in rats), might counteract SSRI
induced sexual side effects (which they believe stem from SSRI activity
at 5HT2 and 5HT3 receptors).
They thus had one of their patients take this medication 1 hour before
sex: "On three out of three trials Ms. A noticed a complete recovery of
sexual interest and ability to achieve orgasm."
This is tantalizing enough to warrant further exploration.
Unfortunately, there is at least one drawback: this medication
(available as Kytril, labelled for chemotherapy-related nausea control)
costs an eye-popping $50/pill! (My consulting pharmacist quipped, "It
would have to be a heck of an encounter to justify that!" when she
looked up the price.) I'm sure insurance companies would balk at this
very quickly...
Nelson EB, Keck PE Jr, McElroy SL. Resolution of fluoxetine-induced
sexual dysfunction with the 5-HT3 antagonist granisetron. Journal of
Clinical Psychiatry. 58 (11): 496-7, 1997 Nov.
KYTRIL -- expensive )but not usually $50 per dose!)
+-----------------------------------------------------------------------
Date: Wed, 28 Jan 1998 23:15:21 -0600
From: michelle & evan peterson <dove...@mc.net>
Subject: Yohimbine for SSRI sexual dysfunction
Charles S Berlin wrote:
While yohimbine is often mentioned as potentially helpful for SSRI
sexual side effects, my own clinical experience with this, and reading
the anecdotal reports of others, is that the results in actual use
overall seem to be somewhat disappointing.
Yohimbine evidently increases peripheral blood flow, and its reputation
for improving male sexual performance came from observations of
vasocongestion of genitals in animals that ate it.
YOHIMBINE is disappointing
+-----------------------------------------------------------------------
From: tga...@ix.netcom.com (Theresa Garton,MD)
Date: Sat, 28 Feb 1998 11:04:17 -0800
Subject: SSRI sexual dysfunction
I add bupropion, at a low dose of 75 mg daily, for symptoms of decreased
interest in sex or delayed orgasm in patients who are also using SSRIs.
I have good luck with this specific use. I will admit though, that this
is not infrequently the first step in switching from an SSRI to single
drug therapy with buproprion.
For inability to acheive erection, I would also consider other
etiologies. A thorough history, exam, etc., would probably be in order
for that symptom unless the patient was clearly attributing his lack of
erections to a nonexistant interest in sexual activity.
BUPROPION
------------------------------------------------------------------------
From: M. Kirsten Miller, M.D., M.P.H. <KMil...@aol.com>
Date: Sun, 5 Apr 1998 23:20:01 EDT
Subject: Mirtazapine for SSRI sexual dysfunction
I've used Remeron (mirtazapine) fairly often for SSRI induced sexual
dysfunction -- with or without Wellbutrin.
REMERON, a noradrenaline anti-depressant with 5HT2 blocking effect
+-----------------------------------------------------------------------
Date: Mon, 20 Apr 1998 21:18:12 -0400
From: "Marianna C. Glenday" <MC_Gl...@compuserve.com>
Subject: Urologic workup before initiating treatment
With impotence presumed to because by SSRIs there are a number of
reasons to do a urologic workup before initiating treatment.
There may be another primary or co-morbid cause of the impotence that
would have been subclinical until the addition of the SSRI, and some of
these causes can be major health problems such as undiagnosed diabetes,
vascular disease and even alcoholism. The depression may also be the
result of such a comorbid illness and all three of the problmes found to
be from a common pathology.
SEXUAL DYSFUNCTION sometimes caused by other things than just the SSRI.
+-----------------------------------------------------------------------
From: Ron Podell <Con...@aol.com>
Date: Mon, 4 May 1998 04:04:37 EDT
Subject: SSRI sexual dysfunction
Granisetron is anecdotally reported to help orgastic dysfunction --
inhibited or delayed ejaculation in men and orgastic dysfunction in
women.
Erectile dysfunction in SSRI users is an interesting problem. Does the
man have any history of erectile dysfunction prior to the SSRI? If so,
then a work up with nocturnal penile tumescence testing (for example,
with the Rigiscan) is something that could be done to see if there are
any organic factors present. If there are, Viagra is a very legitimate
choice. If not, the erectile dysfunction is probably secondary to
decreased desire or orgastic dysfunction. If the patient has orgastic
dysfunction then ginkgo biloba and granisetron may be a good
combination.
Viagra does enhance response to sexual stimulation in normals, but who
cares unless you are getting older and want 95% rigidity instead of 80%?
Rigidity matters, but only if it's less than 60-65% or you are dating
much younger women and worry about it.
KYTRIL with GINKO BILOBA
+-----------------------------------------------------------------------
From: "Fier, Eric" <Fie...@MSX.UPMC.EDU>
Subject: SSRI sexual dysfunction
Date: Mon, 18 May 1998 15:48:08 -0400
How much buproprion for a man on Prozac to assist with sexual
impairment?
75-150 mg of the regular or the SR preparation, usually dosed daily; in
some cases, used PRN 1 hour before sex:
Ashton AK, Rosen RC. Bupropion as an antidote for serotonin reuptake
inhibitor-induced sexual dysfunction. Journal of Clinical Psychiatry. 59
(3): 112-5, 1998 Mar.
You may also consider adding nefazadone 50-100 qHS or mirtazapine 7.5-15
qHS.
Has Viagra been tried for this?
Initial studies of sildenafil citrate looked at > 3000 patients with
erectile dysfunction secondary to assorted etiologies; success rate of
70-80% reportedly included patients with antidepressant-induced
impotence. No specifics yet on this cohort. Dose 50 mg initially; may
try 75 or 100 mg if no improvement.
BUPROPION; TRADOZONE / NEFADOZONE; REMERON; VIAGRA,
+-----------------------------------------------------------------------
Date: Tue, 19 May 1998 23:51:01 -0400
From: "Howard Rudominer, M.D." <hru...@home.com>
Subject: SSRI sexual dysfunction
I have had to use as much as 300 mg of buproprion SR to see results on
occasion. I would stay away from the regular preparation because of the
increased risk of seizures. I see no reason to use it over the SR form
unless the patient had an idiosyncratic reaction to it.
The problem with mirtazapine is that it may work to reverse the sexual
dysfunction, but not without the cost of marked weight gain.
Nefazadone does not have as favorable a side effect profile as
buproprion SR.
I have had some success with ginkgo biloba 120 mg bid.
BUPROPION; TRADOZONE / NEFADOZONE; GINKO BILOBA
+-----------------------------------------------------------------------
Date: Thu, 21 May 1998 22:37:09 -0400
From: Ivan Goldberg <Psy...@psycom.net>
Subject: Sildenafil for SSRI sexual dysfunction
One of my female patients with Prozac-induced anorgasmia tried 100 mg of
her husband's Viagra and reported that it made it much easier for her to
reach orgasm.
VIAGRA, also in females.
+-----------------------------------------------------------------------
Date: Thu, 21 May 1998 20:15:31 -0700 (PDT)
From: Ronald Shlensky <300...@west.net>
Subject: Sildenafil for SSRI sexual dysfunction
What has made Viagra so attractive is not that it is the only remedy for
erectile dysfunction, as potency problems are called medically. There
are half a dozen other effective treatments. But unlike the others,
Viagra is a pill, making it a far simpler and more discreet remedy than
its rivals, which include drugs injected or inserted into the penis and
devices implanted and inflated.
But in the wave of enthusiasm surrounding this drug over the last two
months, many physicians and their patients have ignored its limitations
and side effects -- those already known and those that may become
apparent after millions of men have used it.
"Whenever a new drug is introduced, pharmaceutical companies always tout
it as extraordinarily effective and without side effects," said Dr.
Robert Kolodny, medical director of the Behavioral Medicine Institute in
New Canaan, Conn., and a former associate of the pioneering sex
researchers, Dr. William Masters and Virginia Johnson.
"In every case, a year or two later when the drug becomes widely used,
new side effects emerge that were not previously seen," Dr. Kolodny
said. "This is uncharted territory. There may be interactions between
Viagra and other drugs men are taking. Men may use it at higher doses
than it was designed to be used. And it will undoubtedly be used by a
wide range of people, not all of whom are suitable or adequately
screened medically beforehand."
Dr. Kolodny noted that some women are already taking Viagra, even though
no data have shown its effectiveness or hazards for women. Likewise with
adolescents, who may take it because of a medical problem that causes
impotence or simply as a recreational drug in hopes of enhancing their
virility.
Because most men with potency problems are in the later decades of life,
some Viagra users no doubt will be in very poor health, suffering from
diabetes, heart disease, arthritis and other ailments. Will their hearts
stand the physical demands of sexual intercourse? How will Viagra
interact with other medicines they may be taking?
Men who are rendered impotent by drugs for high blood pressure or
depression are likely to constitute a large share of Viagra users, but
until large numbers use the potency enhancer, its possible adverse
interactions with their medicines will not be fully known.
What is known so far about Viagra, also known as sildenafil, is that it
cannot safely be taken by anyone using nitrate medications and,
according to a report last week in The New England Journal of Medicine,
about a third of men experience one or more minor side effects,
including headaches, flushing, indigestion, stuffy nose and temporary
changes in visual perception of color or brightness. But in tests of
Viagra in hundreds of men, few dropped out because of such effects.
"Whether the promise of sildenafil will be realized after many more men
have been treated and the drug has been taken repeatedly for prolonged
periods remains to be seen," Dr. Robert D. Utiger cautioned in an
editorial in the same issue of the journal.
--NY Times
VIAGRA, POSSIBLE PROBLEMS WITH [New York Times article].
+-----------------------------------------------------------------------
From: Ron Podell <Con...@AOL.COM>
Date: Fri, 22 May 1998 00:49:50 EDT
Subject: Sildenafil for SSRI sexual dysfunction
Viagra helps with the excitement phase of the sexual response. It does
nothing for desire -- except what it might contribute psychologically to
a person who now believes he can have sexual relations. The orgastic
problem with SSRIs is a threshold problem. The hill one has to climb to
reach orgasm is higher. The increased excitement phase response due to
Viagra has helped some of my patients climb the hill all the way to the
top and over. The only question is whether that will continue. But it
does not directly affect desire or orgastic phases.
VIAGRA is some help.
+-----------------------------------------------------------------------
From: Henry F. Crabbe <Pmc...@aol.com>
Date: Tue, 26 May 1998 03:46:07 EDT
Subject: Sildenafil for SSRI sexual dysfunction
My experience is similiar. Viagra 50 mg reversed anorgasmia in a female
patient treated with Prozac.
Date: Tue, 26 May 1998 14:11:48 -0700 (PDT)
From: Denis Franklin <de...@itsa.ucsf.edu>
Subject: Sildenafil for SSRI sexual dysfunction
I, too, had a female patient who overcame anorgasmia by taking her
husband's sildenafil... and giving it to her boyfriend.
VIAGRA works in females too.
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
COMMENT: female sexual dysfunction
is different. Male sexual dysfunction is more often circulatory /
erectile, hence responds will to Viagra, Ginko, or Yohimbine.
Female sexual dysfunction is sometimes circulatory / erectile
(of the clitoris), but more often a failure of desire i.e. dopamine;
for this reason bupropion, amantidine, or bromocriptine will often
work better for females.
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
+-----------------------------------------------------------------------
Date: Sun, 07 Jun 1998 07:12:35 -0400
From: Ivan Goldberg <Psy...@psycom.net>
Subject: Sildenafil for SSRI sexual dysfunction
While I believe that it is too soon to prescribe sildenafil (Viagra) for
antidepressant-induced sexual difficulties, about a dozen of my male and
female patients have obtained it by various means and have tried it out.
The success rate seems to be about 75% in both men and women, and the
side effects seem to be minimal, so far.
VIAGRA works in 75%
+-----------------------------------------------------------------------
This topic is indexed under the following subjects:
Antidepressants, selective serotonin reuptake inhibitors
Sexual problems
Buspirone
Antidepressants, new (bupropion, mirtazapine, nefazodone, venlafaxine)
Antidepressants, other and in general
Dopaminergic agents
Serotonin antagonists
Stimulants
Antidepressants, tricyclic
Yohimbine
Antidepressants, monoamine oxidase inhibitors
Sildenafil
Herbs
Serotonin antagonists
Match: all terms any term
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
http://www.priory.com/psych/sexherb.htm
THE USE OF NATURAL PRODUCTS
IN THE TREATMENT OF
FEMALE SEXUAL DYSFUNCTION
add or switch to Saint John's Wort (potent herbal anti-depressant)
http://altmedicine.about.com/od/sexualhealth/a/TreatFemaleSexu_2.htm
Natural Treatments for Female Sexual Dysfunction
From Cathy Wong, N.D.,
Your Guide to Alternative Medicine.
FREE Newsletter. Sign Up Now!
St. JOHN'S WORT
St. John's wort (Hypericum perforatum) is used as a herbal
antidepressant that may be helpful for sexual dysfunction related to
depression. It's effectiveness for mild to moderate depression has been
substantiated by much research. Many people self-prescribe it hoping to
lessen symptoms of depression without the use of prescription
medications. People should work with a health professional when
exploring their treatment options.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
http://www.priory.com/psych/sexdys.htm
Antidepressant-Induced Sexual Dysfunction Associated with Low Serum Free
Testosterone
no remedies suggested
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
http://content.health.msn.com/content/article/88/99769.htm
Question:
During sex I persistently have trouble climaxing (ejaculating). Is there
anything I can do? I feel like I won't be satisfied until I'm able to
ejaculate during intercourse with my girlfriend.
Answer:
I assume he's saying that he can't reach point of ejaculation. That's
not unusual for older men and is probably due to age-related nerve
damage, but it can also be induced by SSRI's, a popular class of
antidepressants.
If he is older, and it's due to the loss of nerve function that occurs
naturally with age, there isn't anything that can be done.
If it's due to SSRI's, the dosage of the SSRI can be reduced or the type
of SSRI can be changed. The SSRI with least chance to produce sexual
????
dysfunction is Welbutrin.
I think you mean "anti-depressant" :-(
[bupropion / wellbutrin is NOT an ssri]
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
http://www.truestarhealth.com/Notes/1452005.html
Interactions with Herbs
GINKO BILOBA
In three men and two women treated with fluoxetine or sertraline (SSRI
drugs closely related to paroxetine) for depression who experienced
sexual dysfunction, addition of Ginkgo biloba extract (GBE) in the
amount of 240 mg per day effectively reversed the sexual dysfunction.6
This makes sense because ginkgo has been reported to help men with some
forms of erectile dysfunction.7
http://www.mhsanctuary.com/borderline/ginkgo.htm
Ginkgo Biloba for Antidepressant-Induced Sexual Dysfunction
Alan J. Cohen M.D.
University of California at San Francisco, San Francisco, California,
USA
Barbara Bartlik
New York Hospital-Cornell Medical Center, New York, New York, USA
In an open trial gingko biloba, an extract derived from the leaf of the
Chinese ginkgo tree and noted for its cerebral enhancing effects, was
found to be 84 % effective in treating antidepressant-induced sexual
dysfunction predominately caused by selective serotonin reuptake
inhibitors (SSRIs, N = 63). Women (n = 33) were more responsive to the
sexually enhancing effects of ginkgo biloba than men (N = 30), with
relative success rates of 91% versus 76%. Gingko biloba generally had a
positive effect on all 4 phases of the sexual response cycle:
http://www.natural-hrt.com/artman/publish/article_114.shtml
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
http://www.marinurology.com/articles/sex/
Sexual dysfunction is a concern shared by all cultures. Aphrodisiacs,
remedies taken to enhance sexual desire and performance, are described
throughout the world. I found Johan's Guide to Aphrodisiacs a
fascinating and encyclopedic introduction to the subject.
Are they all placebos? Well probably, although our current literature
hints otherwise. It seems that GINKO BILOBA may be useful for loss of
libido and orgasm in patients taking SSRI antidepressants, such as
Prozac or Effexor. About 40% of patients taking these drugs report some
degree of sexual dysfunction. Gingko, in the reported experience of one
clinician, improved sexual desire and orgasm in most of these men and
women.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
<URL: http://www.drugstore.com/qxa1251_333181_sespider-can_monoamine_
oxidase_inhibitors_maois_cause_sexual_dysfunction.htm >
Phenelzine (brand name Nardil), tranylcypromine (Parnate), isocarboxazid
(Marplan), and selegiline (Eldepryl) are drugs called monoamine oxidase
inhibitors (MAOIs). These drugs have been associated with sexual
dysfunction in some people. Sexual dysfunction is a general term for
symptoms such as decreased sex drive, difficulty with erections, loss of
sexual sensation, inability to reach orgasm, painful ejaculation,
delayed ejaculation, and vaginal dryness. Experts don't know the rate of
sexual dysfunction occurring in people taking MAOIs because this effect
has not been well recorded. MAOIs may cause less sexual dysfunction than
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
other antidepressants called selective serotonin reuptake inhibitors
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
http://www.drugstore.com/qxa1250_333181_sespider-can_selective_serotonin
_reuptake_inhibitors_ssris_cause_sexual_dysfunction.htm
Can selective serotonin-reuptake inhibitors (SSRIs) cause sexual
dysfunction?
+-----------------------------------------------------------------------
At least 30 percent to 60 percent of people taking selective serotonin-
reuptake inhibitors (SSRIs) have reported sexual dysfunction. Sexual
dysfunction is a general term for symptoms such as decreased sex drive,
difficulty with erections, loss of sexual sensation, inability to reach
orgasm, painful ejaculation, and vaginal dryness. SSRIs are a group of
antidepressant drugs including fluoxetine (brand name Prozac),
sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and
citalopram (Celexa).
There are several ways to regain normal sexual function while taking
antidepressants. Sometimes normal sexual function returns on its own as
antidepressant therapy is continued. Another approach is to reduce the
antidepressant dose, although this should only be tried under the close
supervision of your doctor. Changing to a different type of anti-
depressant drug is another option. Bupropion (Wellbutrin),
~~~~~~~~~~~~~~~~~~~~~~
nefazodone (Serzone), and mirtazapine (Remeron) are antidepressants with
~~~~~~~~~~~~~or Tradozone~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
few or no reported sexual side effects.
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Hope This Helps!
-- . . : : ,; . : ' ___.
uno, dos, tres, |FUEGO| .:. .:. .:': :' .:':' :. . : (") #oH|
' ' :' : :' : .::. H_ ~~~|
< > __ ,;;,. \\::// R_) |
'-|"""(") {__}::===== ....'''' ' ' ' ___..\||/....L\. ...|
____||--|_'--/__\___ '' .--''':::::::::::::::::::::
\ / /////////////S.Coronado/////
;'^';-._.-;'^';-._.-;'^';-._.-;'^';-._;'^';-._.-;'^';-._.-;'^';-._.-;'^
LRonHubbard is shelled byGoats inHell.READ http://www.ronthewarhero.org
Ernie Sty
"Dave Bird" <dave.xemu...@nospam.demon.co.uk> wrote in message
news:Wg6XNfA$wnNB...@xemu.demon.co.uk...
> In article<89c8d6f6.04083...@posting.google.com>, john russel
> <john...@hotmail.com> writes:
>>Hi,
>>
>> About a year ago a new doctor switched me from Paxil to Prozac,
>>because the Paxil seemed to have burnt out (after 2 years). After 3
>>days on Prozac I had an unusual orgasm, where there was a long (4
>>seconds?) delay after the orgasm started (no pulsing) and before
>>ejaculation, and then the semen just ran out, it didn't "shoot" as
>>usual. The next orgasm, 2 days later, was more normal and did not have
>>the delay, but the semen just ran out again, and the feeling was not
>>nearly as intense as normal. When the same thing happened again (a
>>couple days later) I quit taking the prozac. The change in orgasm
>>didn't go away, and the feeling is still not very intense - it's been
>>over a year now.
>> Is there anything I can do to correct this problem and be back to
>>normal? I cross-posted this to the prostate group, as someone there
>>may have an answer. There was never any pain during orgasm. I think it
>>would be quite a coincedence if I actually have a problem with my
>>prostate.
>
> SSRIs often cause reduced, delayed, or no- orgasm. The effect is
> less obvious with paxil than prozac, because paxil clears from the body
> in about 2.5 days but prozac in about 21 days.
Three weeks? I thought it was more like four to six?
Dr. Wayne Simon
"Ernie Sty" <fake_...@yahoo.com> wrote in message
news:3_ednQBbRbg...@giganews.com...
>heard a few patients that have been switched from typical antihypertensive
>meds, to ARB's (angiotensin receptor blockers), that their sexual climax
>was enhanced. I have never looked this up in the literature to see if it
>has been reported in the medical literature. Just a thought based on a few
>cases.
Bob Travis
testosterone, psychogenic problems. I would talk to my psychiatrist or
seriously consider getting a second opinion. Possibly qnother drug would
work better: Wellbutrin, Elavil, perhaps an MAO inhibitor, or maybe a
different SSRI with fewer side effects.
"Ernie Sty" <fake_...@yahoo.com> wrote in message
news:3_ednQBbRbg...@giganews.com...
>
Dave Bird
in three weeks, hence 6 to 9 weeks to get rid of it altogether.
I have never used it myself.
In article<is36f.500804$xm3.474223@attbi_s21>, Bob Travis
<e_q...@hotmail.com> writes:
>Maybe there are additional factors to be considered: pre-diabetes, low
>testosterone, psychogenic problems. I would talk to my psychiatrist or
>seriously consider getting a second opinion. Possibly qnother drug would
>work better: Wellbutrin, Elavil, perhaps an MAO inhibitor, or maybe a
>different SSRI with fewer side effects.
Search the web, or the record of this newsgoup, for terms
'SSRI' AND 'Sexual Dysfunction'. I have written about it before.
You should try *** STABLON *** and WELLBUTRIN combined. Doses of
3mg Aprima/Apomorphine, currently sold as a viagra type sexual booster,
might also benefit individual occasions. (I am not an MD).