Posted by bleauberry on July 6, 2009, at 17:09:55
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
I think at some point we all have to ask ourselves what do we want more, to be free of depression or to have fabulous sex on demand? I think it is unrealistic to expect both. It doesn't apply just to depression, but to diabetes, heart disease, liver disease, strokes, limb injury, lyme disease, prostate, and gosh the list could go on and on if I thought about it. Anyone with a disease has probably had their sex life impacted in one way or another, both from the disease itself and from the treatment of it.
Remeron is not a good antidepressant in my opinion. It scores well in clinical trials because of generally robust decreases in the depression questionnaire topics relating to sleep, anxiety, and appetite, but not very well in core depressive symptoms. It can however help with sex on SSRIs by partially blocking the serotonin receptors. That is, if the patient can manage taking one of the most potent antihistamines on the planet, which is what it does much more strongly than anything else it is supposedly and erroneously claimed to do. But that is another topic.
Of the SSRIs, my experience is that Lexapro is the most sex friendly. Lexapro, unknown to most people, can be therapeutic and even induce total remission, in doses far too low to cause any significant side effects. This will get some laughs, but seriously I am talking of a dose range of 1/10th 1mg up to 5mg. Don't look to clinical studies for this kind of success, because they don't do it. The real world is what counts.
In the TCA category I only have experience with Nortriptyline and Desipramine. I think Desipramine did have some side effects due to its strong peripheral noradrenergic effect. Nortriptyline on the other hand actually improved desire, frequency, and ability, above baseline. This was after the first few days where it felt like sex was going dead. That was short lived. I give Nortriptyline the thumbs up. At reasonable doses that is.
If someone is stable and well on an SSRI, but the sex department is closed, there are ways to deal with that. It's just that the patient will not have normal daily thoughts or desires of sex. But they can stimulate them on demand. Things that are short-lived dopamine boosters can do that. Specifically I am thinking of Ritalin. Or if someone experiences a boost of sex in the first day or two of Wellbutrin, then take the Wellbutrin only on days when sex is planned.
Which brings up another point. The disease comes first. We gotta deal with that. What good is having sex if the other 23 hours of your day are hell. When depression is properly treated, and sexual side effects are present, we have to relearn a life of planned sex rather than spontaneous sex. Some verbal dirty talk and foreplay through text messaging and voicemails can heighten the experience and anticipation of a planned evening.
When the ability to have sex is hampered, Viagra works pretty good most of the time. Tricks to make it work best include chewing the pill, letting it rest under the tongue a few minutes before swallowing, and taking it on an empty stomach. No food for the previous 3 hours. The bedroom is important. Candles if you like them. Block out noise with a fan or a hummer or music. No distractions. No hurry. No pressure.
In the herbal category there are some potent pro-sex herbs. Horny goat weed, tongkat ali, and a couple others. Do a search on Passion RX for some good ideas. These herbs can be taken on the day of planned sex, maybe the day before as well with some experimentation, but not continuously. They frequently come with stimulation and insomnia as side effects. But they can be quite potent in the sex department.
Find your best antidepressant. Stay on the lowest dose possible. Then when you see what kind of side effects are there, manage them. I think once an illness hits, it is unrealistic to expect everything to go on as normal, or as pre-illness.
In the meds category I can think of nothing more sex friendly than ultra low dose Lexapro combined with low dose Nortriptyline. For many people Wellbutrin is a miracle. For me, it did the opposite by inducing a much worse depression and killing all desire and ability for sex. But that may be because I tried generic instead of brand. but that is another topic.
Treat the depression. Then manage the sex. Millions of people with dozens of diseases have to do the same thing. That's just the way it is.
Stay away from Paxil. That one in particular is so anti-sex you would need some serious management skills to deal with it.
poster:bleauberry
thread:905031
URL: http://www.dr-bob.org/babble/20090630/msgs/905290.html