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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by gilbert on June 4, 2001, at 22:15:03
I have tried to submit this on a follow up thread and it won't take so here I go again. I am currenlty on xanax does great for panic but excaserbates my OCD. I have tried all of the ssris plus effexor with anorgasmia starting very quickly at very low doses. I have tried the cures for ssri induced anorgasmia without success. I have tried wellbutrin gave me tachycardia, i have tried remeron and was too dizzy to drive same with desyrel, I have tried serzone and felt awful, I have tried 3 tricyclics all with cardiac side effects, and I am on Zestril for high blood pressure so I do not want cardiac side effects, I have tried buspar monotherapy. What the heck can I try that helps my ocd and panic together, I have never stayed on an ssri past 4 weeks because the side effects kept getting progressively worse....no sign of sexual recovery. I am currently on 5 mg prozac and after 5 days already my Mr Happy is numb during orgasm. Should I stick out the dose Prozac Any other meds to try.....I seem to be stuck between no panic and sex with ocd or no ocd no panic no sex. AAHHHHHHHHHHH!
Gil
Posted by SalArmy4me on June 4, 2001, at 22:20:29
In reply to Cam, John L. or any med braniacs I need help, posted by gilbert on June 4, 2001, at 22:15:03
Methylphenidate †
- 5-40 mg/d
- For SSRIs or venlafaxine
- Libido, arousal, orgasmDextroamphetamine †
- 5-40 mg/d
- Avoid night dosing (insomnia)
- Libido, arousal, orgasmPemoline †
- 18.75-75 mg/d
- Check liver function
- Libido, arousal, orgasmGinkgo biloba extract †
- 180-240 mg/d, tid, divided doses
- Potential increased clotting time, possible flatulence
- Libido, arousal, orgasmBethanechol †
- 10-50 mg prn 1 hour before sex
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalNeostigmine †
- 200 mg/d, tid divided doses
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalEstrogen creams or lubricants
- As needed
- For vaginal dryness, atrophy of vaginal tissue
- ArousalAmantadine
- 100 mg bid
- Caution in patients predisposed to psychosis
- OrgasmCyproheptadine
- 4-12 mg qhs
- MAOIs, TCAs, SSRIs, venlafaxine; watch for reemergence of depressive symptoms; sedating
- OrgasmBuspirone †
- 30-60 mg/d, bid divided doses
-
- Libido, orgasmNefazodone †
- Start 50 mg/d, up to 150 mg/d
- SSRIs, venlafaxine
- OrgasmSildenafil
- 50-100 mg/d
- Contraindicated with nitrates
- Libido, arousal, orgasmYohimbine †
- 5.4 mg tid
- Can be anxiogenic; ? safety with MAOIs
- Libido, arousal, orgasm
Posted by gilbert on June 4, 2001, at 22:36:37
In reply to Re: Cam, John L. or any med braniacs I need help » gilbert, posted by SalArmy4me on June 4, 2001, at 22:20:29
> Methylphenidate †
> - 5-40 mg/d
> - For SSRIs or venlafaxine
> - Libido, arousal, orgasm
>
> Dextroamphetamine †
> - 5-40 mg/d
> - Avoid night dosing (insomnia)
> - Libido, arousal, orgasm
>
> Pemoline †
> - 18.75-75 mg/d
> - Check liver function
> - Libido, arousal, orgasm
>
> Ginkgo biloba extract †
> - 180-240 mg/d, tid, divided doses
> - Potential increased clotting time, possible flatulence
> - Libido, arousal, orgasm
>
> Bethanechol †
> - 10-50 mg prn 1 hour before sex
> - Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
> - Arousal
>
> Neostigmine †
> - 200 mg/d, tid divided doses
> - Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
> - Arousal
>
> Estrogen creams or lubricants
> - As needed
> - For vaginal dryness, atrophy of vaginal tissue
> - Arousal
>
> Amantadine
> - 100 mg bid
> - Caution in patients predisposed to psychosis
> - Orgasm
>
> Cyproheptadine
> - 4-12 mg qhs
> - MAOIs, TCAs, SSRIs, venlafaxine; watch for reemergence of depressive symptoms; sedating
> - Orgasm
>
> Buspirone †
> - 30-60 mg/d, bid divided doses
> -
> - Libido, orgasm
>
> Nefazodone †
> - Start 50 mg/d, up to 150 mg/d
> - SSRIs, venlafaxine
> - Orgasm
>
> Sildenafil
> - 50-100 mg/d
> - Contraindicated with nitrates
> - Libido, arousal, orgasm
>
> Yohimbine †
> - 5.4 mg tid
> - Can be anxiogenic; ? safety with MAOIs
> - Libido, arousal, orgasmThanks Sal what a list You should be a phamacist...maybe you are... but my pdoc wont give me any of the speedy type solutions because I have experienced tachycardia whenever my ephinephrine or norephrinine levels get tweeked. Saw a cardio doc and any of the stimulant types including caffeine are a no go for me. I did try the ginko and the buspar the serzone and remeron wihtout results. Some of the organics like ginseng have sent my heart on a little race as well I seem to be so sensitive to any upper type herbs or drugs also any vasodialotors I had tachycardia on calcium channel blockers too when the pipes get too opened up my heart decides to go for ride very scaaaaary!
Gil
Posted by SalArmy4me on June 4, 2001, at 22:53:57
In reply to re:salarmyforme, posted by gilbert on June 4, 2001, at 22:36:37
You're pretty much screwed....unless you try Amantadine or Viagra.
Posted by gilbert on June 4, 2001, at 23:02:50
In reply to Re: re:salarmyforme » gilbert, posted by SalArmy4me on June 4, 2001, at 22:53:57
> You're pretty much screwed....unless you try Amantadine or Viagra.
I am pretty much screwed but since I can't screw I might as well get screwed....LOL...I know mine is an unusual case and my doc is even reluctant to give me the viagra cuz he is afraid my pipes will open up too much vasodialation and then its off to the races pulse 220.......
I have not tried remeron monotherapy for a long period but am a little concerned with norepinephrine effects is remeron strong there if it is weak maybe I can give it a shot...also is the whole cholesterol thing overblown with remeron don't want to add a cholesterol med to the list if I don't have too. My liver will go on strike.
Gil
Posted by Elizabeth on June 4, 2001, at 23:53:20
In reply to Cam, John L. or any med braniacs I need help, posted by gilbert on June 4, 2001, at 22:15:03
Have you tried combinations? Like Prozac + Buspar? Wellbutrin + propranolol (reverses tachycardia, can also help with some panic symptoms)? An AD plus a low-dose antipsychotic? etc.
How bad was the tachycardia from Wellbutrin, if you remember? (i.e., what was your pulse?) Wellbutrin isn't a great choice for you unless it was just to offset the sexual side effects of SSRIs: it tends to exacerbate anxiety symptoms and has been shown to be of no value for OCD or PAD. The same is true of stimulant drugs such as amphetamine, Ritalin (methylphenidate), and Cylert (pemoline).
What were the cardiac side effects you got on TCAs?
Which anti-anorgasmia tricks did you try?
Tachycardia from Ca++ blockers can sometimes be alleviated by drinking a lot of fluids. Hypertension is complicated to treat because of the ways your body tries to compensate for the effects of the drugs used to treat it -- one drug is quite often not sufficient. You might need to add a beta blocker (propranolol, which I mentioned above, is an example), ACE inhibitor, etc.
It sounds like you're supersensitive to side effects -- a common trait among people with anxiety disorders, especially those associated with somatic sensitivity, like panic disorder. You might need to use a complicated combination in order to offset these side effects and keep your blood pressure under control. Also, starting at very low doses is the way to go with most meds (especially SSRIs and TCAs) if you have extreme sensitivity to side effects.
Hope this helps.
-elizabeth
Posted by SalArmy4me on June 5, 2001, at 0:44:20
In reply to Salarmy at least lie to me to make me feel better, posted by gilbert on June 4, 2001, at 23:02:50
I like Remeron, and I think it may have a chance at helping you. Here's my shameless plug for Remeron:
--It can be used for all types of depression, anxiety, OCD, and insomnia.
--It is convienient because it is taken only once at bedtime.
--It may improve libido and sexual performance (its the only medication that improves mine). Dr. Bob Hsieung's fellow doctors recommend it for sexual dysfunction.
--You can take Remeron with most antidepressants except MAOIs.
--It has none of the anticholinergic effects of SSRIs.
--It has gained recognition as a very useful medication from psychiatrists in only four years of FDA approval.I myself started Remeron at 60 mg right away and had no side-effects. I had no weight gain or sedation during the day.
http://www.dr-bob.org/tips/split/Mirtazapine-for-SSRI-ADRs.html
www.remeron.com
http://www.rxlist.com/cgi/generic/mirtaz.htm
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