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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by lrc on July 21, 2001, at 14:39:54
After paxil, I'm almost afraid to take anything but I was wondering about the sexual disfunction while on Wellbutrin. I need to quit smoking and lose some weight too. How about anxiety attacks, would it help that or hurt?
Posted by pellmell on July 21, 2001, at 16:53:20
In reply to Wellbutrin and sexual disfunction?, posted by lrc on July 21, 2001, at 14:39:54
Hi,
Wellbutrin can actually increase your libido and might even help with arousal. I've seen one or two people on this board complain of sexual dysfunction while taking it, but from everything else I've read they've got to be in the extreme minority. At any rate it'll be nothing like Paxil, which likely inhibits nitric oxide synthease in addition to causing typical SSRI-induced sexual dysfunction.
Wellbutrin should help you quit smoking, too, and might help you lose some weight. It made me so anxious, though, that I was eating all the time. Which brings me to your last question... For many people, including me, Wellbutrin is very anxiogenic. For some it's just a start-up side-effect that they can push through over a few weeks, but it didn't go away for me during the month I tried it.
I think if Wellbutrin makes you more anxious you should look for another drug, or at least supplement it with a benzo.
-pm
> After paxil, I'm almost afraid to take anything but I was wondering about the sexual disfunction while on Wellbutrin. I need to quit smoking and lose some weight too. How about anxiety attacks, would it help that or hurt?
Posted by JohnL on July 21, 2001, at 19:25:12
In reply to Re: Wellbutrin and sexual disfunction? » lrc, posted by pellmell on July 21, 2001, at 16:53:20
Dittos to everything pellmell said.
Posted by MB on July 21, 2001, at 22:07:27
In reply to Re: Wellbutrin and sexual disfunction? » lrc, posted by pellmell on July 21, 2001, at 16:53:20
< snip >> At any rate it'll be nothing like Paxil, which likely inhibits nitric oxide synthease in addition to causing typical SSRI-induced sexual dysfunction.
< snip >
So less nitric oxide = sexual side effects?
Posted by pellmell on July 23, 2001, at 16:48:10
In reply to Re: Wellbutrin and sexual disfunction? » pellmell, posted by MB on July 21, 2001, at 22:07:27
> So less nitric oxide = sexual side effects?
Nitric oxide is essential in producing an erection in men and clitoral swelling and lubrication in females. Viagra works somewhere along this pathway; I forget exactly where (anyone else know?).
So NO synthease inhibition probably doesn't affect libido or orgasm directly. But, of course, it helps to have an erection (of the penis or clitoris) if you're trying to have an orgasm, and a few frustrating nights with ah, malfunctioning equipment, can chill your libido. :/
-pm
Posted by Mb on July 23, 2001, at 17:12:38
In reply to Re: Wellbutrin and sexual disfunction? » MB, posted by pellmell on July 23, 2001, at 16:48:10
This is all very interesting. I'm always amazed (but then again, I guess I shouldn't be) at how complex biochem can get. Biology is a subject I always wish I had taken more of...I guess there's always still time.
Parenthetically, a few years ago, some kids were found dead in Golden Gate park. They had stolen a tank of what they believed to be nitrous oxide and inhaled it. It turned out to be NO. I guess the stuff is pretty nasty.
Posted by pellmell on July 23, 2001, at 20:09:22
In reply to Re: Wellbutrin and sexual disfunction? » pellmell, posted by Mb on July 23, 2001, at 17:12:38
...(well, *almost* everything) I learned from a textbook written by Stephen M. Stahl entitled _Essential Psychopharmacology_. It was fascinating. I read every word in the damn thing, except the reveiw exercises at the end. And the index. :) The cartoon diagrams are great (especially the ones that involve free radicals..hehe). I'll be reluctant to return it to the library.
And I'm an English major. Haven't taken a biochemistry class since before I learned what a moron I was in the lab. I can do the conceptual stuff, but I just don't get along well at all with reagents. :)
-pm
Yeah, playing with a tank of NO might give you the last erection of your life...
Posted by Sunnely on July 23, 2001, at 22:56:13
In reply to Re: Wellbutrin and sexual disfunction? » MB, posted by pellmell on July 23, 2001, at 16:48:10
How sildenafil (Viagra) works:
The physiologic mechanism of penile erection involves the release of nitric oxide (NO) in the corps cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased level of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus carvernosum and allowing inflow of blood. Viagra has no direct relaxing effect on isolated human corpus cavernosum, but enhances the effect of NO by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by Viagra causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Viagra at recommended doses has no effect in the absence of sexual stimulation.
Studies in vitro have shown that Viagra is selective for PDE5. Its effect is more potent on PDE5 than on other known phosphodiesterases ( >80-fold for PDE1, >1000-fold for PDE2, PDE3, and PDE4). The approximately 4,000-fold selectivity for PDE5 versus PDE3 is important because that PDE is involved in control of heart contractility. Viagra is only about 10-fold as potent for PDE5 compared to PDE6, an enzyme found in the retina; this lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or blood levels of Viagra.
A comprehensive battery of visual function tests was conducted at doses up to twice the maximum recommended dose of Viagra. Mild, transient, dose-related impairment of color discrimination (blue/green) was detected using the Farnsworth-Munsell 100-hue test, with peak effects near the time of peak plasma levels. This finding is consistent with the inhibition of PDE6, which is involved in phototransduction in the retina. In flexible titration studies of 4 to 26 weeks, 3% of patients on Viagra reported visual disturbances, described as color tinge or light sensitivity, compared to no such findings in placebo-treated patients.
> > So less nitric oxide = sexual side effects?
>
> Nitric oxide is essential in producing an erection in men and clitoral swelling and lubrication in females. Viagra works somewhere along this pathway; I forget exactly where (anyone else know?).
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