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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by CLK on August 11, 2001, at 8:15:07
Okay - this is going to sound whiney and wimpy... but here it goes anyway.
I keep hearing people say not to worry about the sexual side effects of the anti-depressant medications. "Deal with the depression first and then worry about your sex life."
How exactly do you do that? I mean the health of my marriage is directly related to my mental state. If things are not going well in my marriage this has a direct effect on my depression.
How the hell am I supposed to tell my husband that not only does he have to put up with me being a lunatic b*tch, moody, irritable, lethargic, tired, snappish, a terrible housekeeper, the side effects (if any) from the one or more medications I have to try, AND you're not likely to get any for 6 months, a year, two years...
Come on. Be realistic. My mom has been on a series of antidepressants for at least a decade. When she stops taking her meds you can TELL - even if she misses just one dose.
According to mom her libido has been practically non-existant for 8 years. EIGHT years. Okay she and dad have been married for almost 40 years - so maybe when you are 60 and have been married for forever it doesn't matter as much - but I'm only 32 and we've only been married for 6 years.
What exactly do I tell my spouse?
Not to mention - what about me? I happen to enjoy having a sex life. I, personally, believe that medication that either lowers my sex drive or interferes with my ability to have an or*asm would be a real 'downer'.
I don't mean to sound b*tchy, but really - how do you totally ignore the potential problems?
Posted by SalArmy4me on August 11, 2001, at 8:58:55
In reply to Sexual side effects and depression...., posted by CLK on August 11, 2001, at 8:15:07
There are a lot of solutions to this problem. I firmly believe in Remeron as the sovereign remedy: http://www.dr-bob.org/tips/split/Mirtazapine-for-SSRI-ADRs.html
http://www.dr-bob.org/tips/split/SSRI-sexual-dysfunction.htmlOther ideas:
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, orgasmBupropion †
- 75-150 mg/d, qd or bid divided doses
- For SSRIs or venlafaxine, fluoxetine may raise bupropion levels; usual precautionary measures for bupropion
- Libido, arousal, orgasmMirtazapine †
- 15-45 mg/d
- For SSRIs, venlafaxine
- OrgasmNefazodone †
- Start 50 mg/d, up to 150 mg/d
- SSRIs, venlafaxine
- OrgasmGranisetron †
- 1 mg prn
- ? Use of other 5-HT3 antagonists
- 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 jason60 on August 11, 2001, at 11:11:49
In reply to Sexual side effects and depression...., posted by CLK on August 11, 2001, at 8:15:07
I agree not being able to have a sex life is unacceptable.
I think there are enough effective medications out there That you should probably be able to find one that works for depression and does not affect your sex life. Tell your doctor that this side
effect is unacceptable and keep trying different
Meds until you find one that works for you.> Okay - this is going to sound whiney and wimpy... but here it goes anyway.
>
> I keep hearing people say not to worry about the sexual side effects of the anti-depressant medications. "Deal with the depression first and then worry about your sex life."
>
> How exactly do you do that? I mean the health of my marriage is directly related to my mental state. If things are not going well in my marriage this has a direct effect on my depression.
>
> How the hell am I supposed to tell my husband that not only does he have to put up with me being a lunatic b*tch, moody, irritable, lethargic, tired, snappish, a terrible housekeeper, the side effects (if any) from the one or more medications I have to try, AND you're not likely to get any for 6 months, a year, two years...
>
> Come on. Be realistic. My mom has been on a series of antidepressants for at least a decade. When she stops taking her meds you can TELL - even if she misses just one dose.
>
> According to mom her libido has been practically non-existant for 8 years. EIGHT years. Okay she and dad have been married for almost 40 years - so maybe when you are 60 and have been married for forever it doesn't matter as much - but I'm only 32 and we've only been married for 6 years.
>
> What exactly do I tell my spouse?
>
> Not to mention - what about me? I happen to enjoy having a sex life. I, personally, believe that medication that either lowers my sex drive or interferes with my ability to have an or*asm would be a real 'downer'.
>
> I don't mean to sound b*tchy, but really - how do you totally ignore the potential problems?
Posted by akrake on August 12, 2001, at 8:21:32
In reply to Sexual side effects and depression...., posted by CLK on August 11, 2001, at 8:15:07
clk, what meds are you on?
>I mean the health of my marriage is directly related to my mental state. If things are not going well in my marriage this has a direct effect on my depression.this is how i feel too...that's why i got off of the sarafem/prozac....even though it WORKED for my pmdd.....i also had the shakes and high bp with it....not just a lack of desire and no way i could have an orgasm....actually, that's not true about the lack of desire....i'd have vivid dreams that were somewhat erotic....and even wild fantasies (boy, did i want to act on some of those!) but what good did they do me if i could orgasm...it was extremely frustrating.
> How the hell am I supposed to tell my husband that not only does he have to put up with me being a lunatic b*tch, moody, irritable, lethargic, tired, snappish, a terrible housekeeper, the side effects (if any) from the one or more medications I have to try, AND you're not likely to get any for 6 months, a year, two years...
i just sort of faked it until i could get to my doc and discuss changing meds. i hate to say that, but it's true. i wanted to have sex, it just wasn't enjoyable anymore.
> What exactly do I tell my spouse?
>
> Not to mention - what about me? I happen to enjoy having a sex life. I, personally, believe that medication that either lowers my sex drive or interferes with my ability to have an or*asm would be a real 'downer'.
>i'm on wellbutrin and it totally turned around my sex life. the funny thing is, 2-3 months before i started the meds that killed my desire, i was having problems having an orgasm anyway (sign of depression/pmdd).
amie
Posted by Ted on August 12, 2001, at 13:41:09
In reply to Re: Sexual side effects and depression.... » CLK, posted by akrake on August 12, 2001, at 8:21:32
CLK & amie,
In addition to my ADs, my wife also takes them. We both have sexual side effects to deal with. You think you're frustrated?!?!
Here are some ideas to try:
1. Switch to zoloft or celexa. They seem to be the weakest ADs and Celexa is supposedly the most specific and least interfering with anorgasmia. (my wife and I take zoloft + wellbutrin)
2. zoloft & celexa both have relatively short half-lives in the bloodstream. Use this to your advantage: Plan with your partner when you want to have sex and don't take your AD that day until afterward. I know this takes the spontaneity out it, but it's better than nothing.
If your symptoms worsen when you skip a dose, take half a dose and see if it OK. If skipping 1 day doesn't do the trick, try 2 days. Paxil & prozac are the worst for anorgasmia because of their long halflives and potent effects.
3. If you have a patient and understanding partner, women have the advantage with sex. I found that oral sex will give my wife all the pleasure she can handle in one evening despite her ADs. :-) Men have it worse: if the ADs don't cause erectile difficulties, then we will die of exhaustion before we get anywhere. :-(
I find the med holidays imperative to satisfying sex. Also, my wife and I have learned to enjoy intercourse without orgasm (after all -- women have had to put up with this for eons). Of course it isn't nearly as satisfying, but it still feels really good. :-)
Good luck
Ted
Posted by Aquage on August 13, 2001, at 17:38:09
In reply to Re: Sexual side effects and depression.... » akrake, posted by Ted on August 12, 2001, at 13:41:09
I would be careful giving advise telling anyone to not take their meds or cut down on their meds without pdoc's knowledge. Some meds can have bad side effects if you miss even a single dose.
This is the end of the thread.
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