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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by DannaB on December 16, 2006, at 20:54:07
I've had a long history of therapy and have been taking medications for years. My symptoms are basically depression as well as intense anxiety. I have tried a number of different drugs (Effexor, Wellbutrin, Lexapro, Celexa, Prozac, Paxil, etc.). The only drug that makes me feel like "myself" is Celexa.
When I am on Celexa, I feel calm. I have no temper to speak of. With Celexa, I'm just "me" and I'm able to laugh things off and not let them get to me. I feel like I'm a nicer person to be around when I'm on the medication. I like myself, and this helps my self esteem. I don't worry nearly as much and am more confident. Therefore, my relationships are much better.
Problem is, I cannot tolerate the sexual side effects I experience with this medication. Basically, I feel completely numb down there and orgasm is an impossibility. THIS side effect has a negative effect on my relationships. What this means is that I don't stay on the drug. I have tried to add Wellbutrin or ginko biloba or L-tryptophan, and nothing helps relieve this side effect. My doctor has tried to wean me off Celexa and try other meds, like Wellbutrin, but every time I start to feel the scary bad feelings and I run back to Celexa. Then I have the side effect and feel the need to go off it.
I guess my question is this. What medications are most similar to Celexa and would therefore be most likely to work? Might there be an anti-anxiety or mood stabilizing med that would give me the calm, relaxed feeling I have on Celexa? Lastly, has anyone dealt successfully with a situation like the one I'm describing?
My doctor is very confident in my ability to get better through therapy. He seems to believe that drugs are not the answer to my depression, since we have not been able to find a drug that works without intolerable side effects. He also thinks that I run back to Celexa in order to "protect" myself from being close to someone sexually, since it makes me lose interest in sex. There may be some truth to this, but the drug also seems to be the only thing that makes me feel happy and relaxed. I'm starting to feel that I'll never get out of this pit of despair.
Posted by Phillipa on December 16, 2006, at 21:47:08
In reply to Can't stay on my antidepressant--help!!!, posted by DannaB on December 16, 2006, at 20:54:07
I don't want to sound mean or disrespectful but if only I could find a med that lets me feel normal, laugh, work again I would stay on it as my husband and I have discussed sexual problems. And to us it doesn't mean a thing as both of us would be so happy to have me back. The only thing you say is your doc thinks theraphy would benefit you more than celexa that you use it to distance yourself. Do you feel you do this? Love Phillipa
Posted by dessbee on December 17, 2006, at 7:56:30
In reply to Re: Can't stay on my antidepressant--help!!! » DannaB, posted by Phillipa on December 16, 2006, at 21:47:08
You may want to try combining Celexa with Buspar, which is for mild/moderate anxiety disorders. It augments the effect of SSRI. That way you may be able to decrease SSRI dosage so you can avoid sexual dysfunction.
Posted by dessbee on December 17, 2006, at 8:36:49
In reply to Re: Can't stay on my antidepressant--help!!! » DannaB, posted by Phillipa on December 16, 2006, at 21:47:08
Sorry Phillipa, I was referring to DannaB
Posted by Quintal on December 17, 2006, at 9:56:48
In reply to Can't stay on my antidepressant--help!!!, posted by DannaB on December 16, 2006, at 20:54:07
Have you tried cyproheptadine to treat the sexual dysfunction DannaB? Cyproheptadine temporarily lowers serotonin levels (abnormally high serotonin levels are believed to be the cause of sexual dysfunction) if taken an hour or so before sex.
http://en.wikipedia.org/wiki/Cyproheptadine
http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Sexual_side_effectsCabergoline is another drug that can counter the low libido and anorgasmia of SSRIs. It sounds unlikely that your pdoc would be willing to prescribe it as cabergoline is quite expensive and is normally used to treat Parkinson's disease. Remeron or bromocriptine are other options. I don't quite buy your pdoc's idea that you're using Celexa to distance yourself from sexual relationships. I don't think you'd be seeking treatment to reverse the sexual dysfunction if that were the case.
I respect what Phillipa is saying regarding sex and mature relationships, but this may not be a realistic an option for young people starting new relationships or who wish to have a more casual sex life.
There are other ADs like Parnate that have few sexual side effects (though this is may be considered an extreme choice and I realise your current pdoc may not be willing to prescribe it). The possibility of using benzos to calm the fear and jitteriness of stimulating ADs like Wellbutrin may be another option. Have you considered trying a different pdoc?
Q
Posted by blueberry1 on December 17, 2006, at 11:33:37
In reply to Can't stay on my antidepressant--help!!!, posted by DannaB on December 16, 2006, at 20:54:07
Since celexa works for you, consider that a blessing. It is more of a blessing than you are aware. Actually, when you stop taking it, you are aware I know.
There are other options for the sexual dysfunction. Buspar has been mentioned. It works sometimes.
Boosting dopamine temporarily helps. Dopamine is the feel-good pleasure neurotransmitter that has a lot to with sex. Celexa dampens down dopamine. You could try a tyrosine supplement from the health food store. It's cheap. You would likely feel very alert, probably insomnia, and the next morning you would maybe have some of the fear, but it would fade fast back to just celexa. Other options...the theory is that sexual dysfunction is caused by too much serotonin at certain specific serotonin receptors...drugs that block those receptors are remeron or zyprexa. And there are dopamine agonists, drugs that basically mimic dopamine.
The closest med to celexa is lexapro. Other than that, you would just have to do a trial and error thing of zoloft or prozac. Forget paxil and effexor, they almost always cause the same problems you already have. Prozac is often, but not always, the most tame in the sex department. Zoloft is ok at low doses. I think though that since celexa works it would be best to keep experimenting with antidotes. You've tried a few already, but there are more.
Posted by Racer on December 19, 2006, at 19:33:25
In reply to Re: Can't stay on my antidepressant--help!!! » DannaB, posted by Quintal on December 17, 2006, at 9:56:48
At least, it worked reliably for me...
It's cheap, safe, temporary, and doesn't tend to cause insomnia nor anxiety. Just the usual anti-histimine things: drowsiness, etc.
Good luck
Posted by yxibow on December 21, 2006, at 1:49:39
In reply to Re: Can't stay on my antidepressant--help!!! » DannaB, posted by Quintal on December 17, 2006, at 9:56:48
> Have you tried cyproheptadine to treat the sexual dysfunction DannaB? Cyproheptadine temporarily lowers serotonin levels (abnormally high serotonin levels are believed to be the cause of sexual dysfunction) if taken an hour or so before sex.
>
> http://en.wikipedia.org/wiki/Cyproheptadine
> http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Sexual_side_effects
>
> Cabergoline is another drug that can counter the low libido and anorgasmia of SSRIs. It sounds unlikely that your pdoc would be willing to prescribe it as cabergoline is quite expensive and is normally used to treat Parkinson's disease. Remeron or bromocriptine are other options. I don't quite buy your pdoc's idea that you're using Celexa to distance yourself from sexual relationships. I don't think you'd be seeking treatment to reverse the sexual dysfunction if that were the case.
>
> I respect what Phillipa is saying regarding sex and mature relationships, but this may not be a realistic an option for young people starting new relationships or who wish to have a more casual sex life.Its an unfortunate aspect of nearly all SSRIs, although Celexa was supposed to have less than others, but there are tradeoffs in life sometimes -- not to coin a phrase of advertising but depression hurts, a lot. I know because I have MDD concomitant with an anxiety disorder or because of the anxiety disorder. Other options include discontinuing the SSRI for a day when one wants to engage in sexual behaviour and then restarting it again.
> There are other ADs like Parnate that have few sexual side effects (though this is may be considered an extreme choice and I realise your current pdoc may not be willing to prescribe it). The possibility of using benzos to calm the fear and jitteriness of stimulating ADs like Wellbutrin may be another option. Have you considered trying a different pdoc?
What level of Wellbutrin did you reach when you tried it for sexual side effects and did you use as noted before some Valium or Klonopin ?Bromocriptine and cyproheptadine are pretty serious drugs -- bromocriptine is generally used more for prolactin sexual side effects with neuroleptics. Cyproheptadine is used in the ER to come down off of serotonin syndrome -- I hadn't really heard of Periactin being used as much orally prescribed, but I guess it is.
Keep at it, there will be a combination that works -- and I completely understand the feeling of coming off of an SSRI only to realize that the SSRI was actually working. Its an odd concept of SSRIs but I've felt that before.-- tidings
Posted by Quintal on December 21, 2006, at 10:26:43
In reply to Re: Can't stay on my antidepressant--help!!!, posted by yxibow on December 21, 2006, at 1:49:39
>What level of Wellbutrin did you reach when you tried it for sexual side effects and did you use as noted before some Valium or Klonopin ?
I took 150mg generic Bupron SR, but as a stimulant to counter the sedation of Klonopin. I've never used personally it to treat sexual problems but it is a recognised treatment for this purpose.
>Bromocriptine and cyproheptadine are pretty serious drugs -- bromocriptine is generally used more for prolactin sexual side effects with neuroleptics. Cyproheptadine is used in the ER to come down off of serotonin syndrome -- I hadn't really heard of Periactin being used as much orally prescribed, but I guess it is.
Not sure what you mean by 'serious drugs'. I think cyproheptadine is rarely used as an antihistamine because it is very sedating. I've seen it used to stimulate appetite in underweight babies though. I suppose it could cause depression in theory if taken for a long time to treat allergies - maybe another reason it is not commonly used for this purpose?
Q
Posted by yxibow on December 21, 2006, at 13:21:57
In reply to Re: Can't stay on my antidepressant--help!!! » yxibow, posted by Quintal on December 21, 2006, at 10:26:43
Just referring that bromocriptine has a pretty guaranteed list of side effects and isn't regularly rx'd. Cyproheptadine can have atropine toxicity and the only use I had really heard of was in Serotonin Syndrome because other more modern agents are available for its original intent, in general.
Posted by Karen44 on December 22, 2006, at 23:05:10
In reply to Can't stay on my antidepressant--help!!!, posted by DannaB on December 16, 2006, at 20:54:07
Your doctor sounds like a smart person and someone to listen to. Sounds like you may do better on Celexa, in part, because you can avoid sex--maybe ambivalent about it all??? Sounds like staying on Celexa and exploring in therapy what it means for you now to have or not have sex. What are the negative and positives of both--to have sex and to not have sex.
Karen44
> I've had a long history of therapy and have been taking medications for years. My symptoms are basically depression as well as intense anxiety. I have tried a number of different drugs (Effexor, Wellbutrin, Lexapro, Celexa, Prozac, Paxil, etc.). The only drug that makes me feel like "myself" is Celexa.
>
> When I am on Celexa, I feel calm. I have no temper to speak of. With Celexa, I'm just "me" and I'm able to laugh things off and not let them get to me. I feel like I'm a nicer person to be around when I'm on the medication. I like myself, and this helps my self esteem. I don't worry nearly as much and am more confident. Therefore, my relationships are much better.
>
> Problem is, I cannot tolerate the sexual side effects I experience with this medication. Basically, I feel completely numb down there and orgasm is an impossibility. THIS side effect has a negative effect on my relationships. What this means is that I don't stay on the drug. I have tried to add Wellbutrin or ginko biloba or L-tryptophan, and nothing helps relieve this side effect. My doctor has tried to wean me off Celexa and try other meds, like Wellbutrin, but every time I start to feel the scary bad feelings and I run back to Celexa. Then I have the side effect and feel the need to go off it.
>
> I guess my question is this. What medications are most similar to Celexa and would therefore be most likely to work? Might there be an anti-anxiety or mood stabilizing med that would give me the calm, relaxed feeling I have on Celexa? Lastly, has anyone dealt successfully with a situation like the one I'm describing?
>
> My doctor is very confident in my ability to get better through therapy. He seems to believe that drugs are not the answer to my depression, since we have not been able to find a drug that works without intolerable side effects. He also thinks that I run back to Celexa in order to "protect" myself from being close to someone sexually, since it makes me lose interest in sex. There may be some truth to this, but the drug also seems to be the only thing that makes me feel happy and relaxed. I'm starting to feel that I'll never get out of this pit of despair.
Posted by speed on December 23, 2006, at 2:03:46
In reply to Can't stay on my antidepressant--help!!!, posted by DannaB on December 16, 2006, at 20:54:07
> I've had a long history of therapy and have been taking medications for years. My symptoms are basically depression as well as intense anxiety. I have tried a number of different drugs (Effexor, Wellbutrin, Lexapro, Celexa, Prozac, Paxil, etc.). The only drug that makes me feel like "myself" is Celexa.
>
> When I am on Celexa, I feel calm. I have no temper to speak of. With Celexa, I'm just "me" and I'm able to laugh things off and not let them get to me. I feel like I'm a nicer person to be around when I'm on the medication. I like myself, and this helps my self esteem. I don't worry nearly as much and am more confident. Therefore, my relationships are much better.
>
> Problem is, I cannot tolerate the sexual side effects I experience with this medication. Basically, I feel completely numb down there and orgasm is an impossibility. THIS side effect has a negative effect on my relationships. What this means is that I don't stay on the drug. I have tried to add Wellbutrin or ginko biloba or L-tryptophan, and nothing helps relieve this side effect. My doctor has tried to wean me off Celexa and try other meds, like Wellbutrin, but every time I start to feel the scary bad feelings and I run back to Celexa. Then I have the side effect and feel the need to go off it.
>
> I guess my question is this. What medications are most similar to Celexa and would therefore be most likely to work? Might there be an anti-anxiety or mood stabilizing med that would give me the calm, relaxed feeling I have on Celexa? Lastly, has anyone dealt successfully with a situation like the one I'm describing?
>
> My doctor is very confident in my ability to get better through therapy. He seems to believe that drugs are not the answer to my depression, since we have not been able to find a drug that works without intolerable side effects. He also thinks that I run back to Celexa in order to "protect" myself from being close to someone sexually, since it makes me lose interest in sex. There may be some truth to this, but the drug also seems to be the only thing that makes me feel happy and relaxed. I'm starting to feel that I'll never get out of this pit of despair.Try Remeron. No sexual side effects and you will sleep great. I am able to take just 7.5mg by cutting the 15mg in half. I have tried them all and this has worked for me.
Posted by itsme2003 on December 27, 2006, at 12:41:42
In reply to Re: Can't stay on my antidepressant--help!!! » DannaB, posted by blueberry1 on December 17, 2006, at 11:33:37
> Boosting dopamine temporarily helps. Dopamine is the feel-good pleasure neurotransmitter that has a lot to with sex. Celexa dampens down dopamine. You could try a tyrosine supplement from the health food store. It's cheap. You would likely feel very alert, probably insomnia, and the next morning you would maybe have some of the fear, but it would fade fast back to just celexa. Other options...the theory is that sexual dysfunction is caused by too much serotonin at certain specific serotonin receptors...drugs that block those receptors are remeron or zyprexa. And there are dopamine agonists, drugs that basically mimic dopamine.I want to add a vote for the idea of tyrosine. I have had some luck of countering the sexual side effects of an SSRI using it. I used a fairly high dosage, about 15 grams per day. I was using the powered form and mixing it into water. If you use this it is essential that you start with a low dose and work your way up. If you notice any problems as you increase the dosage, then you should stop increasing the dosage. The dosage that you should work your way up to depends on your body weight. You should take about 5 or 6 grams per day per 100 pounds of body weight.
Posted by myblusky on December 30, 2006, at 17:43:33
In reply to Can't stay on my antidepressant--help!!!, posted by DannaB on December 16, 2006, at 20:54:07
I'm sorry but I don't believe in blaming the patient because the medication has failed them. Celexa works for you except for the sexual side effects. Well as we should all know by now that is one of the side effects of SSRI's for many people - numbness in the genitals. Lexapro did that to me and I was only on it a month. I have no issues with sex either. The damn drug had side effects for me, just as the Celexa does for you. I'm lucky that I'm able to be on Prozac and so far, it has increased my libido.
But back to you....
Please find another doctor and get a second opinion. If your doctor is unwilling to try and find a solution then find someone who is more determined to help you instead of blaming you for the shortcomings of the medication. It's a nice out for everyone to blame the patient so the drug companies don't have to make better medications and the doctors don't have to work harder to find combinations that work for each individual.
Listen to some interviews with Dr. Peter Kramer or read his books. He discusses over and over how medications need to be better and they need to cause less side effects - especially in the area of sex.Good luck to you, but please consider getting a second opinion. My friend has worked with her psychiatrist for several years and they are always tweeking and adjusting her medications. She is on a crap load of drugs, but her doctor spent the time to find a combination that works for her and she has very few side effects.
Posted by Phillipa on December 30, 2006, at 20:08:35
In reply to Re: Can't stay on my antidepressant--help!!! » DannaB, posted by Phillipa on December 16, 2006, at 21:47:08
Two pdocs basically fired me cause the meds didn't work. It was my fault. So they said get another opinion. One I asked in the beginning do you think we will be a good fit . He said yes when the meds work for you. Where do you find a pdoc like you have. Desperated. Seriously. Love Phillipa ps no tweeking just do as I say.
Posted by myblusky on December 30, 2006, at 21:06:08
In reply to Re: Can't stay on my antidepressant--help!!! » Phillipa, posted by Phillipa on December 30, 2006, at 20:08:35
I go to a non-profit clinic. Both my doctor and therapist work for the same clinic and in the same building. It helps because they can consult with one another. After going to the therapist for about 6 weeks she said that she didn't think I could do it without medication so she scheduled me an appointment with the psychiatrist.
If you have a therapist then maybe they can give you a referal to a psychiatrist. If not then I would ask friends or family members or try to find a referal through your insurance - even look online. Also - you can try and see if a university near you has a medical program as part of their school and ask them to refer you to a psychiatrist. I had a medical problem years ago that I could not find treatment for so I actually wrote a letter to a doctor who published an article about the condition in a magazine. I asked him if he could refer me to someone in my area and he sent me a letter back with a referal to a doctor near me.
There are people with treatment resistant depression, but I think most of the time doctors fail to work enough with a patient to find a solution. Yes, a lot of us have to live with some side effects, but I don't think we should give up the joys of sex because we have to be on anti-depressants. That's part of taking pleasure in life and part of being human.
Posted by Phillipa on December 30, 2006, at 22:28:59
In reply to Re: Can't stay on my antidepressant--help!!!, posted by myblusky on December 30, 2006, at 21:06:08
New area no friends. Tried three therapists. Did go on line for a pdoc and got screwed to put it bluntly. I have someone looking for me now but until then I will have to travel 4 hours each way to see my old pdoc who say what would you like to try? Love Phillipa
This is the end of the thread.
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