Posted by Tusco on April 10, 2012, at 15:46:07
In reply to Re: advice needed » Tusco, posted by tensor on April 9, 2012, at 15:04:34
I was on mirtazapine 30 mg for a long time, about 4 years. First for about 2 years mirtazapine was taken combined with setraline, then on its own and eventually with lithium.
I have tried buproprion too but not at an higher dose than 300mg. I don't think that I have post-ssri sexual dysfunction because my sexual issues started with my first episode of major depression, before I tok any medication, and then at times things were better or worse but I never regained the pre-major depression sexual standard. I just don't want to make things worse with ADs. I think I will ask my psychiatrist what he thinks of combining agomelatine with buproprion at 450mg, but he's a stubborn type so I guess he'll ask me to keep taking nortriptyline...I will see what to do.> > I have a long term problem of depression, I have tried many medications and talk
> > therapies with limited or temporary successes. I did well on a cocktail of
> > mirtazapine and sertraline but I discontinued it because of sexual and
> > non-sexual side effects. Duloxetine worked too but made me impotent, thankfully
> > that was reversed when I discontinued the medication.
> > I am fed up with medications and I am looking into transcranial magnetic
> > stimulation and even ECT, electroconvuslive therapy.
> > Nevertheless at the moment I really need medication and I am on agomelatine 50mg
> > but my psychiatrist wants me on nortriptyline too because I am just too unwell.
> > Nortryptiline is a tricyclic antidepressant, an old type, pre-ssri,
> > antidepressant.
> > I can already see already that diminishes my libido and makes harder for me to
> > achieve erections, my doc suggests me to keep using it saying that sexual side
> > effects could diminish with time, but I don't believe that, because in my
> > experience with previous ADs that never happened. In any case he suggests I
> > could use levitra or cialis.
> > I am in two minds, I really need to improve my depression because I am suicidal
> > but I don't want to have sexual problems. Also I fear that tricyclics too, like
> > SSRIs could cause long term sexual issues.
> > Do you have any advice? Thanks
> >
> >
> >
>
> I have found that mirtazapine reverses SSRI-induced sexual dysfunction. What doses were you on? There is also bupropion/Wellbutrin, have you tried it? It can also reverse AD-induced sexual problems. An idea is to take Wellbutrin with Zoloft, a well-known combo that often works well. You could add mirtazapin to either agomelatine or nortriptyline. As long as you don't take too high dose of nortriptyline, there would be minimal sexual problems.
>
> /t
poster:Tusco
thread:1015262
URL: http://www.dr-bob.org/babble/20120328/msgs/1015331.html