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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by cache-monkey on December 30, 2004, at 18:03:22
Hey,
I kind of got scared off of SSRIs after my experience with Celexa: wieght gain and complete loss of orgasm. It's the sexual side effects that were most troublesome. Other than that I felt really good. I've since been trying out various other meds that are supposed to not effect sexual function (and to a lesser extent weight).
I'm on a trial of Lamictal (+low dose BuSpar) right now, but depending on how this goes, I'm thinking that I should go back and try an SSRI again. I think that Zoloft might be a good choice for me for a number of reasons.
I realize that sexual side effects are likely with all SSRIs. I'm wondering if, based on the collective experience of the male posters on this board, one of the SSRIs seems to do better than the others in this regard. I realize that such a beast might not exist, though.
I would particularly be interested in hearing from males whose sexual function was *not* affected while on an SSRI.
Hopefully,
cache-monkey
Posted by ed_uk on December 30, 2004, at 19:42:08
In reply to SSRI with least male anorgasmia? (chimerical hope?, posted by cache-monkey on December 30, 2004, at 18:03:22
Hi!
Paxil causes more sexual side effects than other SSRIs, Lexapro would probably be quite similar to Celexa. I'd suggest trying Zoloft or Prozac. Taking Buspar with an SSRI can sometimes reverse the sexual side effects of the SSRI- that might be a useful combination for you.
Ed.
Posted by Larry Hoover on December 30, 2004, at 22:24:27
In reply to SSRI with least male anorgasmia? (chimerical hope?, posted by cache-monkey on December 30, 2004, at 18:03:22
> I would particularly be interested in hearing from males whose sexual function was *not* affected while on an SSRI.
>
> Hopefully,
> cache-monkeyWell, I get all the side-effects, so I'm not much help to you there. Here are a couple of studies on the subject. I think the difference in the size of the respective statistics is just from different ways of defining sexual dysfunction.
Lar
J Clin Psychiatry. 2001;62 Suppl 3:10-21.
Comment in:
J Clin Psychiatry. 2002 Feb;63(2):168.Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.
Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F.
University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain. angelluis.montejo@globalmed.es
BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
J Clin Psychiatry. 2002 Apr;63(4):357-66.Prevalence of sexual dysfunction among newer antidepressants.
Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, Bass KI, Donahue RM, Jamerson BD, Metz A.
Department of Psychiatric Medicine, University of Virginia, Charlottesville 22903, USA. ahc8v@virginia.edu
BACKGROUND: Sexual dysfunction commonly occurs during antidepressant treatment. However, the reported rates of sexual dysfunction vary across antidepressants and are typically underreported in product literature. The objectives of this study were (1) to estimate the prevalence of sexual dysfunction among patients taking newer antidepressants (bupropion immediate release [IR], bupropion sustained release [SR], citalopram, fluoxetine, mirtazapine, nefazodone, paroxetine, sertraline, venlafaxine, and venlafaxine extended release [XR]) and (2) to compare physician-perceived with patient-reported prevalence rates of antidepressant-associated sexual dysfunction. METHOD: This cross-sectional, observational study was conducted in 1101 U.S. primary care clinics. Adult outpatients (4534 women and 1763 men) receiving antidepressant monotherapy were enrolled. The prevalence of sexual dysfunction was measured using the Changes in Sexual Functioning Questionnaire. RESULTS: In the overall population, bupropion IR (22%) and SR (25%) and nefazodone (28%) were associated with the lowest risk for sexual dysfunction, whereas selective serotonin reuptake inhibitor (SSRI) antidepressants, mirtazapine, and venlafaxine XR were associated with higher rates (36%-43%). In a prospectively defined subpopulation unlikely to have predisposing factors for sexual dysfunction, the prevalence of sexual dysfunction ranged from 7% to 30%, with the odds of having sexual dysfunction 4 to 6 times greater with SSRIs or venlafaxine XR than with bupropion SR. Physicians consistently underestimated the prevalence of antidepressant-associated sexual dysfunction. CONCLUSION: Ours is the first study to assess sexual dysfunction across the newer antidepressants using consistent methodology and a validated rating scale. Overall, SSRIs and venlafaxine XR were associated with higher rates of sexual dysfunction than bupropion or nefazodone. Because antidepressant-associated sexual dysfunction is considerably underestimated by physicians, greater recognition and education are imperative when prescribing antidepressant treatment.
Posted by cache-monkey on December 31, 2004, at 0:59:57
In reply to Re: SSRI with least male anorgasmia? (chimerical hope? » cache-monkey, posted by Larry Hoover on December 30, 2004, at 22:24:27
Thanks, Larry! It's quite unfortunate that nefazodone and buproprion didn't work as ADs for me, since they seem to have the lowest incidences of sexual dysfunction. As I am about to lament in a new thread on Lamictal, I'm starting to think that my depression is inexorably and inversely linked to my sexual function.
cache-monkey
> > I would particularly be interested in hearing from males whose sexual function was *not* affected while on an SSRI.
> >
> > Hopefully,
> > cache-monkey
>
> Well, I get all the side-effects, so I'm not much help to you there. Here are a couple of studies on the subject. I think the difference in the size of the respective statistics is just from different ways of defining sexual dysfunction.
>
> Lar
>
>
> J Clin Psychiatry. 2001;62 Suppl 3:10-21.
> Comment in:
> J Clin Psychiatry. 2002 Feb;63(2):168.
>
> Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.
>
> Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F.
>
> University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain. angelluis.montejo@globalmed.es
>
> BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
>
>
> J Clin Psychiatry. 2002 Apr;63(4):357-66.
>
> Prevalence of sexual dysfunction among newer antidepressants.
>
> Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, Bass KI, Donahue RM, Jamerson BD, Metz A.
>
> Department of Psychiatric Medicine, University of Virginia, Charlottesville 22903, USA. ahc8v@virginia.edu
>
> BACKGROUND: Sexual dysfunction commonly occurs during antidepressant treatment. However, the reported rates of sexual dysfunction vary across antidepressants and are typically underreported in product literature. The objectives of this study were (1) to estimate the prevalence of sexual dysfunction among patients taking newer antidepressants (bupropion immediate release [IR], bupropion sustained release [SR], citalopram, fluoxetine, mirtazapine, nefazodone, paroxetine, sertraline, venlafaxine, and venlafaxine extended release [XR]) and (2) to compare physician-perceived with patient-reported prevalence rates of antidepressant-associated sexual dysfunction. METHOD: This cross-sectional, observational study was conducted in 1101 U.S. primary care clinics. Adult outpatients (4534 women and 1763 men) receiving antidepressant monotherapy were enrolled. The prevalence of sexual dysfunction was measured using the Changes in Sexual Functioning Questionnaire. RESULTS: In the overall population, bupropion IR (22%) and SR (25%) and nefazodone (28%) were associated with the lowest risk for sexual dysfunction, whereas selective serotonin reuptake inhibitor (SSRI) antidepressants, mirtazapine, and venlafaxine XR were associated with higher rates (36%-43%). In a prospectively defined subpopulation unlikely to have predisposing factors for sexual dysfunction, the prevalence of sexual dysfunction ranged from 7% to 30%, with the odds of having sexual dysfunction 4 to 6 times greater with SSRIs or venlafaxine XR than with bupropion SR. Physicians consistently underestimated the prevalence of antidepressant-associated sexual dysfunction. CONCLUSION: Ours is the first study to assess sexual dysfunction across the newer antidepressants using consistent methodology and a validated rating scale. Overall, SSRIs and venlafaxine XR were associated with higher rates of sexual dysfunction than bupropion or nefazodone. Because antidepressant-associated sexual dysfunction is considerably underestimated by physicians, greater recognition and education are imperative when prescribing antidepressant treatment.
>
>
Posted by Larry Hoover on December 31, 2004, at 7:59:43
In reply to Re: SSRI with least male anorgasmia? (chimerical hope? » Larry Hoover, posted by cache-monkey on December 31, 2004, at 0:59:57
> Thanks, Larry! It's quite unfortunate that nefazodone and buproprion didn't work as ADs for me, since they seem to have the lowest incidences of sexual dysfunction. As I am about to lament in a new thread on Lamictal, I'm starting to think that my depression is inexorably and inversely linked to my sexual function.
>
> cache-monkeyNot necessarily. There's a new thread over on the Alternative board about managing depression with St. John's wort. It's quite illuminating.
I don't know what the incidence of sexual dysfunction is on SJW (my own response has varied with different brands), but there's always hope.
Low-dose selegiline (or the new transdermal delivery system) are yet other options.
Lar
Posted by ed_uk on December 31, 2004, at 8:06:24
In reply to SSRI with least male anorgasmia? (chimerical hope?, posted by cache-monkey on December 30, 2004, at 18:03:22
Hi again....
Just in case you do decide to try an SSRI again.......
Have you ever tried a very low dose of an SSRI? Some people do well on low doses with less side effects eg. at the moment Glenn is doing well on 5mg Celexa.
Ed.
Posted by cache-monkey on December 31, 2004, at 10:38:10
In reply to Re: SSRI with least male anorgasmia? (chimerical hope? » cache-monkey, posted by Larry Hoover on December 31, 2004, at 7:59:43
> Low-dose selegiline (or the new transdermal delivery system) are yet other options.
I've actually been thinking about low-dose selegiline, as the dopamine would benefit a cluster of my symptoms that I most want to deal with: social anxiety, smoking, concentration/ADD-like issues. I've also heard it's libido-enhancing, which is a big plus.
BUT, my depressions/dysthymias are usually coupled with pretty bad anxiety. (I might have a soft BP or cyclothymia because I also -- at least in the past -- have had up periods that can be characterized by a nervous, ill-focused type of energy.) So, while I think selegiline would be very beneficial in a number of ways, I'm concerned that it might exacerbate my generalized anxiety due to down-regulation of 5-HT, given the reciprocal relationship between 5-HT and DA systems.
Any thoughts?
cache-monkey
Posted by Larry Hoover on December 31, 2004, at 22:39:25
In reply to Low-dose selegiline and anxiety » Larry Hoover, posted by cache-monkey on December 31, 2004, at 10:38:10
> > Low-dose selegiline (or the new transdermal delivery system) are yet other options.
>
> I've actually been thinking about low-dose selegiline, as the dopamine would benefit a cluster of my symptoms that I most want to deal with: social anxiety, smoking, concentration/ADD-like issues. I've also heard it's libido-enhancing, which is a big plus.
>
> BUT, my depressions/dysthymias are usually coupled with pretty bad anxiety. (I might have a soft BP or cyclothymia because I also -- at least in the past -- have had up periods that can be characterized by a nervous, ill-focused type of energy.) So, while I think selegiline would be very beneficial in a number of ways, I'm concerned that it might exacerbate my generalized anxiety due to down-regulation of 5-HT, given the reciprocal relationship between 5-HT and DA systems.
>
> Any thoughts?
> cache-monkeyIt's fine to do thought experiments, but I've heard of so many paradoxical reactions and such like that, in the end, it comes down to a drug trial. There are various ways to manipulate the anxiogenic and anxiolytic effects of meds, if you go at it systematically. That's a large part of what we talk about on the Alternative board; augmentative strategies, synergies, treatment of side effects.
Lar
Posted by cache-monkey on January 2, 2005, at 1:11:02
In reply to Re: Low-dose selegiline and anxiety » cache-monkey, posted by Larry Hoover on December 31, 2004, at 22:39:25
"It's fine to do thought experiments, but I've heard of so many paradoxical reactions and such like that, in the end, it comes down to a drug trial. There are various ways to manipulate the anxiogenic and anxiolytic effects of meds, if you go at it systematically. That's a large part of what we talk about on the Alternative board; augmentative strategies, synergies, treatment of side effects."
Thanks, Larry. I've just started following the Alternative board, and find the information there quite useful.
I do think I'll end up giving selegiline a trial. But, I guess I have to see where Lamictal takes me first... The annoying thing with that right now seems to be decreased sexual interest/function, which was kind of unexpected. I'm hoping it's transient. Since you're one of the sources of institutional knowledge around here, I'm wondering if you've heard of this before?
Best,
cache-monkey
This is the end of the thread.
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