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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 46. This is the beginning of the thread.
Posted by bearfan on July 5, 2009, at 3:47:43
Anyone know of a antidepressant or drug that helps with anxiety and depression that doesn't interfere with erection or sex drive (other than wellbutrin or using an erection pill like viagra). Not being able to perform in bed with adequate performance is depressing in itself.
Posted by SLS on July 5, 2009, at 5:34:46
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
Posted by X-ray on July 5, 2009, at 6:47:58
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
Hi,
Remeron (mirtazapine) is the drug that you are looking for.
This drug doesn't have a negative impact on libido.
I can verify that myself comparing Elavil (amitriptyline) and Remeron.
Best regards,
X-ray
Posted by linkadge on July 5, 2009, at 11:06:52
In reply to Re: Best Antidepressants for men?, posted by X-ray on July 5, 2009, at 6:47:58
Some studies that women responded better to SSRI's wherase men responded better to imipramine. SSRI's make me a little....wimpy.
Linkadge
Posted by Phillipa on July 5, 2009, at 11:17:43
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 5, 2009, at 11:06:52
You guys are taking over!!!! Scott that was cute!!!. Link truth that SSRI's better for women. BTW what do you think of generic luvox? Phillipa
Posted by bearfan on July 5, 2009, at 17:19:08
In reply to Re: Best Antidepressants for men?, posted by X-ray on July 5, 2009, at 6:47:58
I have tried Remeron once before. It really just put me to sleep, made me hungry and I couldn't hardly coordinate my walking the next following day (It was a bad experience). Does this get any better.
Posted by bulldog2 on July 5, 2009, at 18:08:37
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
> Anyone know of a antidepressant or drug that helps with anxiety and depression that doesn't interfere with erection or sex drive (other than wellbutrin or using an erection pill like viagra). Not being able to perform in bed with adequate performance is depressing in itself.
ssri's should be avoided by men. They are the worst ad's men can take. There is evidence they lower dopamine and elevate prolactin. That lowers testosterone and human growth hormone. Parnate (maoi) and certain tcas should not have as much impact on sexual performance as ssris which work specifically on serotonin where most tcas work more on serotonin.
Be aware that if a man is on an ssri long term the suppression of testosterone could become permanant as the testes may not be able to bounce back after being inactive for so long.
Posted by linkadge on July 5, 2009, at 18:43:27
In reply to Re: Best Antidepressants for men?, posted by bulldog2 on July 5, 2009, at 18:08:37
>ssri's should be avoided by men. They are the >worst ad's men can take. There is evidence they >lower dopamine and elevate prolactin. That >lowers testosterone and human growth hormone. >Parnate (maoi) and certain tcas should not have >as much impact on sexual performance as ssris >which work specifically on serotonin where most >tcas work more on serotonin.
Eh. I don't know if I'd go that far. I know a few men that did horrible on drugs like wellburtin or remeron (major increase in anger) but did just fine on SSRI's. It really depends on the depression. I certainly think there can be a serotonergic component to depression in men as well.
Where I think SSRI's should be avoided is in later life depression in men. This is more likely due to decreased androgen production.
>Be aware that if a man is on an ssri long term >the suppression of testosterone could become >permanant as the testes may not be able to >bounce back after being inactive for so long.
Well, testosterone is still definately being produced when patients are on SSRI's. There is a decrease, but I don't think it necessarily has to do with drug interference at the level of the testicles. Instead, it is probably due to lower levels of dopaminergically mediated release of testosterone. Hormone imballences may exist post SSRI use, but to be honest most AD's are neuroendocrine disruptors. I think time will probably help.
Linkadge
Posted by linkadge on July 5, 2009, at 18:45:12
In reply to Re: Best Antidepressants for men?, posted by bulldog2 on July 5, 2009, at 18:08:37
There is evidence too that when MAO inhibition becomes pronounce there is a decrease in dopamine synthesis.
We really don't have any specific dopaminergic antidepressants - except perhaps SAMe.
Linkadge
Posted by bulldog2 on July 5, 2009, at 19:05:34
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 5, 2009, at 18:45:12
> There is evidence too that when MAO inhibition becomes pronounce there is a decrease in dopamine synthesis.
>
> We really don't have any specific dopaminergic antidepressants - except perhaps SAMe.
>
> LinkadgeI read an article online where a group of men had their testosterone tested before and after parnate usage. It was an eight week study and testosterone actually increased about 20%. Really don't recall much more. It seems as if parnate may be a little more friendly to dopamine production and perhaps increase it.
As far as to how much testosterone production is disturbed by an ssri that may be a function dosage and duration of treatment. If the dosage is high enough and treatment long enough could an ssri totally turn off testosterone? I don't know if there are any studies about that possibility. Would a dopamine agonist prevent this problem? One psychiatrist said that when he uses buspar with an ssri that sexual problems with ssris are often reversed.
I should have stated in my first post that tcas work more with norepinephrine. I think I said serotonin.
Posted by linkadge on July 5, 2009, at 19:17:06
In reply to Re: Best Antidepressants for men?, posted by bulldog2 on July 5, 2009, at 19:05:34
>I read an article online where a group of men >had their testosterone tested before and after >parnate usage. It was an eight week study and >testosterone actually increased about 20%. >Really don't recall much more. It seems as if >parnate may be a little more friendly to >dopamine production and perhaps increase it.
You could be right.
>As far as to how much testosterone production is >disturbed by an ssri that may be a function >dosage and duration of treatment. If the dosage >is high enough and treatment long enough could >an ssri totally turn off testosterone? I don't >know if there are any studies about that >possibility. Would a dopamine agonist prevent >this problem? One psychiatrist said that when he >uses buspar with an ssri that sexual problems >with ssris are often reversed.
I don't think that an SSRI could ever competely shut off testosterone production. Buspart can alleviate sexual dysfunction but it apparently works better in women. I think 5-ht1a agonists are aphrodisacs for women. Buspar is acutally a moderate d2 antagonist though so it may lower dopamine receptor signalling more - who knows. Not sure if improvement in sexual dysfunction is acompanied by improvements in testosterone levels.
Linkadge
Posted by bearfan on July 5, 2009, at 19:24:29
In reply to Re: Best Antidepressants for men?, posted by bulldog2 on July 5, 2009, at 18:08:37
I am a long time SSRI user and my testosterone levels have been checked recently and were low. There is some evidence that they can reduce testosterone count.
Posted by linkadge on July 5, 2009, at 20:38:35
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 19:24:29
While I do think there is a link between SSRI use and decreased testosterone - there is also the possibility that decreased testosterone preceeded SSRI use to some extent. Decreased testosterone can cause depression and is sometimes associated with other depression comorbidities.
For instance, one study suggested that disturbing sleep will decease testosterone somewhat. Just like it can mess up blood sugar
Linkadge
Posted by bearfan on July 5, 2009, at 23:35:01
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 5, 2009, at 20:38:35
> While I do think there is a link between SSRI use and decreased testosterone - there is also the possibility that decreased testosterone preceeded SSRI use to some extent. Decreased testosterone can cause depression and is sometimes associated with other depression comorbidities.
>That is a good point linkage; although I forgot to mention that there were some scientific studies published that linked the two together. I have tried hormonal testosterone supplements, and there was a mood lift; more particularly increased self confidence.
Posted by sowhysosad on July 6, 2009, at 4:31:54
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 5, 2009, at 11:06:52
> Some studies that women responded better to SSRI's wherase men responded better to imipramine. SSRI's make me a little....wimpy.
A word of warning: imipramine gave me erectile dysfunction. Apparently it's fairly common.
Posted by SLS on July 6, 2009, at 5:12:25
In reply to Re: Best Antidepressants for men?, posted by sowhysosad on July 6, 2009, at 4:31:54
> > Some studies that women responded better to SSRI's wherase men responded better to imipramine. SSRI's make me a little....wimpy.
>
> A word of warning: imipramine gave me erectile dysfunction. Apparently it's fairly common.Hmm. I don't know about that.
This is the first time I have heard this said of any tricyclic with the exception of clomipramine. I have been on quite a few of them, and never had a problem, even at maximum dosages. I'm just one person, of course. However, I don't believe that TCAs cause ED. They might perhaps exaggerate the cremaster reflex during orgasm, but this does not affect the orgasm itself.
- Scott
Posted by SLS on July 6, 2009, at 5:32:05
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 19:24:29
I believe SSRIs blunt the gonadal response to FSH and LH, and thus lowers testosterone secretion. This might contribute something to SSRI-induced ED, but I think the major portion of ED is the result of a more direct (upstream) muting of the arousal pathways in the brain by a hyperserotonergic state. This probably involves NE more than DA.
- Scott
Posted by linkadge on July 6, 2009, at 7:20:48
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 23:35:01
Yes, I realize there is some evidence of a link that is why I am not disputing that.
However, I don't think that it would not be uncommon for testosterone levels to be low in a subpopulation of depressed men before treatment.
Decreased levels of other hormones have been noted in depression. In one study venlafaxine improvement was associated with normalization of low pretreatment DHEA levels.
Linkadge
Posted by linkadge on July 6, 2009, at 7:22:25
In reply to Re: Best Antidepressants for men?, posted by SLS on July 6, 2009, at 5:12:25
>They might perhaps exaggerate the cremaster >reflex during orgasm, but this does not affect >the orgasm itself.
I don't even want to know what that is :)
Linkadge
Posted by linkadge on July 6, 2009, at 7:24:57
In reply to Re: Best Antidepressants for men?, posted by SLS on July 6, 2009, at 5:32:05
I think it is also possible that suopression of REM sleep can contribute to sexual dysfunction. The ballance of acetycholine to monoamines is important for proper function. SSRI' also supress night time HGH secretion.
Its funny, taken acutetly, SSRI's have always been sexual stimulants for me. After a week or so this changes to dysfunction.
Linkadge
Posted by bearfan on July 6, 2009, at 8:38:09
In reply to Re: Best Antidepressants for men?, posted by SLS on July 6, 2009, at 5:12:25
In the PDR, Sexual Dysfunction is listed as a possible side effect for tricylcics, although apparently its just less common than SSRIs.
Posted by SLS on July 6, 2009, at 10:40:04
In reply to Re: Best Antidepressants for men? » SLS, posted by linkadge on July 6, 2009, at 7:22:25
I hope one of these new 5-HT1a partial agonists come by soon. I think they may go to relieve SSRI problems with sexual asrousal when taken at the same time. Does buspirone help at all?
I don't completely understand the FDA's refusal to approve gepirone. For me personally, I don't think I could handle either buspirone or gepirone (and tandospirone) because the metabolite, 1-PP, is a NE alpha-2 receptor antagonists. My system does not like drugs that do that. Remeron and idazoxan both made me feel worse. I would prefer to see flesinoxan come to market, but I think the patent has expired on it.
- Scott
Posted by sowhysosad on July 6, 2009, at 14:20:23
In reply to Re: Best Antidepressants for men?, posted by SLS on July 6, 2009, at 5:12:25
> > > Some studies that women responded better to SSRI's wherase men responded better to imipramine. SSRI's make me a little....wimpy.
> >
> > A word of warning: imipramine gave me erectile dysfunction. Apparently it's fairly common.
>
> Hmm. I don't know about that.
>
> This is the first time I have heard this said of any tricyclic with the exception of clomipramine. I have been on quite a few of them, and never had a problem, even at maximum dosages. I'm just one person, of course. However, I don't believe that TCAs cause ED. They might perhaps exaggerate the cremaster reflex during orgasm, but this does not affect the orgasm itself.Imipramine certainly caused it for me - not a complete inability to achieve an erection, but big problems sustaining one.
I Googled at the time and found ED listed as a side effect of imipramine on many sites.
I'd guess imipramine-induced hypotension might affect blood flow to the penis?
Posted by bearfan on July 6, 2009, at 14:40:34
In reply to Re: Best Antidepressants for men? » SLS, posted by sowhysosad on July 6, 2009, at 14:20:23
So what tends to be the least offending Anti-depressant since most of them to have that side effect? I've heard out the SSRIs, Lexapro and Celexa tended to cause less problems.
Posted by sowhysosad on July 6, 2009, at 16:21:41
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 6, 2009, at 14:40:34
> So what tends to be the least offending Anti-depressant since most of them to have that side effect? I've heard out the SSRIs, Lexapro and Celexa tended to cause less problems.
Yep, a vote for Lexapro here, especially at lower doses.
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