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Dr. Bob is Robert Hsiung, MD,
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Posted by tensor on January 1, 2006, at 10:49:18
Hi all,
I've been off this board for awhile, I've been doing fine, no relapse. I take nortriptyline 125mg and Remeron 15mg daily at bedtime against depression. The nortrip is making me a bit anorgasmic, it's very hard to reach orgasm often impossible, no problem with erection. I've tried ginkgo biloba for a month, although it seems to have a good effect for my memory it does nothing for my sexual problems.
So, what to try next? I read about cyproheptadine, but have no experiences from it, and i haven't checked if it is available in Finland. What about yohimbine? It would be nice to take as needed.Any input appreciated.
Thanks guys,
Mattias
Posted by ed_uk on January 1, 2006, at 13:28:11
In reply to Drug induced anorgasmia, posted by tensor on January 1, 2006, at 10:49:18
Hi Mattias
Bethanechol is the traditional treatment for erectile and ejaculatory problems induced by anticholinergic tricyclic antidepressants. Bethanechol is usually given at a dose of ~ 20mg when required - 45 minutes to 2 hours before sex.
>cyproheptadine
Cyproheptadine is used to reduce the sexual side effects of SSRIs and other strongly serotonergic ADs. I don't think it would help you.
>What about yohimbine?
I don't think you would like it. It would probably make you very restless and agitated, a bit like the time you tried the high dose of Remeron - but worse :( Also, I don't think it would help!
Regards
Ed
Posted by tensor on January 2, 2006, at 9:49:34
In reply to Re: Drug induced anorgasmia » tensor, posted by ed_uk on January 1, 2006, at 13:28:11
Hi Ed!
> Bethanechol is the traditional treatment
It is not available in Finland :-/ Are there other cholinergic drugs that are (almost) equivalent?
>Yohimbine
> I don't think you would like it.Ok, this one can be bought without prescription, and is fairly inexpensive, maybe worth a try?
I'm wondering, could it not be the weak serotonergic effect of nortrip causing this s/e?Thank you,
Mattias
Posted by ed_uk on January 2, 2006, at 11:20:59
In reply to Re: Drug induced anorgasmia » ed_uk, posted by tensor on January 2, 2006, at 9:49:34
Hi Mattias
>Are there other cholinergic drugs that are (almost) equivalent?
There's carbachol........but I think it's been discontinued in Finland.
>Ok, this one can be bought without prescription, and is fairly inexpensive, maybe worth a try?
Have plenty of Klonopin or Xanax on hand if you do. It might cause restlessness, racing heart and other nasty side effects!
>I'm wondering, could it not be the weak serotonergic effect of nortrip causing this s/e?
It's possible but I don't think it's the likely cause. Nort is only a very weak SRI.
Regards
Ed
Posted by tensor on January 2, 2006, at 13:15:22
In reply to Re: Drug induced anorgasmia » tensor, posted by ed_uk on January 2, 2006, at 11:20:59
Hi again :-)
I read that yohimbine + TCA is generally not a good idea.
I don't like adding buspiron, made me feel sick. Maybe amantadine or bupropion prn?
Why is there never an easy solution...regards,
Mattias
Posted by ed_uk on January 2, 2006, at 13:55:16
In reply to Re: Drug induced anorgasmia » ed_uk, posted by tensor on January 2, 2006, at 13:15:22
Hi M
>Bethanechol.......not available in Finland......
Bethanechol is a cholinergic drug. AFAIK, pyridostigmine (Mestinon), another cholinergic drug, is available in Finland for the treatment of myasthenia gravis and certain forms of severe constipation. A *low* dose might possibly help, by reducing the anticholinergic effects of nortriptyline. There isn't any evidence that it works though, I'm just guessing. If you do manage to get a prescription (which, I imagine, would be extremely difficult!) you could try a very low dose. Don't take a high dose, serious side effects might occur!
Take care
Ed
Posted by Cece on January 5, 2006, at 20:05:13
In reply to Re: Drug induced anorgasmia » tensor, posted by ed_uk on January 2, 2006, at 13:55:16
I'm a woman, but tried a very low dose of yohimbe because I was having orgasmic problems- took me hours to come! Turned out that my problem was hormonal which doesn't help you. But the Yohimbe made me feel extremely agitated, dizzy, sick- it was horrible and took over 24hrs to abate. I take a TCA, Surmontil (Trimipramine) 25mg, a pretty small dose.
Wellbutrin can sometimes help counteract the sexual side effects of ADs. That aspect of it turned up unexpectedly in trials of it's effectiveness for depression, it hasn't been widely studied beyond that, but there is good anecdotal evidence.
Posted by tensor on January 6, 2006, at 9:09:27
In reply to Re: Drug induced anorgasmia, posted by Cece on January 5, 2006, at 20:05:13
Hi Cece,
i'm now taking 2x10mg of buspar daily. I've been taking it for a few days so i can't say if it's working or not.
Buspar is a NE-alpha2 antagonist like remeron, which i also take. NE-alpha2 antagonists are thought to combat sexual dysfunction. I guess time will tell.Regards,
Mattias
This is the end of the thread.
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