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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by mattye on December 21, 2006, at 12:05:54
I have a feeling that if one SSRI causes significant sexual side effects, then there won't be much improvement by switching to another. I know this topic has been done before, but has anyone had any luck switching SSRIs to alleviate sexual SE's? My friend said Cymbalta did the trick for him. I myself am on Lexapro.
Posted by med_empowered on December 21, 2006, at 12:09:25
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
it may be more an issue of adding something than switching...buspar and wellbutrin can both help. I think in cases where there's a lot of apathy along w/ the sexual issues, the options are wellbutrin and stimulants (ritalin, adderall, etc.).
Good luck.
Posted by tensor on December 21, 2006, at 12:47:42
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
It seems like every med that boosts serotonin will cause some form of sexual dysfunction. Like med_emp said, adding is probably the only way around it. Buspar did work well for me, both for impotence and anorgasmia, I'm male, don't know how it works for women. It gives a little hangover though. 10-20mg ~1h before the 'act'.
/Mattias
Posted by Quintal on December 21, 2006, at 15:07:31
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
Lexapro and Celexa are probably the most tolerable SSRIs in terms of sexual dysfunction. Cymbalta often causes sexual dysfunction itself.
The antihistamine cyproheptadine (Periactin) can also be used to temporarily lower serotonin levels and reverse sexual dysfunction.
Q
Posted by jimmygold70 on December 21, 2006, at 15:26:16
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
Of all the SSRIs, Zoloft has the least sexual side effects ON AVERAGE. However, there is no way to predict how you'll react to any other SSRI. I personnaly have not seen many people with sexual side effects on 50 MG of Zoloft. Higher doses give higher side effects.
Posted by tensor on December 21, 2006, at 15:29:04
In reply to Re: Best SSRI for sexual SE's?, posted by jimmygold70 on December 21, 2006, at 15:26:16
>I personnaly have not seen many people with sexual side effects on 50 MG of Zoloft.
I'm just curious, how have you 'seen' this?
/Mattias
Posted by jimmygold70 on December 21, 2006, at 15:40:34
In reply to Re: Best SSRI for sexual SE's? » jimmygold70, posted by tensor on December 21, 2006, at 15:29:04
> >I personnaly have not seen many people with sexual side effects on 50 MG of Zoloft.
>
> I'm just curious, how have you 'seen' this?
>
> /MattiasWell seen might have not been the best word (-:
I know quite a lot of people who take Zoloft and never haird complaints from those reporting taking 50 MG. I've heard complaints from people taking higer doses. This is not a scientific study, of course.
However, the global impression of two psychopharmacologists I personally know is that Zoloft is more successful than other SSRIs with regard to weight gain and sexual side effects. However, there is a huge interpersonal variability.
Posted by tensor on December 21, 2006, at 15:48:40
In reply to Re: Best SSRI for sexual SE's?, posted by jimmygold70 on December 21, 2006, at 15:40:34
>Well seen might have not been the best word (-:
I know, I was just joking :-) I agree, though that zoloft is the least problematic SSRI. I'm actually at 50mg Zoloft now and it hasn't been much of a problem, delayed orgasm is the most notable. It could be that Zoloft might have a weak dopaminergic effect.
/Mattias
Posted by jimmygold70 on December 21, 2006, at 15:54:27
In reply to Re: Best SSRI for sexual SE's? » jimmygold70, posted by tensor on December 21, 2006, at 15:48:40
(-:
You know I personally had huge luck with Ginkgo Biloba Stadardized Extract 120 MG twice a day. There was a well-designed triple-blind (!) study which showed null effect. But I can swear it worked for me. But that might be my personal sick chemistry (-:
BTW It takes a month to kick in.
> >Well seen might have not been the best word (-:
>
> I know, I was just joking :-) I agree, though that zoloft is the least problematic SSRI. I'm actually at 50mg Zoloft now and it hasn't been much of a problem, delayed orgasm is the most notable. It could be that Zoloft might have a weak dopaminergic effect.
>
> /Mattias
Posted by rosa63 on December 21, 2006, at 15:55:12
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
I have had sexual SE with all SSRI's (unless combined with Wellbutrin). The SSNRI's aren't so bad.
Posted by jimmygold70 on December 21, 2006, at 15:59:57
In reply to Re: Best SSRI for sexual SE's?, posted by rosa63 on December 21, 2006, at 15:55:12
Interesting to hear. I have hell with all the SSRIs in doses effetive for me (higher ones). Same for Effexor (150+) but 75 doesn't (and not effective for me). Don't know about other SNRIs. Remeron is not really a SNRI but doesn't carry any sexual side effects.
> I have had sexual SE with all SSRI's (unless combined with Wellbutrin). The SSNRI's aren't so bad.
Posted by blueberry1 on December 21, 2006, at 19:01:11
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
It is an experiment that varies from person to person. Just opinion, but I think overall zoloft has less sexual side effects, especially if it is around 50mg. I had terrible sexual side effects from lexapro at just 5mg, fairly bad but tolerable sexual side effects from 10mg prozac, but hardly any from 50mg zoloft. And as your friend did ok with cymbalta, even just tiny amounts of cymbalta gave me horrendous sexual side effects. Go figure.
Finding a med to counter lexapro side effects is a journey down experimental lane also.
Posted by theo on December 21, 2006, at 19:38:54
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
I'm male and Prozac never caused much side effects. Delayed ejaculation but it was actually nice, because I could when I was ready!
Posted by elanor roosevelt on December 22, 2006, at 9:27:48
In reply to Re: Best SSRI for sexual SE's?, posted by jimmygold70 on December 21, 2006, at 15:26:16
it is so different by individual
on lexapro and celexa i have very healthy libido (especially when i can find someone to share the joy)
on wellbutrin i am absolutely randy for a few weeks and then the sexual side effects are just slight
wasn't there a separate med mentioned to help this?
Posted by mattye on December 22, 2006, at 14:09:57
In reply to Re: Best SSRI for sexual SE's?, posted by blueberry1 on December 21, 2006, at 19:01:11
I just talked to a new pdoc today about this. My old doc had no experience with this issue. He said that my sexual SE's may be presenting recently due to my tapering off remeron. He said that remeron, in theory, may block some receptor activity that supresses orgasm.
He also mentioned that Cymbalta has a lower sexual SE profile than the SSRIs, but as blueberry mentioned, your mileage may vary. It just goes to show you that everyone's body chemistry is so different. There is just such a complex mix of neurotransmitters and horomones, I really don't think anyone can give a hard and fast reason as to why these side effects occur. I guess it just takes some empirical research to find out whats best for you.
I have a ton of Zoloft samples sitting around... but I really don't feel like doing the whole med switching thing right now.
Any other input would be appreciated!
> It is an experiment that varies from person to person. Just opinion, but I think overall zoloft has less sexual side effects, especially if it is around 50mg. I had terrible sexual side effects from lexapro at just 5mg, fairly bad but tolerable sexual side effects from 10mg prozac, but hardly any from 50mg zoloft. And as your friend did ok with cymbalta, even just tiny amounts of cymbalta gave me horrendous sexual side effects. Go figure.
>
> Finding a med to counter lexapro side effects is a journey down experimental lane also.
Posted by tensor on December 22, 2006, at 14:28:03
In reply to Re: Best SSRI for sexual SE's?, posted by mattye on December 22, 2006, at 14:09:57
>He said that remeron, in theory, may block some receptor activity that supresses orgasm.
In theory, Remeron blocks 5HT2a receptors that combat SSRI sexual dysfunction. Boosting serotonin will cause some form of sexual dysfunction.
/Mattias
Posted by speed on December 23, 2006, at 13:09:44
In reply to Best SSRI for sexual SE's?, posted by mattye on December 21, 2006, at 12:05:54
> I have a feeling that if one SSRI causes significant sexual side effects, then there won't be much improvement by switching to another. I know this topic has been done before, but has anyone had any luck switching SSRIs to alleviate sexual SE's? My friend said Cymbalta did the trick for him. I myself am on Lexapro.
You are going to have sexual side effects on all the SSRI's. I take Remeron for that reason. Believe me, I have been on everything.
Posted by mattye on December 23, 2006, at 16:25:33
In reply to Re: Best SSRI for sexual SE's?, posted by speed on December 23, 2006, at 13:09:44
Arghhhh!!! If only Remeron actually did anything for me besides turning me into a complete carb whore! I am just waiting for the magic fix everything pill to come out.
> > I have a feeling that if one SSRI causes significant sexual side effects, then there won't be much improvement by switching to another. I know this topic has been done before, but has anyone had any luck switching SSRIs to alleviate sexual SE's? My friend said Cymbalta did the trick for him. I myself am on Lexapro.
>
> You are going to have sexual side effects on all the SSRI's. I take Remeron for that reason. Believe me, I have been on everything.
>
Posted by Oppycat on December 26, 2006, at 9:13:31
In reply to Re: Best SSRI for sexual SE's? » speed, posted by mattye on December 23, 2006, at 16:25:33
> Arghhhh!!! If only Remeron actually did anything for me besides turning me into a complete carb whore! I am just waiting for the magic fix everything pill to come out.
>
> > > I have a feeling that if one SSRI causes significant sexual side effects, then there won't be much improvement by switching to another. I know this topic has been done before, but has anyone had any luck switching SSRIs to alleviate sexual SE's? My friend said Cymbalta did the trick for him. I myself am on Lexapro.
> >
> > You are going to have sexual side effects on all the SSRI's. I take Remeron for that reason. Believe me, I have been on everything.
> >
>
>Although Remeron also made me eat like a pig at average dosages, I can control my appetite at 15mg daily. For that reason, I have just gone back on Remeron and plan to augment it with something, as yet to be determined. I combined it with 10mg Lexapro about a year ago with some success and a terrific sexual response.
Michael
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