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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by bleauberry on July 6, 2009, at 17:09:55
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
I think at some point we all have to ask ourselves what do we want more, to be free of depression or to have fabulous sex on demand? I think it is unrealistic to expect both. It doesn't apply just to depression, but to diabetes, heart disease, liver disease, strokes, limb injury, lyme disease, prostate, and gosh the list could go on and on if I thought about it. Anyone with a disease has probably had their sex life impacted in one way or another, both from the disease itself and from the treatment of it.
Remeron is not a good antidepressant in my opinion. It scores well in clinical trials because of generally robust decreases in the depression questionnaire topics relating to sleep, anxiety, and appetite, but not very well in core depressive symptoms. It can however help with sex on SSRIs by partially blocking the serotonin receptors. That is, if the patient can manage taking one of the most potent antihistamines on the planet, which is what it does much more strongly than anything else it is supposedly and erroneously claimed to do. But that is another topic.
Of the SSRIs, my experience is that Lexapro is the most sex friendly. Lexapro, unknown to most people, can be therapeutic and even induce total remission, in doses far too low to cause any significant side effects. This will get some laughs, but seriously I am talking of a dose range of 1/10th 1mg up to 5mg. Don't look to clinical studies for this kind of success, because they don't do it. The real world is what counts.
In the TCA category I only have experience with Nortriptyline and Desipramine. I think Desipramine did have some side effects due to its strong peripheral noradrenergic effect. Nortriptyline on the other hand actually improved desire, frequency, and ability, above baseline. This was after the first few days where it felt like sex was going dead. That was short lived. I give Nortriptyline the thumbs up. At reasonable doses that is.
If someone is stable and well on an SSRI, but the sex department is closed, there are ways to deal with that. It's just that the patient will not have normal daily thoughts or desires of sex. But they can stimulate them on demand. Things that are short-lived dopamine boosters can do that. Specifically I am thinking of Ritalin. Or if someone experiences a boost of sex in the first day or two of Wellbutrin, then take the Wellbutrin only on days when sex is planned.
Which brings up another point. The disease comes first. We gotta deal with that. What good is having sex if the other 23 hours of your day are hell. When depression is properly treated, and sexual side effects are present, we have to relearn a life of planned sex rather than spontaneous sex. Some verbal dirty talk and foreplay through text messaging and voicemails can heighten the experience and anticipation of a planned evening.
When the ability to have sex is hampered, Viagra works pretty good most of the time. Tricks to make it work best include chewing the pill, letting it rest under the tongue a few minutes before swallowing, and taking it on an empty stomach. No food for the previous 3 hours. The bedroom is important. Candles if you like them. Block out noise with a fan or a hummer or music. No distractions. No hurry. No pressure.
In the herbal category there are some potent pro-sex herbs. Horny goat weed, tongkat ali, and a couple others. Do a search on Passion RX for some good ideas. These herbs can be taken on the day of planned sex, maybe the day before as well with some experimentation, but not continuously. They frequently come with stimulation and insomnia as side effects. But they can be quite potent in the sex department.
Find your best antidepressant. Stay on the lowest dose possible. Then when you see what kind of side effects are there, manage them. I think once an illness hits, it is unrealistic to expect everything to go on as normal, or as pre-illness.
In the meds category I can think of nothing more sex friendly than ultra low dose Lexapro combined with low dose Nortriptyline. For many people Wellbutrin is a miracle. For me, it did the opposite by inducing a much worse depression and killing all desire and ability for sex. But that may be because I tried generic instead of brand. but that is another topic.
Treat the depression. Then manage the sex. Millions of people with dozens of diseases have to do the same thing. That's just the way it is.
Stay away from Paxil. That one in particular is so anti-sex you would need some serious management skills to deal with it.
Posted by chumbawumba on July 6, 2009, at 17:29:11
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
I took Prozac for about 9 years and during that time my testosterone levels tested below normal so I took testosterone injections to compensate. Since I've been off Prozac for about 6 months, my blood levels have rebounded and are within the normal range.
I tried Wellbutrin and it didn't do anything for me.
Posted by linkadge on July 6, 2009, at 18:18:39
In reply to Re: Best Antidepressants for men?, posted by chumbawumba on July 6, 2009, at 17:29:11
I personally don't care much about sex. If I could push a little red button and delete that aspect of my life (and ever having known about it) I would. It just makes things complicated. It brings out all sorts of lower brainstem neanderthul like emotions. And besides, it just ends up making you more miserable when you can't get what you want.
Linkadge
Posted by bearfan on July 6, 2009, at 18:28:37
In reply to Re: Best Antidepressants for men?, posted by bleauberry on July 6, 2009, at 17:09:55
What is your opinion on similar Celexa and Effexor XR/Pristiq vs Lexapro?
> Of the SSRIs, my experience is that Lexapro is the most sex friendly.
Posted by bearfan on July 6, 2009, at 21:06:21
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 6, 2009, at 18:18:39
Sometimes I feel that way, but what about the lady friends?
Posted by Alexanderfromdenmark on July 8, 2009, at 9:14:51
In reply to Re: Best Antidepressants for men?, posted by sowhysosad on July 6, 2009, at 16:21:41
Sorry Lexapro made me secondary hypogonadal. It's still a major problem now. I wouldn't recommend it.
Male antidepressants? Stablon, agomelantine, remeron, wellbutrin, parnate, Emsam.
Forget lexapro.
Posted by bearfan on July 8, 2009, at 16:46:44
In reply to Re: Best Antidepressants for men?, posted by Alexanderfromdenmark on July 8, 2009, at 9:14:51
Have you tried agomelantine or Stablon? I think agomelantine is due in the U.S. in the next few years. How long were you on the Lexapro? Did that specifically cause hypogonadal symptoms are generally all SSRIs. Also do benzodiazipenes generally cause any problems?
> Sorry Lexapro made me secondary hypogonadal. It's still a major problem now. I wouldn't recommend it.
>
> Male antidepressants? Stablon, agomelantine, remeron, wellbutrin, parnate, Emsam.
>
> Forget lexapro.
Posted by Phillipa on July 8, 2009, at 19:27:43
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 8, 2009, at 16:46:44
Bearfan there is a thread on agomelatine now on the board see if you can find it. Have heard it said no sexual difficulties and good for depression/anxiety. Phillipa
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