Psycho-Babble Medication Thread 972824

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Back to TCA

Posted by tensor on December 7, 2010, at 9:14:01

I was taking clomipramine awhile ago and it worked great on my depression and anxiety. Its anxiolytic effect at 150mg is far better than with any SSRI. But not being able to orgasm I was eager to switch to escitalopram. It has worked ok for a couple of months but I feel my energy gradually deteriorates.
I now take 20mg of escitalopram with 30mg mirtazapine and my sexual ability is normal, so I figure the sexual problems with CMI must be a result of ACh(m) blockage. Since many of the problems with TCAs are of anticholinergic nature why is there so little focus on cholinergic agents that could reverse the side effects?


/Mattias

 

Re: Back to TCA

Posted by Conundrum on December 7, 2010, at 10:19:49

In reply to Back to TCA, posted by tensor on December 7, 2010, at 9:14:01

> I was taking clomipramine awhile ago and it worked great on my depression and anxiety. Its anxiolytic effect at 150mg is far better than with any SSRI. But not being able to orgasm I was eager to switch to escitalopram. It has worked ok for a couple of months but I feel my energy gradually deteriorates.
> I now take 20mg of escitalopram with 30mg mirtazapine and my sexual ability is normal, so I figure the sexual problems with CMI must be a result of ACh(m) blockage. Since many of the problems with TCAs are of anticholinergic nature why is there so little focus on cholinergic agents that could reverse the side effects?
>
>
> /Mattias
>
>
Hi, I don't know much about ACh blockage and sexual dysfunction but SSRIs and NRIs, like reboxetine, cause sexual dysfunction. Clomipramine does both those things, as well as block ACh. Also, yohimbine an alpha 2 adrenergic antagonist is used to treat sexual dysfunction in men. Nefazodone, a 5 HT2A antagonist is used to treat SSRI induced sexual dysfunction. Remeron is both a alpha 2 adrenergic antagonist and a 5 HT2A antagonist.

The title of your post says "Back to TCA." Are you planning on going back to clomipramine because it was more effective at treating your depression and anxiety? You could always talk to your doctor about taking remeron with clomipramine. Never heard of the combo but it might help the sexual side effects.

 

Re: Back to TCA ยป Conundrum

Posted by tensor on December 7, 2010, at 11:13:51

In reply to Re: Back to TCA, posted by Conundrum on December 7, 2010, at 10:19:49

> Hi, I don't know much about ACh blockage and sexual dysfunction but SSRIs and NRIs, like reboxetine, cause sexual dysfunction. Clomipramine does both those things, as well as block ACh. Also, yohimbine an alpha 2 adrenergic antagonist is used to treat sexual dysfunction in men. Nefazodone, a 5 HT2A antagonist is used to treat SSRI induced sexual dysfunction. Remeron is both a alpha 2 adrenergic antagonist and a 5 HT2A antagonist.
>
> The title of your post says "Back to TCA." Are you planning on going back to clomipramine because it was more effective at treating your depression and anxiety? You could always talk to your doctor about taking remeron with clomipramine. Never heard of the combo but it might help the sexual side effects.

Hi,

yes I'm considering going back to CMI. I did take 30mg of Remeron with CMI but it didn't help with anorgasmia, but I had no erectile dysfunction nor libido problems, which makes the problem worse. I didn't have so much problems with s/e otherwise.
Did try 20mg of buspirone before sex but helped nothing.
Wonder if bethanechol would be effective. It isn't available here though it perhaps could be imported. Yohimbine is something worth trying, not sure where it is sold though.

/Mattias


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