Posted by JohnL on February 23, 2000, at 5:24:32
In reply to Celexa and sexa !!!, posted by Alan on February 22, 2000, at 11:33:57
Unfortunately there's no easy answer to the sexual side effects issue. Sometimes a drug from the same class won't give any problems. With me I had terrible problems on Paxil, Zoloft, Celexa, and Effexor, but experienced a surprising unexpected increase of sexual desire and ability on Prozac. The first week I thought, oh no here we go again. But then wow. Prozac gives the same sexual problems as the other SSRIs to many people, but we do sporadically hear of cases where sex is actually enhanced with Prozac. We hardly ever hear those same claims with the other SSRIs. Just based on that, I would be tempted in your shoes to try Prozac before Luvox.
If you like the results from Celexa (other than the sexual problems) then it makes sense to try other drugs in the same class. A 2 to 3 week trial of each will identify a best fit, if one exists. If after 2 or 3 weeks there are enduring sexual side effects on one, move quickly to another. Explore them all in short order to identify a favorite. Then once one is found, continue with longer time trials and possibly higher doses.
The most common approach is to either augment or substitute with Wellbutrin. Adding Wellbutrin to the Celexa would be a very common approach with most GPs. Sometimes other dopamine agents, like psychostimulants, can counter the sexual side effects as well. Buspar addition is sometimes helpful, but usually in women more than men.
In the natural arena there are things like Yohimbe, L-Arginine(amino acid precursor to nitrous oxide enabling erections and desire) and other formulas containing supposed aphrodisiac herbs like muira puama, damiana, tribulus, avena sativa, and more. I've tried them all and found L-Arginine and/or Yohimbe to be more useful than the others. Yohimbe is a powerful herb and has activating side effects too uncomfortable for some people. There are some theories that SSRIs inhibit NO synthesis, so the addition of L-Arginine counteracts that. And there are clinical studies indicating longterm use of Ginkgo Biloba as being effective in countering SSRI sexual side effects (ginkgo doses about 240mg/day).
Confusing, huh? So many choices, where to go from here? Based on my own experiences, I would start by trying short trials of all the SSRIs, then move on to addition of Wellbutrin, and then stimulants. Unfortunately we can discover the best fit only through trial and error. We all respond so differently.
poster:JohnL
thread:23083
URL: http://www.dr-bob.org/babble/20000220/msgs/23293.html