Posted by Sad Panda on June 27, 2004, at 10:03:24
In reply to Re: Best dopaminergic for..., posted by Questionmark on June 26, 2004, at 3:57:33
> > > What do you think the best dopaminergic drug for anorgasmia would be? This includes efficacy, lack of side effects, increased cognitive function, increased drive/motivation, lack of aggravation of anxiety or depression, and etc. Oh, and apart from aminaptine, apomorphine, and maybe cabergoline, since they are not available in the U.S. (unless cabergoline is [?]). Oh and i'm on Nardil so i couldn't take selegeline with it.
> > > Methylphenidate, bromocriptine, parlodel (sp?), pemoline, pramipexole, ropinirole, pergolide, other?
> > > Mucho mucho thanks to anyone who can help.
> >
> >
> > As Panda mentions, a 5HT-2 blocker might really be what you're looking for. Stahl in "Essential Psychopharmacology" says that the specific problem of anorgasmia is related to stimulation of 5HT-2A (serotonin 2A) receptors in the spinal cord. You are experiencing this on the Nardil because it is a very serotonergic medication, and this is likewise a notorious side effect of SSRIs such as Lexapro also.
> >
> > Remeron would be a good 5HT-2A blocker to try, but this drug does have significant side effects, especially weight gain. If you really want to try a dopaminergic drug, I suppose you could (cautiously and carefully) add a stimulant; these would also increase your cognitive focus and drive. There is a considerable amount of anecdotal information that the dopamine agonists such as bromocriptine and pramipexole (also cabergoline, which is available in the US but is extremely expensive) can have a very beneficial effect on libido, but I question if they would do as well on anorgasmia. They also tend to have significant side effects, particularly somnolence and nausea.
> >
> > Todd
>
>
> Thanks for your comments.
> i understand the serotonin issue and the 5-HT2 involvement in anorgasmia. However, i have tried both of the only two 5-HT2 antagonists that are available (outside of APs, which antagonize DA receptors as well and would be worthless for me)-- cyproheptadine and mirtazapine-- and neither helped me in the least. And both made me feel horrible, too.
> i could not STAND Remeron's antihistaminic effects, even after 5 weeks of use (and i never even upped it to 30mg/day). i could really use some weight gain, so that wouldn't bother me. But all i wanted to do on Remeron was just lie around and sleep. Even speaking demanded extraordinary effort.
> The same basic thing happened with cyproheptadine (Periactin), 4mg, although i never took this one on a daily basis. But it made me incredibly "antihistaminily" drowsy, and i never noticed any ease in ability to have an orgasm.
> So this is why i am on to dopaminergics now. i failed the 5-HT2 blocking trials. i am currently taking amantadine, but it is difficult to say what its effects actually are since they seem to vary so much. Sometimes i get extremely depressed, sometimes i get a modest lift in mood, sometimes i get somewhat nervous/anxious, sometimes i feel more calm/confident (i think), sometimes i get really tired, sometimes i have more motivation, and sometimes i notice nothing at all. The one thing that HASN'T been altered or helped, however, is my anorgasmia! So, i hope i find something. i'm really really getting tired of this.
> i'm truly starting to be afraid that there isn't any way to help this significantly at all, though. So i'm on this great antidepressant, feeling astoundingly better mood-wise, have miraculously lowered levels of anxiety (SP), am finally getting my life together and improving it (oh so gradually), ... and yet my ability to feel sexual pleasure has all but disappeared! What a trade-off.
> i still much prefer the current Nardil-given state of things to the alternative or former. But even still, would i want to go on living if i continued to have this side effect? i don't think i would (at least eventually). And it's really looking like i won't be able to get relieve this side effect. Life is always so negatively ironic.
> Sorry no more blabbering.
>
>You can blabber all you like, I think that's the whole point of this board. :) Other 5-HT2A blockers you could try are Nortriptyline & Trazodone. I would guess 25mg of Trazodone would be a good place to start.
Cheers,
Panda.
poster:Sad Panda
thread:359682
URL: http://www.dr-bob.org/babble/20040627/msgs/360938.html