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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by matze on April 15, 2001, at 12:04:16
Hi,
Does anybody know the differences of the tricyclics
in causing sexual dysfunction?
Does for example imipramine cause more sexual dysfunction than nortriptyline?
I want to try a TCA after many antidepressant trials, that were not very effective.
I suffer from dysthymia.Thanks for response
Posted by Mr. Scott on April 15, 2001, at 23:07:40
In reply to tricyclics differences (sexual dysfunction), posted by matze on April 15, 2001, at 12:04:16
Most made me impotent.. Sinequan (doxepin) did not. I like it enough to stick with it for 3 years until Prozac came out..
mr.scott
Posted by SalArmy4me on April 15, 2001, at 23:45:08
In reply to tricyclics differences (sexual dysfunction), posted by matze on April 15, 2001, at 12:04:16
Desipramine is the gentlest of the tricylics (this is proven by the statistics on the desipramine monograph); it may not have the sexual side-effects.
Posted by JohnL on April 16, 2001, at 5:45:22
In reply to tricyclics differences (sexual dysfunction), posted by matze on April 15, 2001, at 12:04:16
> Hi,
> Does anybody know the differences of the tricyclics
> in causing sexual dysfunction?
> Does for example imipramine cause more sexual dysfunction than nortriptyline?
> I want to try a TCA after many antidepressant trials, that were not very effective.
> I suffer from dysthymia.
>
> Thanks for responseSince it is dysthymia you are trying to treat, then that implies you will need longterm medication. With that in mind, you want one that works real well and has few side effects, because you will have to live with it for a long time. The TCAs are proven workhorse antidepressants, but they do not really have a side effect profile conducive to longterm treatment. Even the mildest ones like Desipramine or Nortriptyline can have some side effects of dry mouth, urination frequency and difficulty, possible impotence and possible mild cognitive dulling. Sure all drugs have side effects, but none of the TCAs have ever been known as drugs with mild side effects. I would think for longterm treatment you might want to look instead at things with a mild side effect profile and things with a lot of success stories.
I would suggest that a trial of Zyprexa, and then Risperdal, would be a better way to go. Choose your favorite AD so far, start just a low dose of it, and add Zyprexa to it. The reasoning is because:
1. We hear a lot of success stories with these drugs.
2. They are often wonderful antidepressants when antidepressants alone don't work.
3. Side effects are generally much milder.
4. Response time is often within days or a couple weeks at the most.On the back burner, Amisulpride and/or Adrafinil from international mailorder are also far superior to most antidepressants I have tried over the years. I think there are better choices for you before you leap into the TCA arena.
John
Posted by matze on April 16, 2001, at 11:03:48
In reply to Re: tricyclics differences (sexual dysfunction), posted by JohnL on April 16, 2001, at 5:45:22
> > Hi,
> > Does anybody know the differences of the tricyclics
> > in causing sexual dysfunction?
> > Does for example imipramine cause more sexual dysfunction than nortriptyline?
> > I want to try a TCA after many antidepressant trials, that were not very effective.
> > I suffer from dysthymia.
> >
> > Thanks for response
>
> Since it is dysthymia you are trying to treat, then that implies you will need longterm medication. With that in mind, you want one that works real well and has few side effects, because you will have to live with it for a long time. The TCAs are proven workhorse antidepressants, but they do not really have a side effect profile conducive to longterm treatment. Even the mildest ones like Desipramine or Nortriptyline can have some side effects of dry mouth, urination frequency and difficulty, possible impotence and possible mild cognitive dulling. Sure all drugs have side effects, but none of the TCAs have ever been known as drugs with mild side effects. I would think for longterm treatment you might want to look instead at things with a mild side effect profile and things with a lot of success stories.
>
> I would suggest that a trial of Zyprexa, and then Risperdal, would be a better way to go. Choose your favorite AD so far, start just a low dose of it, and add Zyprexa to it. The reasoning is because:
> 1. We hear a lot of success stories with these drugs.
> 2. They are often wonderful antidepressants when antidepressants alone don't work.
> 3. Side effects are generally much milder.
> 4. Response time is often within days or a couple weeks at the most.
>
> On the back burner, Amisulpride and/or Adrafinil from international mailorder are also far superior to most antidepressants I have tried over the years. I think there are better choices for you before you leap into the TCA arena.
> JohnI currently take remeron 45mg + thyroxine 250mcg/day. I´m considering adding a new "thing" to this combination. Perhaps Lamictal, Zyprexa, Risperdal or Mirapex. I gained much weight on Remeron. Does the combination Zyprexa+ Remeron mean more body weight? Is risperdal perhaps better together with remeron? Anhedonia is my main problem with my dysthymic disorder. Can mirapex handle this problem better (because of dopamine)?
Many Questions but thanks for response (my English is not the best)Matze
Posted by matze on April 17, 2001, at 10:02:29
In reply to Re: tricyclics differences (sexual dysfunction), posted by matze on April 16, 2001, at 11:03:48
Hi,
I currently take remeron 45mg + thyroxine 0.25mg/day. I´m considering adding a new "thing" to this combination. Perhaps Lamictal, Zyprexa, Risperdal or Mirapex. I gained much weight on Remeron. Does the combination Zyprexa+ Remeron mean more body weight than remeron alone? Is risperdal perhaps better together with remeron? Anhedonia is my main problem with my dysthymic disorder. Can mirapex handle this problem better (because of its dopamine action)? Do risperdal and zyprexa differ in causing sexual dysfunction?
Many Questions but many thanks for response (my English is not the best)
Matze
Posted by ChrisK on April 17, 2001, at 16:44:18
In reply to remeron + antipsychotic (or what else?), posted by matze on April 17, 2001, at 10:02:29
Matze,From my own experience only - Mirapex helped me out the most with anhedonia. Zyprexa is great for ruminating thoughts or clearing up really cloudy thinking. I haven't tried Lamictal.
If anhedonia is the problem I would suggest either a Dopamine med like Mirapex or a stimulant like Adderall.
I know the frustration of feeling numb and Mirapex has worked for me for 4 months now.
Chris
Posted by PhoenixGirl on April 18, 2001, at 18:04:58
In reply to Re: remeron + antipsychotic (or what else?), posted by ChrisK on April 17, 2001, at 16:44:18
Hi Matze,
I've struggled with that problem for years, with many different medications. For me, the more a medication increases serotonin, the worse sexual dysfunction it causes. For example, SSRI's and the tricyclic Anafranil (clomipramine) extinguished all of my sex drive and physical sexual sensation. I am now on desipramine, the least serotonin-enhancing drug, and have a sex drive and feeling down there. I think that it has caused some sexual dysfunction, but it's not as severe as many other drugs. If you want to try tricyclics, I would try desipramine first, then nortriptyline. I would not try Anafranil. Remeron is an atypical antidepressant, which does not cause as much dysfunction as other meds, even though it did for me. I'm still trying to bring all of my sexual function back, and will probably try something like Mirapex or selegiline next. By the way, the highly serotonin-enhancing drugs not only caused bad sexual dysfunction for me, but they made me almost unable to cry, even when I was extremely
depressed. They dulled my emotions, and sadness was the only emotion they let me feel intensely. So in my experience, serotonin meds suck, and the more noradrenyline-affecting drugs like desipramine are better. Good luck.
> Matze,
>
> From my own experience only - Mirapex helped me out the most with anhedonia. Zyprexa is great for ruminating thoughts or clearing up really cloudy thinking. I haven't tried Lamictal.
>
> If anhedonia is the problem I would suggest either a Dopamine med like Mirapex or a stimulant like Adderall.
>
> I know the frustration of feeling numb and Mirapex has worked for me for 4 months now.
>
> Chris
Posted by SalArmy4me on April 18, 2001, at 18:37:15
In reply to sexual dysfunction, posted by PhoenixGirl on April 18, 2001, at 18:04:58
Have you tried methylphenidate yet for your sexual dysfunction?
Selegiline definitely improved my sex drive at 30 mg per day.
Posted by CraigF on April 23, 2001, at 17:57:59
In reply to remeron + antipsychotic (or what else?), posted by matze on April 17, 2001, at 10:02:29
I added Risperidone to Serzone and it actually increased my sex drive. I was constantly masturbating in shower and there was never any hot water left for my roomates. Small price to pay :)
This is the end of the thread.
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