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Dr. Bob is Robert Hsiung, MD,
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Posted by BW on June 23, 2001, at 1:08:27
I've been reading "The antidepressant survival guide" by Dr Robert Hedaya. In it he indicates you can agument SSRI's with Ritalin, Symmetrel or Dexedrine for sexual dysfunction. Has anyone tried any of these or anything else that has helped. Any resonse would greatly be appreciated. Thanks in advance BW
Posted by PaulB on June 23, 2001, at 6:39:58
In reply to Augument SSRI's with what for sexual dysfunction ?, posted by BW on June 23, 2001, at 1:08:27
> I've been reading "The antidepressant survival guide" by Dr Robert Hedaya. In it he indicates you can agument SSRI's with Ritalin, Symmetrel or Dexedrine for sexual dysfunction. Has anyone tried any of these or anything else that has helped. Any resonse would greatly be appreciated. Thanks in advance BW
PaulB > > > >
Theres a book called 'When Words Are Not Enough' by a psychiatrist with a chapter which explores the options available when an SSRI causes such a problem.
Other approaches(the ones you mention are cited as possibilites) include:
Buspirone, Periactin, Urecholine, Wellbutrin, Yocon.Periactin(Cyproheptadine) antagonises those serotonin receptors that are causing the sexual disfunction so unlike other approaches this approach tackles the problem as does Nefazadone(below)
Yocon is an alpha-adrenergic antagonist which blocks the alpha receptors that mediate sexual behaviour.
Buspirone and Wellbutrin both affect dopamine in regards to their use with this problem. Wellbutrin can be used by itself too(below)
I know less about Urecholine but the book says it acts on the cholinergic system.
Other approaches include 'drug holidays' which means taking a break from the SSRI or a reduction in the dose without reducing effectiveness is sometimes possible. Some risk in this approach I guess and would depend on whether your psychiatrist/doctor had experience with it?
Switching antidepresants-Wellbutrin by itself, Nefazadone by itself-no sexual-side effects with either.
I hope this gives you some ideas. If you have just started an SSRI you could always wait a while as the side-effects usually lessen with time.
Posted by SalArmy4me on June 23, 2001, at 15:31:33
In reply to Augument SSRI's with what for sexual dysfunction ?, posted by BW on June 23, 2001, at 1:08:27
Guidelines for treatment of Sexual Dysfunction:
Methylphenidate †
- 5-40 mg/d
- For SSRIs or venlafaxine
- Libido, arousal, orgasmDextroamphetamine †
- 5-40 mg/d
- Avoid night dosing (insomnia)
- Libido, arousal, orgasmPemoline †
- 18.75-75 mg/d
- Check liver function
- Libido, arousal, orgasmGinkgo biloba extract †
- 180-240 mg/d, tid, divided doses
- Potential increased clotting time, possible flatulence
- Libido, arousal, orgasmBethanechol †
- 10-50 mg prn 1 hour before sex
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalNeostigmine †
- 200 mg/d, tid divided doses
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalEstrogen creams or lubricants
- As needed
- For vaginal dryness, atrophy of vaginal tissue
- ArousalAmantadine
- 100 mg bid
- Caution in patients predisposed to psychosis
- OrgasmCyproheptadine
- 4-12 mg qhs
- MAOIs, TCAs, SSRIs, venlafaxine; watch for reemergence of depressive symptoms; sedating
- OrgasmBuspirone †
- 30-60 mg/d, bid divided doses
-
- Libido, orgasmBupropion †
- 75-150 mg/d, qd or bid divided doses
- For SSRIs or venlafaxine, fluoxetine may raise bupropion levels; usual precautionary measures for bupropion
- Libido, arousal, orgasmMirtazapine †
- 15-45 mg/d
- For SSRIs, venlafaxine
- OrgasmNefazodone †
- Start 50 mg/d, up to 150 mg/d
- SSRIs, venlafaxine
- OrgasmGranisetron †
- 1 mg prn
- ? Use of other 5-HT3 antagonists
- OrgasmSildenafil
- 50-100 mg/d
- Contraindicated with nitrates
- Libido, arousal, orgasmYohimbine †
- 5.4 mg tid
- Can be anxiogenic; ? safety with MAOIs
- Libido, arousal, orgasm
Posted by Glenn Fagelson on June 24, 2001, at 1:20:49
In reply to Augument SSRI's with what for sexual dysfunction ?, posted by BW on June 23, 2001, at 1:08:27
> I've been reading "The antidepressant survival guide" by Dr Robert Hedaya. In it he indicates you can agument SSRI's with Ritalin, Symmetrel or Dexedrine for sexual dysfunction. Has anyone tried any of these or anything else that has helped. Any resonse would greatly be appreciated. Thanks in advance BW
Hi BW,
My doctor has me on Wellbutrin and Buspar
(Busparone) and my libido is pretty healthy.
I do not know if that helps you or not. I'm
taking 80mg of the Buspar and 400mg of the
Wellbutrin.
Glenn
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