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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 Questionmark on June 24, 2004, at 3:12:27
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.
Posted by Sad Panda on June 24, 2004, at 5:02:06
In reply to Best dopaminergic for..., posted by Questionmark on June 24, 2004, at 3:12:27
> 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.
>
>If you are talking about SRI induced anorgasmia then it would be logical to add a 5-HT2 blocker to counter anogasmia. I really think dopamine is over rated in the chemical scheme of happiness.
Cheers,
Panda.
Posted by King Vultan on June 24, 2004, at 7:56:58
In reply to Best dopaminergic for..., posted by Questionmark on June 24, 2004, at 3:12:27
> 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
Posted by Questionmark on June 26, 2004, at 3:57:33
In reply to Re: Best dopaminergic for... » Questionmark, posted by King Vultan on June 24, 2004, at 7:56:58
> > 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.
Posted by paulbwell on June 26, 2004, at 4:44:23
In reply to Best dopaminergic for..., posted by Questionmark on June 24, 2004, at 3:12:27
> 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.Desoxyn--(Methyl-Amphetamine-Hydrochloride).A 60+ year old Medication, manufactured by, Abbott Drug Company may be of great value in assisting you, in helping to improve upon your mentioned ailments,
Good luck in your next step, with acquiring the Medicine. ;)
Good health to you.
Paul
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.
Posted by Questionmark on June 29, 2004, at 1:18:42
In reply to Re: Best dopaminergic for... » Questionmark, posted by Sad Panda on June 27, 2004, at 10:03:24
Paul, thanks for your suggestion. i seriously doubt i could get Desoxyn prescribed though, for one thing, and it might also be too potent and risky being on an MAOI. i am considering a low/moderate dose of either methylphenidate, dextroamphetamine, or pemoline, however. i wonder if one of these (a stimulant) would be better or worse overall than a straight dopamine agonist.
Panda, i don't think nortriptyline or trazodone would be good due to their H1 blocking properties. i am so sensitive to antihistamines and never seem to develop adequate tolerance to them. i hate em. Also i can't deal with much more anticholinergic effect and so i think nortriptyline would be especially bad. i wish so much i could try something like nomifensine, but nOOOoooo, they won't keep thAt available. Anyway, thanks for your suggestions though.
Posted by Sad Panda on June 29, 2004, at 1:40:07
In reply to Re: Best dopaminergic for..., posted by Questionmark on June 29, 2004, at 1:18:42
> Paul, thanks for your suggestion. i seriously doubt i could get Desoxyn prescribed though, for one thing, and it might also be too potent and risky being on an MAOI. i am considering a low/moderate dose of either methylphenidate, dextroamphetamine, or pemoline, however. i wonder if one of these (a stimulant) would be better or worse overall than a straight dopamine agonist.
>
> Panda, i don't think nortriptyline or trazodone would be good due to their H1 blocking properties. i am so sensitive to antihistamines and never seem to develop adequate tolerance to them. i hate em. Also i can't deal with much more anticholinergic effect and so i think nortriptyline would be especially bad. i wish so much i could try something like nomifensine, but nOOOoooo, they won't keep thAt available. Anyway, thanks for your suggestions though.
>
>Clomipramine is the TCA that has the least H1 antagonism for the most 5-HT2A antagonism, but forbidden with an MAOI. Nortriptyline has about twice as much H1 antagonism, but is very mild compared to the sedating TCA's. Trazodone doesn't block H1, it gets all of it's sedative properties from 5-HT2A & A1 blockade. Not sure how much M1 antagonism Traz has, but Nortriptyline has some.
Cheers,
Panda.
Posted by paulbwell on June 29, 2004, at 1:54:27
In reply to Re: Best dopaminergic for..., posted by Questionmark on June 29, 2004, at 1:18:42
> Paul, thanks for your suggestion. i seriously doubt i could get Desoxyn prescribed though, for one thing, and it might also be too potent and risky being on an MAOI. i am considering a low/moderate dose of either methylphenidate, dextroamphetamine, or pemoline, however. i wonder if one of these (a stimulant) would be better or worse overall than a straight dopamine agonist.
>
> Panda, i don't think nortriptyline or trazodone would be good due to their H1 blocking properties. i am so sensitive to antihistamines and never seem to develop adequate tolerance to them. i hate em. Also i can't deal with much more anticholinergic effect and so i think nortriptyline would be especially bad. i wish so much i could try something like nomifensine, but nOOOoooo, they won't keep thAt available. Anyway, thanks for your suggestions though.Ha? Methyphenidate *IS* a dopamine against, as well as considered to be a MILD stimulant, as compared to Dex a stronger and older (80yrs)stimulant, and a proper amphetamine,opposed to "amphetamine like" with Desoxyn considered a STRONG stimulant, (and yes i was kidding with you about using it, as you would have a job in your case), it is usually *always* reserved for last resort cases of severe, failed everything else, narcolepsy, Obesity-seldomly, and ADHD ADD, it is also very expensive, at around $3US per 5mg pill, and the recently discontinued Desoxyn SR 15mg selling at $6 per pill.
Posted by Questionmark on June 29, 2004, at 9:44:19
In reply to Re: Best dopaminergic for... » Questionmark, posted by Sad Panda on June 29, 2004, at 1:40:07
This is the end of the thread.
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