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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Chairman_MAO on September 13, 2005, at 9:25:51
In an effort to remedy my sexual dysfunction, I discontinued my buprenorphine. As of now, it's working! I barely have any sexual dysfunction whatsoever except somewhat delayed orgasm (good, IMHO) and minor loss of sensation (about 50% or less of what I'd experience on an SSRI). Also, I had been taking Cialis fairly regularly, and my doctor informed me that it actually can IMPAIR ORGASM! Thus now I have to wait two weeks for it to completely wash out of my system before he's comfortable treating the sexual dysfunction. If it returns despite my bupe discontinuation, I am confident I'll be able to remedy it.
BTW, if anyone is near New Brunswick, NJ, with treatment-resistant depression, etc. I can refer to you a doctor @ the University of Medicine and Dentistry of NJ that has many years of experience prescribing MAOIs and no qualms about using them.
There is also another doctor there who is a specialist in treating medication-induced sexual dysfunction whom my pdoc said he'd refer me to if he could not successfully treat the sexual problems I'm having with the Nardil.Another note: I have been up and down the dosage range of 60-90mg, and although I didn't spend much more than a week or so at any dose less than 90mg, only 90mg seems to work completely. Considering I am 86kg, this seems to back up the 1mg/kg dosage cited in the literature. Thus, if anyone's trying Nardil, one cannot say a complete trial has been conducted unless they take 1mg/kg bodyweight for 6-8 weeks. For some folks this could require going up to 105mg/day or perhaps more.
Also, most of my side effects have waned to tolerable levels except water retention, which is treated with 50mg hydrochlorothiazide/day.
I'm a happy camper right now. If this abatement of my sexal problems continues, I'll be able to say something that I never thought I'd be able to: my illness is in remission! I have started training with a personal trainer--may end up doing a triathalon or a marathon! Previous to taking Nardil I never did anything althletic in my life (that would've required effort) nor was ever in shape.
Note I met this trainer who offered to train me for only $30/session all because I was comfortable being social and not isolating.
Posted by SLS on September 13, 2005, at 10:16:26
In reply to Cialis can cause anorgasmia/Nardil update (good), posted by Chairman_MAO on September 13, 2005, at 9:25:51
> BTW, if anyone is near New Brunswick, NJ, with treatment-resistant depression, etc. I can refer to you a doctor @ the University of Medicine and Dentistry of NJ that has many years of experience prescribing MAOIs and no qualms about using them.
Hi C_M.
I would appreciate you forwarding this information to slsfan1776@yahoo.com
Thanks.
- Scott
Posted by iforgotmypassword on September 13, 2005, at 10:26:55
In reply to Re: Cialis can cause anorgasmia/Nardil update (good), posted by SLS on September 13, 2005, at 10:16:26
it seems that not only do you need a doctor that prescribes them, but also one that is willing to push the dose into an actual effective range (a doctor i had was not willing to go over 40mg with the parnate), because they recognize their own concept of what an "effective range" is.
btw, chairman mao, it is great to hear that you are doing so well.
it makes me wonder what it is about serotonergic meds that cause sexual dysfunction, maybe 5HT2 overstimulation? i wonder if there is also a noradrenergic component as well, as when i was on desipramine i was very sexually unresponsive to touch.
Posted by Chairman_MAO on September 13, 2005, at 13:03:05
In reply to Re: Cialis can cause anorgasmia/Nardil update (goo » SLS, posted by iforgotmypassword on September 13, 2005, at 10:26:55
> it seems that not only do you need a doctor that prescribes them, but also one that is willing to push the dose into an actual effective range (a doctor i had was not willing to go over 40mg with the parnate), because they recognize their own concept of what an "effective range" is.
Even when my pdoc at the clinic in New Brunswick was a resident, she was still comfortable with writing a script for up to 80mg/day tranylcypromine. Back then I had no medicaid, so I ended up buying the Parnate from a chemical supply house and encapsulating it myself (I knew someone with a USP-spec capsule filler). When I had my own stock and she didn't have to write the script, I was totally open with her about taking 120-200mg/day and there was no chastizing of me.
Now my doctor is the guy who supervised her. While I do not know if he'd be comfortable using ultra-high doses, I do know that they have no problems going up to 80mg/day Parnate or 90mg/day Nardil. If for some reason you fail to respond at all, there is some likelihood they'd push the dose higher. I am not certain of that, however.
>
> btw, chairman mao, it is great to hear that you are doing so well.
Thanks. After being mentally ill in some capacity for most of my life, it's a breath of fresh air for sure.> it makes me wonder what it is about serotonergic meds that cause sexual dysfunction,
maybe 5HT2 overstimulation? i wonder if there is
The 5ht2 stimulation inhibits dopamine release.
With MAO inhibitors, if there is too much MAO inhibition, there can also be a concomitant fall of DA synthesis. Too much SE can also raise prolactin levels due to inadequate stimulation of D2 receptors in the hypothalamus. This is why the drug cabergoline seems to work so well for sexual dysfunction from serotonergic medications--in addition to eliminating the male refractory period (only with intermittent dosing).>also a noradrenergic component as well, as when i was on desipramine i was very sexually unresponsive to touch.
Stimulation of alpha adrenoreceptors in the male reproductive tract impairs blood flow and consequentially sensitivity as well.
The whole story is WAY more complex than this.
Posted by Iansf on September 13, 2005, at 18:54:56
In reply to Re: Cialis can cause anorgasmia/Nardil update (goo » iforgotmypassword, posted by Chairman_MAO on September 13, 2005, at 13:03:05
> Now my doctor is the guy who supervised her. While I do not know if he'd be comfortable using ultra-high doses, I do know that they have no problems going up to 80mg/day Parnate or 90mg/day Nardil. If for some reason you fail to respond at all, there is some likelihood they'd push the dose higher. I am not certain of that, however.
>
>
Is the likelihood of a hypertensive crisis heightened by upping the dosage?
Posted by Chairman_MAO on September 16, 2005, at 10:58:18
In reply to Re: Cialis can cause anorgasmia/Nardil update (goo, posted by Iansf on September 13, 2005, at 18:54:56
Maybe in the case of Parnate (additive effects of greater concentrations of sympathomimetic metabolites), but I doubt that an increase from 90mg Nardil upward would increase the risk that much. I dont know for sure, though.
This is the end of the thread.
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