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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by law663 on January 9, 2006, at 7:40:55
Does anyone know if the biological pathway that causes sexual dysfunction with SSRI's has been identified or, more likely, a good theory that has posited the effect?
Posted by bipolarspectrum on January 9, 2006, at 12:16:31
In reply to What is the biological pathway... sex and SSRI?, posted by law663 on January 9, 2006, at 7:40:55
Posted by law663 on January 9, 2006, at 12:19:54
In reply to Increased Prolactin (nm), posted by bipolarspectrum on January 9, 2006, at 12:16:31
I've had my prolactin measured and it's not elevated. Are there studies that suggest prolactin?
Posted by Racer on January 9, 2006, at 12:23:00
In reply to What is the biological pathway... sex and SSRI?, posted by law663 on January 9, 2006, at 7:40:55
I don't know all the details, but it's got to do with receptors -- 5HT2c if I remember correctly, which I probably don't -- in the spinal cord. Since the SSRI affects those receptors, they can't respond properly to sexual pleasure. I think there's some connection to dopamine (in the sense of interfering with normal dopamine transport, because the serotonin is hanging out), but can't remember the details.
What has worked for me, though, is cyproheptidine. It temporarily blocks the effects of the SSRI, thus allowing for a lovely bout of rolling around and screaming. Apparently doesn't work for everyone, but since it's a cheap, benign drug, with few side effects -- standard anti-histimine, so it'll make you sleepy -- and a shortish half life, it's worth trying.
Good luck.
Posted by Colleen D. on January 9, 2006, at 17:54:23
In reply to What is the biological pathway... sex and SSRI?, posted by law663 on January 9, 2006, at 7:40:55
The sex act involves large motor activity which normally releases serotonin in the brain. Since SSRIs create abnormally higher levels in our bodies, there is not the big change from little to lots like there should be during and after a good roll in the sack.
This is how I've come to understand it after talking with my son's autism 7-person evaluation team - all psychologists. Large motor workouts for my son lessen his sensitivty to the light touch and unusual textures that he normally is disturbed by.
Does this make any sense?
Colleen
Posted by blueberry on January 9, 2006, at 17:58:52
In reply to What is the biological pathway... sex and SSRI?, posted by law663 on January 9, 2006, at 7:40:55
As Racer said, the 5ht2c receptor has a lot to do with it. Over the years I noticed paxil gave me profound sexual side effects, but I actually had some pro-sexual side effects on prozac, celexa, and zoloft. It took me a while to figure out why. With paxil, it was the only med I took. With all the others, I was also taking zyprexa, which just so happens to block the 5ht2c receptor. Recently I tried removing the zyprexa, and all the usual ssri side effects came back bigtime. For me anyway, zyprexa blocks most of the serotonin side effects of nausea, insomnia, and sexual dysfunction. And I do believe it has a lot to do with that 5ht2c receptor.
Prolactin was mentioned. If a drug increases prolactin levels, say goodbye to any sex life. Drugs that usually do that are ones that have a stimulating effect on dopamine, but not so much with the ssri's.
I'm certainly no expert, but just passing on what I've experienced myself over the years.
Posted by Phillipa on January 9, 2006, at 19:28:15
In reply to Re: What is the biological pathway... sex and SSRI?, posted by blueberry on January 9, 2006, at 17:58:52
Prolactin? Fondly, Phillipa
Posted by law663 on January 9, 2006, at 19:47:29
In reply to Re: What is the biological pathway... sex and SSRI?, posted by blueberry on January 9, 2006, at 17:58:52
Humm, that's interesting. I'm suprised to hear about zyrexa as it increases prolactin and blocks DA which is needed for sex. I'm skeptical of the prozac claim b/c of the high prevalence of sex side effects with those on it (and it killed my sex drive) [but appeciate the feedback].
I've often wondered what are the effects of raising 5HT levels in all areas of the brain. we already know that it dramatically changes sleep arcitecture.
> As Racer said, the 5ht2c receptor has a lot to do with it. Over the years I noticed paxil gave me profound sexual side effects, but I actually had some pro-sexual side effects on prozac, celexa, and zoloft. It took me a while to figure out why. With paxil, it was the only med I took. With all the others, I was also taking zyprexa, which just so happens to block the 5ht2c receptor. Recently I tried removing the zyprexa, and all the usual ssri side effects came back bigtime. For me anyway, zyprexa blocks most of the serotonin side effects of nausea, insomnia, and sexual dysfunction. And I do believe it has a lot to do with that 5ht2c receptor.
>
> Prolactin was mentioned. If a drug increases prolactin levels, say goodbye to any sex life. Drugs that usually do that are ones that have a stimulating effect on dopamine, but not so much with the ssri's.
>
> I'm certainly no expert, but just passing on what I've experienced myself over the years.
Posted by blueberry on January 10, 2006, at 6:25:19
In reply to Re: What is the biological pathway... sex and SSRI, posted by law663 on January 9, 2006, at 19:47:29
Actually zyprexa rarely increases prolactin levels. And when it does, it is usually only a little bit and it is usually transitory, falling back to baseline within a few weeks. The most guilty ones for increasing prolactin are risperdal and amisulpride.
As far as blocking DA, it isn't that simple. Even though zyprexa does block some but not all DA receptors, it does so rather weakly, and it also stimulates increased DA levels as an indirect result of blocking 5HT receptors. The DA blockade is rather weak compared to the increased DA release, especially at lower doses.
I tried increasing 5HT in all areas of my brain by taking 5HTP supplements. I have never experienced such severe sexual side effects as I did with 5HTP. Much much worse than SSRIs. For me anyway.
> Humm, that's interesting. I'm suprised to hear about zyrexa as it increases prolactin and blocks DA which is needed for sex. I'm skeptical of the prozac claim b/c of the high prevalence of sex side effects with those on it (and it killed my sex drive) [but appeciate the feedback].
>
> I've often wondered what are the effects of raising 5HT levels in all areas of the brain. we already know that it dramatically changes sleep arcitecture.
Posted by Meri-Tuuli on January 10, 2006, at 11:14:26
In reply to Re: What is the biological pathway... sex and SSRI, posted by law663 on January 9, 2006, at 19:47:29
Hey there!
> I've often wondered what are the effects of raising 5HT levels in all areas of the brain. we already know that it dramatically changes sleep arcitecture.
It really really really does. When I was on celexa (straight) I had to sleep all the time. And I was soooo apathic! Actually, I'm quite bitter about it all, I feel as if I wasted a year of my life on the stuff and all I was was a zombie. Eating, sleeping and going to work, was all I could do.
Now, off the stuff since summer (and only taking one st john's wort pill a day) I can not believe how much more energy and motivation I have!! I feel much better off the stuff that I did on it!
I have vowed now not to take any 'proper' pysch drugs, unless I am completely gone. The side effects of the SSRIs are pretty bad (at least to me) and they don't really work (for me again also).I seriously don't think SSRIs are all they are cracked up to be.
Posted by Declan on January 10, 2006, at 13:16:09
In reply to Re: What is the biological pathway... sex and SSRI » law663, posted by blueberry on January 10, 2006, at 6:25:19
Hi blueberry
This is a bit off thread, but since I can't babblemail you I'll put it here. You found 5htp to be really negative sex wise. How much were you takeing? And anything else you want to add.
Declan
Posted by Sarah T. on January 10, 2006, at 21:44:13
In reply to Re: What is the biological pathway... sex and SSRI » law663, posted by Meri-Tuuli on January 10, 2006, at 11:14:26
Hi Merri,
When I read your post, I wanted to give you a standing ovation. Those are my sentiments exactly.
S.
Posted by linkadge on January 11, 2006, at 16:58:42
In reply to Re: What is the biological pathway... sex and SSRI » Meri-Tuuli, posted by Sarah T. on January 10, 2006, at 21:44:13
Yeah, the 5-ht2c receptor plays a big role.
Serotonin agonism at this receptor inhibits orgasm as well as generally lowering mesolimbic dopamine release.
I would perhaps try periactin if you can get your hands on it.
Linkadge
Posted by linkadge on January 11, 2006, at 17:01:58
In reply to Re: What is the biological pathway... sex and SSRI » Meri-Tuuli, posted by Sarah T. on January 10, 2006, at 21:44:13
Thats another reason why AD's poop out I think.
They generally alter sleep archetecture and supresses certain stages, I think if you go long enough without the full range of sleep stages, then you loose daytime alertness.
If kind of builds up over time, till the day and the night become one large expanse of time.
Linkadge
Posted by Meri-Tuuli on January 13, 2006, at 5:57:35
In reply to Re: What is the biological pathway... sex and SSRI » Meri-Tuuli, posted by Sarah T. on January 10, 2006, at 21:44:13
> When I read your post, I wanted to give you a standing ovation. Those are my sentiments exactly.
Thanks! :o)
I guess SSRIs where helpful when I was really really gone, but I think that if I haven't tried them, then I might have sort of snapped out of it myself. I don't know. I think therapy like CBT would have been much more useful. I haven't any therapy until recently, and even then its just reading David Burns CBT book. Its a tricky one. From now on, at any rate, I am avoiding all pysch meds unless I am really really really gone, and even then I will try to avoid them. But obviously now I am so much better, I am trying to be preventative measures. For me, at least, I think stress plays a large part, as I can't seem to handle it very well.
And I also think that people (in general) are far too over medicated, and either their doc or they feel the need to pop a pill for every nuance of mood disorder. Pills aren't really the answer, I don't think.
And SSRIs are just plain rubbish, which the Pharm companies want to push to make $.Kind regards
Meri
Posted by Meri-Tuuli on January 13, 2006, at 6:03:26
In reply to Re: What is the biological pathway... sex and SSRI » Sarah T., posted by Meri-Tuuli on January 13, 2006, at 5:57:35
Sorry that last post was typed in a hurry. I meant to say
'Pill aren't really the answer in a lot of people, but obviously they are extremely benefical to some'. Like if you have severe bipolar, schizo-disorders etc, then I guess pills are essential. But for the vast majority of unipolar depression, anxiety etc, then things like exercise, therapy, eating right are probably more benefitial in the long term than the standard course of SSRIs etc etc.
Oh well.
Posted by flmm on January 13, 2006, at 20:35:56
In reply to Re: What is the biological pathway... sex and SSRI, posted by Meri-Tuuli on January 13, 2006, at 6:03:26
Gee thank you Tom Cruise!
Posted by Sarah T. on January 13, 2006, at 22:01:54
In reply to Re: What is the biological pathway... sex and SSRI, posted by Meri-Tuuli on January 13, 2006, at 6:03:26
Hi Meri,
I agree to a large extent. I do think I need some sort of antidepressant, but not any of the currently available ones.
S.
This is the end of the thread.
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