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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by TommyIsland on June 3, 2006, at 1:00:28
I went off of Effexor XR after taking the drug for the better part of the last 8 years or so. I dwindled the dose down from 150 to 75 and then took it everyother day and so forth until I just stopped completely taking the 75 MG capsule. The Mind Zaps have subsided for the most part and it's been close to 3 weeks since I've taken a pill.
QUESTION:
Why am I suddenly experiencing absolutely no orgasmic pleasure during ejaculation. I have no problem getting an erection and no problem climaxing. The problem now is that I'm experiencing absolutely no Orgasm. I am a male 29 years old and even while taking the drug throughout the years I would plan "Drug Holidays" and would be able to experience orgasm as long as I didn't take the pill and waited a day or two to have sex. Now ironically I've stopped taking the medication altogether and I have absolutely no Orgasmic pleasure. It's like Effexor is getting it's hooks in me and haunting me or something........ This must be a discontinuation effect and must have something to do with Brain chemicals readjusting or something along this line. Any information or suggestion would be appreciated.........
Thanks,
Tommy
Jersey
Posted by SLS on June 3, 2006, at 8:21:59
In reply to Effexor Sexual Side Effects After Discontinuation, posted by TommyIsland on June 3, 2006, at 1:00:28
> I went off of Effexor XR after taking the drug for the better part of the last 8 years or so. I dwindled the dose down from 150 to 75 and then took it everyother day and so forth until I just stopped completely taking the 75 MG capsule. The Mind Zaps have subsided for the most part and it's been close to 3 weeks since I've taken a pill.
>
> QUESTION:
>
> Why am I suddenly experiencing absolutely no orgasmic pleasure during ejaculation. I have no problem getting an erection and no problem climaxing. The problem now is that I'm experiencing absolutely no Orgasm. I am a male 29 years old and even while taking the drug throughout the years I would plan "Drug Holidays" and would be able to experience orgasm as long as I didn't take the pill and waited a day or two to have sex. Now ironically I've stopped taking the medication altogether and I have absolutely no Orgasmic pleasure. It's like Effexor is getting it's hooks in me and haunting me or something........ This must be a discontinuation effect and must have something to do with Brain chemicals readjusting or something along this line. Any information or suggestion would be appreciated.........
I don't really have any answers for you except to say that there are people who report a persistence of sexual side effects after discontinuing serotonergic drugs like Effexor.I hope things normalize for you. It might take a few months, though. You could try using cyproheptadine (Periactin). It is to be taken about an hour before having sex. Cyproheptadine has been used in the past to reverse anorgasmia produced by SRI antidepressants. That is not exactly what you describe as happening to you, but it couldn't hurt to try it.
Good luck.
- Scott
Posted by linkadge on June 3, 2006, at 19:47:09
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by SLS on June 3, 2006, at 8:21:59
I have the same problem since coming off them. No problem getting there, but I experience zero pleasure from it. Its almost a waiste of time.
Anyhow, serotonin and norepenephrine (and dopamine) are intricately involved in the pleasure centres of the brain in regulating the reward. Stopping effexor could leave this area a little deficiant.
I hope you have better luck than me. I've been off them a year. On AD's it was harder to get there, but there but the reward was fine. Now off them, getting there is premature and zero reward.
Sorry for being graphic, just thought I'd say I know what you're talking about.
Linkadge
Posted by crabwalk on June 4, 2006, at 14:56:50
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by linkadge on June 3, 2006, at 19:47:09
Go here: www.ssri-side-effects.com
I've been dealing with this problem for almost a year and a half now. Your situtation sounds better than a lot of others', mine for example is very severe. Hopefully you are lucky and everything will come back to you normally.
Posted by ed_uk on June 4, 2006, at 15:08:06
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by linkadge on June 3, 2006, at 19:47:09
Hi Link
>Now off them, getting there is premature and zero reward.
Perhaps the reason that there is little pleasure is that your orgasm is premature? SSRIs and similar ADs suppress orgasm, and premature ejaclation can occur after withdrawal.
Ed
Posted by TommyIsland on June 7, 2006, at 3:46:16
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by linkadge on June 3, 2006, at 19:47:09
> I have the same problem since coming off them. No problem getting there, but I experience zero pleasure from it. Its almost a waiste of time.
>
> Anyhow, serotonin and norepenephrine (and dopamine) are intricately involved in the pleasure centres of the brain in regulating the reward. Stopping effexor could leave this area a little deficiant.
>
> I hope you have better luck than me. I've been off them a year. On AD's it was harder to get there, but there but the reward was fine. Now off them, getting there is premature and zero reward.
>
> Sorry for being graphic, just thought I'd say I know what you're talking about.
>
> LinkadgeI'll tell you the wierdest thing of all: In the past whenever I've discontinued Effexor Xr, I've suddenly experienced an extreme relapse into severe depression but the whole sexual thing would work fine even during the depression. Obviously I wouldn't be that into sex because of the depression but if I did engage in sex the orgasm would be pretty good and intense at least. This time around however, I havn't relapsed into depression and in fact I feel exactly the same as how I felt while taking the Effexor XR except now I feel absolutely no orgasm and my sleeping cycle is terrible with insomnia and only spurts of sleep for 3 hours or so followed by Restless Leg Syndrome and hyperactivity within my entire body. What it seems to me while trying to draw a hypothesis is that since stopping the medication altogether, some kind of chemical change has taken place within my brain that now keeps me out of depression perhaps due to an increase in one or many of my neurotransmitters and at the same time one or many other neurotransmitters that have to do with feelings of pleasure, sex, and emotion have been overshadowed due to any number of possibilities that obviously have to do with the levels of these particular brain chemicals within my brain. So strange the tradeoff. In the past I relapsed with severe depression but the ability to enjoy sex and this time around it's the opposite. Believe me I'm happier that I'm not relapsing into severe depression but at the same time I'd like to get some balance for a change. Why do things always have to be one extreme or the other when dealing with brain chemicals. My experience obviously goes to show you that we are literally a product of our own brain chemicals and our free thinking is really only determined by what's happening in our world of brain chemicals. When their good were good and when their bad we become different with the decisions that we make and our outlook on life in general. I don't mean to sound analytical but how can you not while dealing with this deep rooted stuff called brain chemicals. Any additional help or insight would be great. Has anybody experienced this and then suddenly things in the sex department turned back to normal after a couple weeks or months of discontinuation? Is there some kind of a blood test that I could get done to see if I'm short on Free Testosterone or something?
Tommy
Jersey
Posted by TommyIsland on June 7, 2006, at 3:50:52
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by crabwalk on June 4, 2006, at 14:56:50
> Go here: www.ssri-side-effects.com
>
> I've been dealing with this problem for almost a year and a half now. Your situtation sounds better than a lot of others', mine for example is very severe. Hopefully you are lucky and everything will come back to you normally.Hey buddy, I'd like to know about your particular case. Where you also taking Effexor? Even if you weren't taking Effexor, when you went off your AntiDeppressant in the past did this same thing occur or has it only been this last time around? Also, how long did u take the med for? Have you gotten any insight as to why this is happening and have you gotten any strategy on how to combat this crap? That website link you posted is very good......I joined up.....
Tommy
Jersey
Posted by crabwalk on June 7, 2006, at 13:43:05
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by TommyIsland on June 7, 2006, at 3:50:52
Tommy,
My story is long and marked by disappointment after disappointment, but I'm just one person out of several hundred (probably more) who are trying to beat this. I lost all sexual feeling (libido, tactile pleasure, orgasm pleasure, romantic feelings) while I took paxil for 2 months 2 years ago. I was switched directly to prozac, and for about 3 weeks as the paxil left my system all my sexual feelings returned, I thought I was ok. Then I literally woke up one morning and everything had gone numb again, physically and emotionally. Foolishly I stayed on prozac for another 5 months. I developed severe restless leg syndrome that was so maddening I had no choice but to quit, which I was actually happy about since I thought I'd lose the side effects. The restless leg went away, but the sexual side effects never did, not one bit. I waited three months and then decided to try to do something about it. I started taking buspar, then added ginkgo, and eventually yohimbe; several months later I was still nowhere close to normal. I quit those and immediately had problems with erections, became very depressed for a couple months, then decided to go back on buspar. For some reason this time I had a very bad reaction (akathisia) and had to stop. A few months later I tried tianeptine, and had a terrible reaction to it. Quit that, now I am on emsam and have been for about 6 weeks with no substantial changes sexually, which means I am still very unhappy.
There might be a chance that things will come back for you naturally, it's really up to you to decide how long you want to wait (before trying to treat it) because the only prognosis is 'indefinite'. In the meantime you should see a doctor and get your hormones tested, especially testosterone and prolactin, although hormone imbalance seems to have little if anything to do with this, but just to be sure. If you have a competent doctor, he/she should do a complete blood workup after you tell them the problem (make sure you ask for total testosterone and bioavailable or 'free' and you'll probably have to ask for prolactin) but they are likely to be skeptical. There are a few articles you can print out from the ssri side effects group to show your doctor, also several individual testimonials; if they see these they'll be less likely to dismiss the problem and tell you to 'just keep waiting' or of course blame it on depression. Unfortunately, even if they at least acknowledge the possibility of persistent side effects, they probably won't have much to offer as ideas for treatment as it will almost surely be the first time they've heard of it happening.
The closest we have to a theory is that the problem is primarily due to a compromise of dopaminergic responses in sexual/emotional/pleasurable reward areas of the brain. Serotonin generally inhibits the release of dopamine (this is likely what causes restless leg) and its likely that chronically raising synaptic levels of serotonin causes long-term inhibition or rearrangement of dopaminergic receptors or pathways; this probably occurs due to an alteration of gene expression. That's just a theory though, no one really knows anything beyond an educated guess. Why it persists in some people but reverses quickly in most is the biggest mystery. Based on the dopamine hypothesis, a number of people have tried dopaminergic drugs, but nothing has proven consistently helpful. One of the hardest parts about this for me is that I have had no professional guidance. I've suggested all my treatments based on my research or word of mouth, so everything's been an experiment.
Hope this helps. You could still be able to get better without treatment. I hope this is the case for you.
-C
Posted by TommyIsland on June 7, 2006, at 21:58:34
In reply to Re: Effexor Sexual Side Effects After Discontinuat » TommyIsland, posted by crabwalk on June 7, 2006, at 13:43:05
>Wow man, thanks for all the great insight. I fully understood everything you were saying and I can relate from my differential reactions over the years. It's just so strange that every other time I discontinued a med, my depression returned immediately but my sexual pleasure also would return but of coarse with a lower libidio due to the depression. After taking meds on and off but mostly on for over 10 years straight I suddenly have a reverse scenario playing out and it's completely evident through observation and analysis that this "Altered Gene Expression" obviously has taken place. Are you saying that I probably have a higher level of Serotonin now than in the past and with that it is inhibiting the release of Dopamine which is responsible for pleasure and in this particular case, sexual libido function and orgasmic pleasure? What's strange is that any time in the past that I took Dopamine enhancing drugs I would get immediate negative side effects. For example when taking AntiPsychotics, which are given to people with Schizzophrenia or people with severe depression (As was for my particular case), I would actually begin to develop psychosis symptoms that the prescription is given for in the first place to combat these symptoms for people with Schizzophrenia. I would start to hear auditory hallucinations and feel extrememly lightheaded and dizzy. So that leads me to believe that my Dopamine receptors were already high and when given meds such as AntiPsychotics that increase your level of Dopamine or when I increased my Effexor XR to 225MG from 150MG, I would get negative symptoms as opposed to positive results and this must be playing a role in my chemical spectrum. The bottom line must be that Serotonin levels are now higher than normal and are offsetting my Dopamine levels by keeping them extremely low. The result is a normal level of mood and an extremely low sex drive because of a lack of Dopamine levels that are being suppressed. That actually makes sense but then again who knows how accurate it is. It's exactly like you said, nobody is telling us this info so we are literally the scientists and doctors in these situations. Well I'll talk to you soon and thanks buddy.........
Tommy
Jersey
Tommy,
>
> My story is long and marked by disappointment after disappointment, but I'm just one person out of several hundred (probably more) who are trying to beat this. I lost all sexual feeling (libido, tactile pleasure, orgasm pleasure, romantic feelings) while I took paxil for 2 months 2 years ago. I was switched directly to prozac, and for about 3 weeks as the paxil left my system all my sexual feelings returned, I thought I was ok. Then I literally woke up one morning and everything had gone numb again, physically and emotionally. Foolishly I stayed on prozac for another 5 months. I developed severe restless leg syndrome that was so maddening I had no choice but to quit, which I was actually happy about since I thought I'd lose the side effects. The restless leg went away, but the sexual side effects never did, not one bit. I waited three months and then decided to try to do something about it. I started taking buspar, then added ginkgo, and eventually yohimbe; several months later I was still nowhere close to normal. I quit those and immediately had problems with erections, became very depressed for a couple months, then decided to go back on buspar. For some reason this time I had a very bad reaction (akathisia) and had to stop. A few months later I tried tianeptine, and had a terrible reaction to it. Quit that, now I am on emsam and have been for about 6 weeks with no substantial changes sexually, which means I am still very unhappy.
>
> There might be a chance that things will come back for you naturally, it's really up to you to decide how long you want to wait (before trying to treat it) because the only prognosis is 'indefinite'. In the meantime you should see a doctor and get your hormones tested, especially testosterone and prolactin, although hormone imbalance seems to have little if anything to do with this, but just to be sure. If you have a competent doctor, he/she should do a complete blood workup after you tell them the problem (make sure you ask for total testosterone and bioavailable or 'free' and you'll probably have to ask for prolactin) but they are likely to be skeptical. There are a few articles you can print out from the ssri side effects group to show your doctor, also several individual testimonials; if they see these they'll be less likely to dismiss the problem and tell you to 'just keep waiting' or of course blame it on depression. Unfortunately, even if they at least acknowledge the possibility of persistent side effects, they probably won't have much to offer as ideas for treatment as it will almost surely be the first time they've heard of it happening.
>
> The closest we have to a theory is that the problem is primarily due to a compromise of dopaminergic responses in sexual/emotional/pleasurable reward areas of the brain. Serotonin generally inhibits the release of dopamine (this is likely what causes restless leg) and its likely that chronically raising synaptic levels of serotonin causes long-term inhibition or rearrangement of dopaminergic receptors or pathways; this probably occurs due to an alteration of gene expression. That's just a theory though, no one really knows anything beyond an educated guess. Why it persists in some people but reverses quickly in most is the biggest mystery. Based on the dopamine hypothesis, a number of people have tried dopaminergic drugs, but nothing has proven consistently helpful. One of the hardest parts about this for me is that I have had no professional guidance. I've suggested all my treatments based on my research or word of mouth, so everything's been an experiment.
>
> Hope this helps. You could still be able to get better without treatment. I hope this is the case for you.
>
> -C
Posted by Nezirov on June 8, 2006, at 10:49:36
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by TommyIsland on June 7, 2006, at 21:58:34
Hi Tommy,
Your story is very common.
BTW, antipsychotics actually block dopamine receptors and inhibit dopaminergic neurotransmission. So they frequently cause sexual side effects themselves. There is probably some mechanistic overlap between the sexual dysfunction caused by SSRIs and antipsychotics.
My personal belief is that antipsychotics can make schizophrenia worse over time by persistently screwing up dopamine pathways. The whole field of neuropsychopharmacology is very primitive. With current technology its like trying to do brain surgery with a hammer and saw.
There are some deeply irresponsible psychiatrists out there who will tell you that this is all very simple, but nothing could be further from the truth. Fifty years from now people will look back on this time as a dark age, a genocide of the mind.
Nezirov
> >Wow man, thanks for all the great insight. I fully understood everything you were saying and I can relate from my differential reactions over the years. It's just so strange that every other time I discontinued a med, my depression returned immediately but my sexual pleasure also would return but of coarse with a lower libidio due to the depression. After taking meds on and off but mostly on for over 10 years straight I suddenly have a reverse scenario playing out and it's completely evident through observation and analysis that this "Altered Gene Expression" obviously has taken place. Are you saying that I probably have a higher level of Serotonin now than in the past and with that it is inhibiting the release of Dopamine which is responsible for pleasure and in this particular case, sexual libido function and orgasmic pleasure? What's strange is that any time in the past that I took Dopamine enhancing drugs I would get immediate negative side effects. For example when taking AntiPsychotics, which are given to people with Schizzophrenia or people with severe depression (As was for my particular case), I would actually begin to develop psychosis symptoms that the prescription is given for in the first place to combat these symptoms for people with Schizzophrenia. I would start to hear auditory hallucinations and feel extrememly lightheaded and dizzy. So that leads me to believe that my Dopamine receptors were already high and when given meds such as AntiPsychotics that increase your level of Dopamine or when I increased my Effexor XR to 225MG from 150MG, I would get negative symptoms as opposed to positive results and this must be playing a role in my chemical spectrum. The bottom line must be that Serotonin levels are now higher than normal and are offsetting my Dopamine levels by keeping them extremely low. The result is a normal level of mood and an extremely low sex drive because of a lack of Dopamine levels that are being suppressed. That actually makes sense but then again who knows how accurate it is. It's exactly like you said, nobody is telling us this info so we are literally the scientists and doctors in these situations. Well I'll talk to you soon and thanks buddy.........
>
> Tommy
> Jersey
>
>
>
>
> Tommy,
> >
> > My story is long and marked by disappointment after disappointment, but I'm just one person out of several hundred (probably more) who are trying to beat this. I lost all sexual feeling (libido, tactile pleasure, orgasm pleasure, romantic feelings) while I took paxil for 2 months 2 years ago. I was switched directly to prozac, and for about 3 weeks as the paxil left my system all my sexual feelings returned, I thought I was ok. Then I literally woke up one morning and everything had gone numb again, physically and emotionally. Foolishly I stayed on prozac for another 5 months. I developed severe restless leg syndrome that was so maddening I had no choice but to quit, which I was actually happy about since I thought I'd lose the side effects. The restless leg went away, but the sexual side effects never did, not one bit. I waited three months and then decided to try to do something about it. I started taking buspar, then added ginkgo, and eventually yohimbe; several months later I was still nowhere close to normal. I quit those and immediately had problems with erections, became very depressed for a couple months, then decided to go back on buspar. For some reason this time I had a very bad reaction (akathisia) and had to stop. A few months later I tried tianeptine, and had a terrible reaction to it. Quit that, now I am on emsam and have been for about 6 weeks with no substantial changes sexually, which means I am still very unhappy.
> >
> > There might be a chance that things will come back for you naturally, it's really up to you to decide how long you want to wait (before trying to treat it) because the only prognosis is 'indefinite'. In the meantime you should see a doctor and get your hormones tested, especially testosterone and prolactin, although hormone imbalance seems to have little if anything to do with this, but just to be sure. If you have a competent doctor, he/she should do a complete blood workup after you tell them the problem (make sure you ask for total testosterone and bioavailable or 'free' and you'll probably have to ask for prolactin) but they are likely to be skeptical. There are a few articles you can print out from the ssri side effects group to show your doctor, also several individual testimonials; if they see these they'll be less likely to dismiss the problem and tell you to 'just keep waiting' or of course blame it on depression. Unfortunately, even if they at least acknowledge the possibility of persistent side effects, they probably won't have much to offer as ideas for treatment as it will almost surely be the first time they've heard of it happening.
> >
> > The closest we have to a theory is that the problem is primarily due to a compromise of dopaminergic responses in sexual/emotional/pleasurable reward areas of the brain. Serotonin generally inhibits the release of dopamine (this is likely what causes restless leg) and its likely that chronically raising synaptic levels of serotonin causes long-term inhibition or rearrangement of dopaminergic receptors or pathways; this probably occurs due to an alteration of gene expression. That's just a theory though, no one really knows anything beyond an educated guess. Why it persists in some people but reverses quickly in most is the biggest mystery. Based on the dopamine hypothesis, a number of people have tried dopaminergic drugs, but nothing has proven consistently helpful. One of the hardest parts about this for me is that I have had no professional guidance. I've suggested all my treatments based on my research or word of mouth, so everything's been an experiment.
> >
> > Hope this helps. You could still be able to get better without treatment. I hope this is the case for you.
> >
> > -C
>
>
Posted by sm100378 on June 8, 2006, at 23:04:37
In reply to Re: Effexor Sexual Side Effects After Discontinuat, posted by crabwalk on June 4, 2006, at 14:56:50
Effexor XR is not an SSRI, but rather an SNRI. There is a very noticable difference. Also (being on Effexor from 37.5 to 75), I did have increased impotence, but I was also on Klonopin and was taken off that and now on Xanax and have impotence reduced to about 25%, so when I am off Effexor all will be okay (hopefully).
In summary, there is a big differnce with SSRI / SNRI.
http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor
This is the end of the thread.
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