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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 46. Go back in thread:
Posted by SLS on July 6, 2009, at 10:40:04
In reply to Re: Best Antidepressants for men? » SLS, posted by linkadge on July 6, 2009, at 7:22:25
I hope one of these new 5-HT1a partial agonists come by soon. I think they may go to relieve SSRI problems with sexual asrousal when taken at the same time. Does buspirone help at all?
I don't completely understand the FDA's refusal to approve gepirone. For me personally, I don't think I could handle either buspirone or gepirone (and tandospirone) because the metabolite, 1-PP, is a NE alpha-2 receptor antagonists. My system does not like drugs that do that. Remeron and idazoxan both made me feel worse. I would prefer to see flesinoxan come to market, but I think the patent has expired on it.
- Scott
Posted by sowhysosad on July 6, 2009, at 14:20:23
In reply to Re: Best Antidepressants for men?, posted by SLS on July 6, 2009, at 5:12:25
> > > Some studies that women responded better to SSRI's wherase men responded better to imipramine. SSRI's make me a little....wimpy.
> >
> > A word of warning: imipramine gave me erectile dysfunction. Apparently it's fairly common.
>
> Hmm. I don't know about that.
>
> This is the first time I have heard this said of any tricyclic with the exception of clomipramine. I have been on quite a few of them, and never had a problem, even at maximum dosages. I'm just one person, of course. However, I don't believe that TCAs cause ED. They might perhaps exaggerate the cremaster reflex during orgasm, but this does not affect the orgasm itself.Imipramine certainly caused it for me - not a complete inability to achieve an erection, but big problems sustaining one.
I Googled at the time and found ED listed as a side effect of imipramine on many sites.
I'd guess imipramine-induced hypotension might affect blood flow to the penis?
Posted by bearfan on July 6, 2009, at 14:40:34
In reply to Re: Best Antidepressants for men? » SLS, posted by sowhysosad on July 6, 2009, at 14:20:23
So what tends to be the least offending Anti-depressant since most of them to have that side effect? I've heard out the SSRIs, Lexapro and Celexa tended to cause less problems.
Posted by sowhysosad on July 6, 2009, at 16:21:41
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 6, 2009, at 14:40:34
> So what tends to be the least offending Anti-depressant since most of them to have that side effect? I've heard out the SSRIs, Lexapro and Celexa tended to cause less problems.
Yep, a vote for Lexapro here, especially at lower doses.
Posted by bleauberry on July 6, 2009, at 17:09:55
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
I think at some point we all have to ask ourselves what do we want more, to be free of depression or to have fabulous sex on demand? I think it is unrealistic to expect both. It doesn't apply just to depression, but to diabetes, heart disease, liver disease, strokes, limb injury, lyme disease, prostate, and gosh the list could go on and on if I thought about it. Anyone with a disease has probably had their sex life impacted in one way or another, both from the disease itself and from the treatment of it.
Remeron is not a good antidepressant in my opinion. It scores well in clinical trials because of generally robust decreases in the depression questionnaire topics relating to sleep, anxiety, and appetite, but not very well in core depressive symptoms. It can however help with sex on SSRIs by partially blocking the serotonin receptors. That is, if the patient can manage taking one of the most potent antihistamines on the planet, which is what it does much more strongly than anything else it is supposedly and erroneously claimed to do. But that is another topic.
Of the SSRIs, my experience is that Lexapro is the most sex friendly. Lexapro, unknown to most people, can be therapeutic and even induce total remission, in doses far too low to cause any significant side effects. This will get some laughs, but seriously I am talking of a dose range of 1/10th 1mg up to 5mg. Don't look to clinical studies for this kind of success, because they don't do it. The real world is what counts.
In the TCA category I only have experience with Nortriptyline and Desipramine. I think Desipramine did have some side effects due to its strong peripheral noradrenergic effect. Nortriptyline on the other hand actually improved desire, frequency, and ability, above baseline. This was after the first few days where it felt like sex was going dead. That was short lived. I give Nortriptyline the thumbs up. At reasonable doses that is.
If someone is stable and well on an SSRI, but the sex department is closed, there are ways to deal with that. It's just that the patient will not have normal daily thoughts or desires of sex. But they can stimulate them on demand. Things that are short-lived dopamine boosters can do that. Specifically I am thinking of Ritalin. Or if someone experiences a boost of sex in the first day or two of Wellbutrin, then take the Wellbutrin only on days when sex is planned.
Which brings up another point. The disease comes first. We gotta deal with that. What good is having sex if the other 23 hours of your day are hell. When depression is properly treated, and sexual side effects are present, we have to relearn a life of planned sex rather than spontaneous sex. Some verbal dirty talk and foreplay through text messaging and voicemails can heighten the experience and anticipation of a planned evening.
When the ability to have sex is hampered, Viagra works pretty good most of the time. Tricks to make it work best include chewing the pill, letting it rest under the tongue a few minutes before swallowing, and taking it on an empty stomach. No food for the previous 3 hours. The bedroom is important. Candles if you like them. Block out noise with a fan or a hummer or music. No distractions. No hurry. No pressure.
In the herbal category there are some potent pro-sex herbs. Horny goat weed, tongkat ali, and a couple others. Do a search on Passion RX for some good ideas. These herbs can be taken on the day of planned sex, maybe the day before as well with some experimentation, but not continuously. They frequently come with stimulation and insomnia as side effects. But they can be quite potent in the sex department.
Find your best antidepressant. Stay on the lowest dose possible. Then when you see what kind of side effects are there, manage them. I think once an illness hits, it is unrealistic to expect everything to go on as normal, or as pre-illness.
In the meds category I can think of nothing more sex friendly than ultra low dose Lexapro combined with low dose Nortriptyline. For many people Wellbutrin is a miracle. For me, it did the opposite by inducing a much worse depression and killing all desire and ability for sex. But that may be because I tried generic instead of brand. but that is another topic.
Treat the depression. Then manage the sex. Millions of people with dozens of diseases have to do the same thing. That's just the way it is.
Stay away from Paxil. That one in particular is so anti-sex you would need some serious management skills to deal with it.
Posted by chumbawumba on July 6, 2009, at 17:29:11
In reply to Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 3:47:43
I took Prozac for about 9 years and during that time my testosterone levels tested below normal so I took testosterone injections to compensate. Since I've been off Prozac for about 6 months, my blood levels have rebounded and are within the normal range.
I tried Wellbutrin and it didn't do anything for me.
Posted by linkadge on July 6, 2009, at 18:18:39
In reply to Re: Best Antidepressants for men?, posted by chumbawumba on July 6, 2009, at 17:29:11
I personally don't care much about sex. If I could push a little red button and delete that aspect of my life (and ever having known about it) I would. It just makes things complicated. It brings out all sorts of lower brainstem neanderthul like emotions. And besides, it just ends up making you more miserable when you can't get what you want.
Linkadge
Posted by bearfan on July 6, 2009, at 18:28:37
In reply to Re: Best Antidepressants for men?, posted by bleauberry on July 6, 2009, at 17:09:55
What is your opinion on similar Celexa and Effexor XR/Pristiq vs Lexapro?
> Of the SSRIs, my experience is that Lexapro is the most sex friendly.
Posted by bearfan on July 6, 2009, at 21:06:21
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 6, 2009, at 18:18:39
Sometimes I feel that way, but what about the lady friends?
Posted by Alexanderfromdenmark on July 8, 2009, at 9:14:51
In reply to Re: Best Antidepressants for men?, posted by sowhysosad on July 6, 2009, at 16:21:41
Sorry Lexapro made me secondary hypogonadal. It's still a major problem now. I wouldn't recommend it.
Male antidepressants? Stablon, agomelantine, remeron, wellbutrin, parnate, Emsam.
Forget lexapro.
Posted by bearfan on July 8, 2009, at 16:46:44
In reply to Re: Best Antidepressants for men?, posted by Alexanderfromdenmark on July 8, 2009, at 9:14:51
Have you tried agomelantine or Stablon? I think agomelantine is due in the U.S. in the next few years. How long were you on the Lexapro? Did that specifically cause hypogonadal symptoms are generally all SSRIs. Also do benzodiazipenes generally cause any problems?
> Sorry Lexapro made me secondary hypogonadal. It's still a major problem now. I wouldn't recommend it.
>
> Male antidepressants? Stablon, agomelantine, remeron, wellbutrin, parnate, Emsam.
>
> Forget lexapro.
Posted by Phillipa on July 8, 2009, at 19:27:43
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 8, 2009, at 16:46:44
Bearfan there is a thread on agomelatine now on the board see if you can find it. Have heard it said no sexual difficulties and good for depression/anxiety. Phillipa
Posted by bearfan on July 8, 2009, at 23:31:58
In reply to Re: Best Antidepressants for men? » bearfan, posted by Phillipa on July 8, 2009, at 19:27:43
Thanks Phillipa. Are you still getting good results from Luvox CR?
Posted by Bob on July 9, 2009, at 0:49:53
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 6, 2009, at 18:18:39
> I personally don't care much about sex. If I could push a little red button and delete that aspect of my life (and ever having known about it) I would. It just makes things complicated. It brings out all sorts of lower brainstem neanderthul like emotions. And besides, it just ends up making you more miserable when you can't get what you want.
>
> LinkadgeI'd have to mostly agree here, especially with the last statement - one can be made miserable by not getting sexual satisfaction. However, I'm not sure how fully satisfying a life devoid of all sexual thought, desire or action would be since our very basic nature is imbued with it.
Posted by Bob on July 9, 2009, at 13:18:53
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 5, 2009, at 18:45:12
> There is evidence too that when MAO inhibition becomes pronounce there is a decrease in dopamine synthesis.
>
> We really don't have any specific dopaminergic antidepressants - except perhaps SAMe.
>
> LinkadgeWouldn't a dopamine agonist such as Mirapex serve as a dopamine antidepressant of sorts?
Posted by Bob on July 9, 2009, at 13:21:10
In reply to Re: Best Antidepressants for men?, posted by linkadge on July 5, 2009, at 19:17:06
> >As far as to how much testosterone production is >disturbed by an ssri that may be a function >dosage and duration of treatment. If the dosage >is high enough and treatment long enough could >an ssri totally turn off testosterone? I don't >know if there are any studies about that >possibility. Would a dopamine agonist prevent >this problem? One psychiatrist said that when he >uses buspar with an ssri that sexual problems >with ssris are often reversed.
>
> I don't think that an SSRI could ever competely shut off testosterone production. Buspart can alleviate sexual dysfunction but it apparently works better in women. I think 5-ht1a agonists are aphrodisacs for women. Buspar is acutally a moderate d2 antagonist though so it may lower dopamine receptor signalling more - who knows. Not sure if improvement in sexual dysfunction is acompanied by improvements in testosterone levels.
>
>
> Linkadge
>
>
>
>I've tried Buspar multiple times over the years with no discernible therapeutic effect for either depression or sexual function.
Posted by Bob on July 9, 2009, at 13:26:49
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 5, 2009, at 19:24:29
> I am a long time SSRI user and my testosterone levels have been checked recently and were low. There is some evidence that they can reduce testosterone count.
I am in an identical situation. My testosterone levels are suppressed, and I have had some sort of SSRI in my system for years.
Posted by Bob on July 9, 2009, at 13:30:33
In reply to Re: Best Antidepressants for men?, posted by SLS on July 6, 2009, at 5:12:25
> > > Some studies that women responded better to SSRI's wherase men responded better to imipramine. SSRI's make me a little....wimpy.
> >
> > A word of warning: imipramine gave me erectile dysfunction. Apparently it's fairly common.
>
> Hmm. I don't know about that.
>
> This is the first time I have heard this said of any tricyclic with the exception of clomipramine. I have been on quite a few of them, and never had a problem, even at maximum dosages. I'm just one person, of course. However, I don't believe that TCAs cause ED. They might perhaps exaggerate the cremaster reflex during orgasm, but this does not affect the orgasm itself.
>
>
> - ScottI have been sexually affected by many AD's, including Nortripyline. Admittedly not as much as Citalopram or other SSRI's, but it is not zero either.
Posted by Phillipa on July 9, 2009, at 20:11:18
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 8, 2009, at 23:31:58
Actually just take a low dose seems my brain requires it. Did you find the thread? Love Phillipa
Posted by Bob on July 10, 2009, at 0:32:47
In reply to Re: Best Antidepressants for men?, posted by bleauberry on July 6, 2009, at 17:09:55
>
> In the TCA category I only have experience with Nortriptyline and Desipramine. I think Desipramine did have some side effects due to its strong peripheral noradrenergic effect. Nortriptyline on the other hand actually improved desire, frequency, and ability, above baseline. This was after the first few days where it felt like sex was going dead. That was short lived. I give Nortriptyline the thumbs up. At reasonable doses that is.
>Just out of curiosity, what do you consider to be "reasonable doses" of Nortriptyline?
Posted by Tony P on July 10, 2009, at 23:30:24
In reply to Re: Best Antidepressants for men? » bleauberry, posted by Bob on July 10, 2009, at 0:32:47
All the SSRI's & SNRI's turn me off almost completely -- maybe Lexapro was slightly better???
As far as single A/D's go:
-------------------------
Remeron by itself? Fine, but just try and stay awake!Wellbutrin -- good if you're not BP III as I am - I was so hyper my family had a meeting over it!
Tianeptine -- no side effects but a very low level A/D for me, besides it's not marketed in N.A. and what do you do if your shipment from overseas just doesn't show up one month?? (Answer - go on Lexapro very quickly, been there, got the T-shirt).
Add-ons to SSRI/SNRI's:
----------------------
Trazodone -- a low dose helps to counteract the SSRI effect, especially with ED, but again it may make you too sleepy to be interested. Not as bad as Remeron, though.Dopamine enhancers -- the ones used for Parkinson's & RLS such as Requip have a small but maybe helpful effect. Modafinil or Adrafinil helps more.
Herbals -- Yohimbine is effective for me but has huge side effects - extreme anxiety, then a serious downer the next day. May be Rx-only, depending where you live.
There's one little-known natural herb that's a very powerful sexual stimulant. I hesitate to name it on this board as its legal status is questionable in some countries (currently OK in Canada & US). Unfortunately it's chief "side-effect" is that it's psychedelic <g>, and the effective dose for anorgasmia is very close to the psychedelic dose! Babblemail me if interested, or Google sage wisdom.
I take DHEA supplements which also help, and which many of us need as we grow older anyway: before I started on it, my DHEA & testosterone levels were about right for an 8-year-old!! It does have some antidepressant effect as well as boosting the immune system and other anti-aging benefits.
I don't think there's any one antidepressant that I could say is "better" for men -- we all differ so much in our reaction to all these phancy pharmaceuticals that I think individual response is much more important than gender.
My 4 bits worth,
Tony P
Posted by bearfan on July 11, 2009, at 12:37:06
In reply to Re: Best Antidepressants for men?, posted by Tony P on July 10, 2009, at 23:30:24
Are you still having benefits from Lexapro? And if so what dosage? I had some benefit from Stablon, but it wasn't as strong of an effect.
Posted by Tony P on July 11, 2009, at 14:04:27
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 11, 2009, at 12:37:06
> Are you still having benefits from Lexapro? And if so what dosage? I had some benefit from Stablon, but it wasn't as strong of an effect.
=======================
I switched from Lexapro to Cymbalta because I needed more activation and less serotonin. En route, I tried Effexor, but got very high anxiety from it. For me, the Cymbalta seems to be the best single A/D, although I am taking other meds. If I had to go back on an SSRI, Lexapro would be my #1 choice; I was on 10 mg/day plus 30 mg Remeron.I agree about Stablon/Tianeptine; essentially no side effects, but not a strong enough A/D for me. I do wish it were marketed in N.A., though, as it might be really good in combination.
I read an independent review of Cymbalta recently that said basically it wasn't as good as Effexor (which I guess is why I'm not getting any government subsidy for it). But it's been much better for me, easier to tolerate and more effective against GAD/social phobia, which is also a big part of my problems.
I still don't quite understand how a drug that boosts NE can *reduce* anxiety, but the Cymbalta does seem to work that way; it has a moderate sedative effect, and I think the NE boost makes me more willing to get going, go out and do things & meet people.
Cheers,
Tony
Posted by bearfan on July 11, 2009, at 17:19:12
In reply to Re: Best Antidepressants for men?, posted by Tony P on July 11, 2009, at 14:04:27
I tool couldn't figure out how NE could reduce anxiety until I did more research about it. Part of it has to do with the potential to increase confidence, this in turn, will lesson the type of the anxiety that comes from feeling overwhelmed or not able to do something. Also apparently boosting NE has a subtle effect on increasing dopamine which further can increase feelings of well being and ability. Although, on the other hand, excessive activation can increase anxiety.
Apparently Cymbalta has a powerful effect on Serotonin and increase NE in a different way than Effexor. This probally in the reason it can be better for anxiety than effexor in some people.
As for Lexapro, did you find that memory recall and outgoingness seem to lesson? Also in some cases I felt a bit dopey (most apparent during beginning phase). Not sure if this is because of the more sedating effect of it.
Posted by Tony P on July 12, 2009, at 11:41:33
In reply to Re: Best Antidepressants for men?, posted by bearfan on July 11, 2009, at 17:19:12
> I tool couldn't figure out how NE could reduce anxiety until I did more research about it. Part of it has to do with the potential to increase confidence, this in turn, will lesson the type of the anxiety that comes from feeling overwhelmed or not able to do something. Also apparently boosting NE has a subtle effect on increasing dopamine which further can increase feelings of well being and ability. Although, on the other hand, excessive activation can increase anxiety.
>
> Apparently Cymbalta has a powerful effect on Serotonin and increase NE in a different way than Effexor. This probally in the reason it can be better for anxiety than effexor in some people.
>
TP>> makes sense to me. I notice the increased self-confidence.> As for Lexapro, did you find that memory recall and outgoingness seem to lesson? Also in some cases I felt a bit dopey (most apparent during beginning phase). Not sure if this is because of the more sedating effect of it.
TP>> I have a lot of trouble with memory/concentration on everything... don't remember Lexapro (Cipralex in Canada) being any worse, but I started on Remeron as well a couple of weeks later, and that of course is **very** sedating -- I only discovered recently its half-life is 20-40 hours, so I was sedated all the time.
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