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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by tensor on December 9, 2010, at 8:01:44
I have posted before about the anorgasmia that comes with clomipramine (and TCAs in general). I wonder if you have any input with using stimulants (prn) such as methylphenidate to reverse this.
Regards,
Mattias
Posted by Keith Talent on December 9, 2010, at 23:57:22
In reply to Anorgasmia antidotes, posted by tensor on December 9, 2010, at 8:01:44
Yes I have experience of both dextroamphetamine and methylphenidate - neither did a thing for the anorgasmia. This is with, at various times, clomipramine and fluoxetine.
Posted by tensor on December 10, 2010, at 3:18:39
In reply to Re: Anorgasmia antidotes, posted by Keith Talent on December 9, 2010, at 23:57:22
> Yes I have experience of both dextroamphetamine and methylphenidate - neither did a thing for the anorgasmia. This is with, at various times, clomipramine and fluoxetine.
>Thank you! This is the info I needed.
/M
Posted by tensor on December 10, 2010, at 3:20:35
In reply to Re: Anorgasmia antidotes, posted by Keith Talent on December 9, 2010, at 23:57:22
> Yes I have experience of both dextroamphetamine and methylphenidate - neither did a thing for the anorgasmia. This is with, at various times, clomipramine and fluoxetine.
>BTW, did you find something that did work?
/M
Posted by SLS on December 10, 2010, at 5:39:57
In reply to Anorgasmia antidotes, posted by tensor on December 9, 2010, at 8:01:44
> I have posted before about the anorgasmia that comes with clomipramine (and TCAs in general). I wonder if you have any input with using stimulants (prn) such as methylphenidate to reverse this.
You could look at buspirone for chronic administration. If it is to work, it should do so before two weeks pass. For acute administration (PRN), you could investigate whether cyproheptadine appeals to you.
- Scott
-----------------------------------------* Performing your original search, buspirone sexual, in PubMed will retrieve 37 records.
J Clin Psychopharmacol. 1999 Jun;19(3):268-71.
Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors.Landén M, Eriksson E, Agren H, Fahlén T.
Institute of Clinical Neuroscience, Department of Psychiatry, Göteborg University, Sweden. mikael.landen@neuro.gu.se
AbstractTo evaluate the possible influence of buspirone on sexual dysfunction in depressed patients treated with a selective serotonin reuptake inhibitor (SSRI), we analyzed data from a placebo-controlled trial designed to explore the efficacy of buspirone as add-on treatment for patients not responding to an SSRI alone. At baseline, all patients met the criteria for a major depressive episode according to DSM-IV and had received citalopram or paroxetine during a minimum of 4 weeks without responding to the treatment. Buspirone (flexible dosage, 20-60 mg/day) or placebo was added to the SSRI for 4 weeks; the mean daily dose of buspirone at endpoint was 48.5 mg (SD = 1.0). Sexual dysfunction was evaluated using a structured interview. Before starting medication with buspirone or placebo, 40% (47 of 117) reported at least one kind of sexual dysfunction (decreased libido, ejaculatory dysfunction, orgasmic dysfunction). During the 4 weeks of treatment, approximately 58% of subjects treated with buspirone reported an improvement with respect to sexual function; in the placebo group, the response rate was 30%. The difference between placebo and active drug treatment was more pronounced in women than in men. The response was obvious during the first week, with no further improvement during the course of the study. It is suggested that the effect of buspirone on sexual dysfunction is a result of a reversal of SSRI-induced sexual side effects rather than of an antidepressant effect
---------------------------------------------
Posted by Keith Talent on December 10, 2010, at 5:53:01
In reply to Re: Anorgasmia antidotes » Keith Talent, posted by tensor on December 10, 2010, at 3:20:35
No. I also tried that cousin of mirtazepine that also starts with m - mianserin, that's it. Didn't do a thing either except make me want to fall asleep. Hardly conducive to intimacy!
Posted by tensor on December 10, 2010, at 6:15:44
In reply to Re: Anorgasmia antidotes » tensor, posted by SLS on December 10, 2010, at 5:39:57
> You could look at buspirone for chronic administration. If it is to work, it should do so before two weeks pass. For acute administration (PRN), you could investigate whether cyproheptadine appeals to you.
>
>
> - Scott
Hi Scott!I'm looking for prn solution, not keen on the idea of chronic administration for a side effect that isn't 'dangerous'. Since I have no problems with my sexual ability now (thanks to mirtazapine) with mirtazapine/escitalopram combo I figure that the anorgasmia on mirtazapine/CMI combo isn't due to increased serotonin levels. Makes sense?
I have done some research on this topic and the way cyproheptadine is thought to work is through 5HT2-antagonism, which both mirtazapine and clomipramine have plenty of.
This makes me believe that ACh(m)-blockage is the culprit and that an effective antidote could be bethanechol. What do you think?/Mattias
Posted by SLS on December 10, 2010, at 15:35:04
In reply to Re: Anorgasmia antidotes » SLS, posted by tensor on December 10, 2010, at 6:15:44
> > You could look at buspirone for chronic administration. If it is to work, it should do so before two weeks pass. For acute administration (PRN), you could investigate whether cyproheptadine appeals to you.
> >
> >
> > - Scott
>
>
> Hi Scott!
>
> I'm looking for prn solution, not keen on the idea of chronic administration for a side effect that isn't 'dangerous'. Since I have no problems with my sexual ability now (thanks to mirtazapine) with mirtazapine/escitalopram combo I figure that the anorgasmia on mirtazapine/CMI combo isn't due to increased serotonin levels. Makes sense?
> I have done some research on this topic and the way cyproheptadine is thought to work is through 5HT2-antagonism, which both mirtazapine and clomipramine have plenty of.
> This makes me believe that ACh(m)-blockage is the culprit and that an effective antidote could be bethanechol. What do you think?
>
> /MattiasI have not heard that an antimuscarinic could be responsible for anorgasmia. There needs to be a balance between 5-HT2c and 5-HT1a receptor activation in order to function sexually. Libido, erections, and orgasm are affected by SSRIs. I believe that, when stimulated, 5-HT2c receptors are responsible for achieving erections. 5-HT1a receptor stimulation is responsible for maintaining libido. Of course, circuits using other neurotransmitters (NE and DA) play a role in facilitating orgasm.
- Scott
Posted by bleauberry on December 10, 2010, at 17:28:40
In reply to Anorgasmia antidotes, posted by tensor on December 9, 2010, at 8:01:44
Over at least the last 10 years this has been a rather common question and I do recall anyone ever having a reliable antidote.
The only two fairly reliable methods I am aware of are reducing the dose, or waiting a few more months to see if it partially resolves because it can in time.
The desire for sex is usually easier to remedy, but anorgasmia is a tough one. There's just too much serotonin where it is not supposed to be.
All that said, two partially effective helpers in my experience were remeron or zyprexa, most likely from their serotonin receptor blocking action.
Posted by tensor on December 10, 2010, at 20:19:21
In reply to Re: Anorgasmia antidotes » tensor, posted by SLS on December 10, 2010, at 5:39:57
Hmm.. maybe Scott's idea with buspirone is worth looking into after all. Combined with bleauberry's advice I could push Remeron dosage to 60mg. It's something to start with.
I will keep you posted on the progress.Thanks!
Posted by tensor on December 10, 2010, at 20:27:12
In reply to Re: Anorgasmia antidotes » tensor, posted by SLS on December 10, 2010, at 15:35:04
> I have not heard that an antimuscarinic could be responsible for anorgasmia.
> - ScottLook at these:
http://theintimacycenter.com/isw/resources/7092/boyarsky2000.pdf
http://books.google.se/books?id=h7lva61Muq4C&pg=PA196&lpg=PA196&dq=tca+bethanechol+sexual&source=bl&ots=AvBjszqWC7&sig=-5b2gPWZprWA5k8cqFff0Ohl5Js&hl=sv&ei=LfsBTfzOFI7tOe_kyPgB&sa=X&oi=book_result&ct=result&resnum=8&ved=0CEsQ6AEwBw#v=onepage&q=tca%20bethanechol%20sexual&f=false
http://www.currentpsychiatry.com/pdf/0303/0303_Pcupdate.pdf/Mattias
Posted by SLS on December 11, 2010, at 6:30:36
In reply to Re: Anorgasmia antidotes » SLS, posted by tensor on December 10, 2010, at 20:27:12
> > I have not heard that an antimuscarinic could be responsible for anorgasmia.
> > - Scott
>
> Look at these:
> http://theintimacycenter.com/isw/resources/7092/boyarsky2000.pdf
> http://books.google.se/books?id=h7lva61Muq4C&pg=PA196&lpg=PA196&dq=tca+bethanechol+sexual&source=bl&ots=AvBjszqWC7&sig=-5b2gPWZprWA5k8cqFff0Ohl5Js&hl=sv&ei=LfsBTfzOFI7tOe_kyPgB&sa=X&oi=book_result&ct=result&resnum=8&ved=0CEsQ6AEwBw#v=onepage&q=tca%20bethanechol%20sexual&f=false
> http://www.currentpsychiatry.com/pdf/0303/0303_Pcupdate.pdf
>
> /Mattias
Interesting. Nitric oxide has been known to facilitate erections. That's what Viagara is all about. Still, I have a problem with the notion that anticholinergic can produce erectile problems. Sex was a more intense experience for me when I first responded to imipramine. Both libido and erections improved. As anticholinergic as imipramine is, I was unaffected. Of course, that's me. However, I have never before encountered in the literature a prominent place for acetylcholine in sexual response. Perhaps ejaculation, but not orgasm. I also have a problem with the fact that I am not sufficiently educated enough to be sure of myself.
- Scott
Posted by tensor on December 16, 2010, at 2:45:36
In reply to Anorgasmia antidotes, posted by tensor on December 9, 2010, at 8:01:44
Of the horny goat weeds on this site: http://www.discountvitaminsandherbs.com/search.htm
is there one that is preferrable to the others?/Mattias
Posted by Hombre on December 16, 2010, at 5:52:17
In reply to Re: Anorgasmia antidotes » tensor, posted by SLS on December 11, 2010, at 6:30:36
Don't know about epidemium used alone, but there are two Chinese patent formulas that help a lot with SSRI induced sexual (and urinary) dysfunction:
- Jin Gui Shen Qi Wan
- You Gui Wan
I take the first, and it definitely helps. The second is for similar indications, but has a somewhat different composition. You can order it online at a cost of about $3-4 a week (or more if you want). Expect results in a month or so, maybe sooner.
I've even gone so far as to have made the formula myself out of raw herbs. If you are into DIY, you can expect much better results with raw herbs. It's no harder than making soup. The formulation for these two formulas is available in any Chinese herbal. Raw herbs are relatively cheap, and widely available online.
In fact, treating sexual dysfunction/male hormonal problems parallels depression treatment in many ways. A lot of the same supplements touted for bodybuilding (not the gimicky ones) are also good for fighting depression.
Posted by jerryTRD on December 22, 2010, at 13:19:17
In reply to Horny goat weed, posted by tensor on December 16, 2010, at 2:45:36
> Of the horny goat weeds on this site: http://www.discountvitaminsandherbs.com/search.htm
> is there one that is preferrable to the others?
>
> /MattiasI tried Horny Goat Weed and it nothing for me. I suffer from low libido, anorgasmia, etc. But I also found out a couple months ago my Testosterone lvls were low - which I am now on testosterone replacement therapy and have seen a decrease in my sexual side effects.
Posted by jerryTRD on December 22, 2010, at 13:28:27
In reply to Anorgasmia antidotes, posted by tensor on December 9, 2010, at 8:01:44
> I have posted before about the anorgasmia that comes with clomipramine (and TCAs in general). I wonder if you have any input with using stimulants (prn) such as methylphenidate to reverse this.
>
>
> Regards,
> MattiasTCAs - imipramine and nortriptyline. both ENHANCED my sexual drive, erections, intensity of orgasm. I'm on Effexor now which seems to be helping along with testosterone replacement therapy.
This is the end of the thread.
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