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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by SLS on August 25, 2009, at 6:28:52
In reply to Post SSRI Sexual Dysfunction, posted by Brainbeard on August 25, 2009, at 4:53:57
> I see this as conclusive evidence that SSRIs lead to 'permanent brain changes' - to put it neutrally
I agree. Chronic exposure to any antidepressant is bound to change the brain in one way or the other.
- Scott
Posted by Phil on August 25, 2009, at 9:43:29
In reply to Re: Post SSRI Sexual Dysfunction, posted by SLS on August 25, 2009, at 6:28:52
Any proof of this? Not saying I doubt it but would like backup.
I've been on meds 25 years and don't 'feel' that much has changed. Hard to tell but if changes have occurred, they are subtle.
Thanks...
Posted by Brainbeard on August 25, 2009, at 10:01:05
In reply to Re: Post SSRI Sexual Dysfunction » SLS, posted by Phil on August 25, 2009, at 9:43:29
You should read the post I refer to as well as the Wikipedia article. There are several strains of direct evidence, but perhaps more important there is indirect evidence that the phenomenon discussed has been methodologically excluded or marginalized in the relevant research studies.
It's the same idea as the weight neutrality myth concerning the SSRIs: there has hardly been any real long-term (6 months or more) research after the weight effects of SSRIs. Since for many people weight gain takes at least half a year to become fully manifest, clinicians can still hold up the myth that weight gain is not causally related to these drugs. I don't want to change the subject, but the point is that faulty methodology leads to false assumptions. As with the weight gain issue, the burden of proof for the assumption that SSRIs don't have persistent negative effects on sexual functioning should ly with the origibal researchers, who simply haven't investigated the matter appropiately.
If you ask for proof, another good question would be in these cases: why is there no proof?
Posted by Phil on August 25, 2009, at 10:10:02
In reply to Re: Post SSRI Sexual Dysfunction, posted by Brainbeard on August 25, 2009, at 10:01:05
I must be asleep. I thought this was about permanent 'brain' changes.
I've never pretended to be knowledgeble about more than the most basic effects of meds.
If I'm starting a new one, I research it like mad but once I'm on my way, I don't remember much.
after approx 80 meds, who cares? I know which ones not to take.
carry on. : ))
Posted by Phillipa on August 25, 2009, at 10:40:02
In reply to Re: Post SSRI Sexual Dysfunction » Brainbeard, posted by Phil on August 25, 2009, at 10:10:02
I feel sometimes that not knowing all it more beneficial when drug extremely naive I did much better. That's me of course. Phillipa
Posted by SLS on August 25, 2009, at 13:27:19
In reply to Re: Post SSRI Sexual Dysfunction » SLS, posted by Phil on August 25, 2009, at 9:43:29
> Any proof of this?
Great question. Keep us honest. :-)
When someone responds well to an SSRI, and that SSRI poops-out and never works again, this is the result of changes in the brain, right? It's called tachyphylaxis, and you should be able to find citations regarding this on Google. A similar phenomenon is sometimes seen with lithium. There are articles on Medline that refer to this phenomenon as being lithium-induced lithium refractoriness. Look for RM Post as the author.
I don't have any evidence to provide you regarding the persistence of sexual dysfunction after SSRI discontinuation. I just never looked into it.
> I've been on meds 25 years and don't 'feel' that much has changed. Hard to tell but if changes have occurred, they are subtle.
There is only one effect that comes to mind that I have had persist after drug discontinuation. I have had an exaggerated cremaster reflex upon orgasm. This began after I took my first antidepressant drug, imipramine. It does get better when I respond favorably to treatment, leading me to believe it is an autonomic effect.
- Scott
Posted by Phil on August 25, 2009, at 14:40:44
In reply to Re: Post SSRI Sexual Dysfunction » Phil, posted by SLS on August 25, 2009, at 13:27:19
Posted by bulldog2 on August 25, 2009, at 16:06:48
In reply to Re: Post SSRI Sexual Dysfunction, posted by SLS on August 25, 2009, at 6:28:52
> > I see this as conclusive evidence that SSRIs lead to 'permanent brain changes' - to put it neutrally
>
> I agree. Chronic exposure to any antidepressant is bound to change the brain in one way or the other.
>
>
> - ScottI believe your statement is correct. But what makes ssris particulary troubling is the selective inhibition of serotonin reuptake appears to have a dramatic effct over time on dopamine. This in turn causes prolactin to rise which causes hgh and testosterone to lower. This could eventually have a profound effect on hormonal levels and cause premature aging.
Still docs continue to prescribe them like candy because of their "safety". Overdose unlikely to kill you and generally safe with other drugs and foods. So our society is gradually being neutered by these safe and not so effective pills.
Give me parnate anytime with all its so called dangers.
Posted by SLS on August 25, 2009, at 16:43:19
In reply to Re: Post SSRI Sexual Dysfunction » Phil, posted by SLS on August 25, 2009, at 13:27:19
This is off-topic regarding post-SSRI sexual dysfunction, but related to long-term drug induced changes in neural function.
Treatment resistance is often a function of the number of prior drug exposures. We already knew this, but now it has been formalized in studies.
- Scott
----------------------------------------------------1: Neuropsychobiology. 2009;59(4):227-33. Epub 2009 Jul 2.Click here to read Links
Tachyphylaxis after repeated antidepressant drug exposure in patients with recurrent major depressive disorder.
Amsterdam JD, Williams D, Michelson D, Adler LA, Dunner DL, Nierenberg AA, Reimherr FW, Schatzberg AF.Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, USA. jamsterd@mail.med.upenn.edu
OBJECTIVE: The aim of this post hoc analysis was to examine whether tachyphylaxis occurs after repeated courses of antidepressant drug therapy. METHOD: 276 patients with major depressive disorder (MDD) were treated with sertraline (150-200 mg daily) for 8 weeks. Patients with persistent MDD after sertraline therapy were randomized to continuation therapy with either sertraline plus atomoxetine (n = 72) or sertraline plus placebo (n = 74) for 8 additional weeks. Logistic regression was used to test the hypothesis that an increase in prior antidepressant drug exposure is associated with a reduced responsiveness to sertraline therapy. RESULTS: The number of prior antidepressant drug exposures was negatively associated with response to initial sertraline therapy (odds ratio = 0.81, p = 0.0035). The odds ratio indicates a 19.9% reduced likelihood of response with each prior antidepressant treatment trial. In contrast, the number of prior antidepressant treatment trials was not associated with response to continuation sertraline plus atomoxetine or sertraline plus placebo therapy. CONCLUSION: This observation supports the hypothesis that tachyphylaxis may develop after repeated antidepressant drug trials. Copyright 2009 S. Karger AG, Basel.
----------------------------------------------------
1: J Affect Disord. 2009 May;115(1-2):234-40. Epub 2008 Aug 9.Click here to read Links
Does tachyphylaxis occur after repeated antidepressant exposure in patients with Bipolar II major depressive episode?
Amsterdam JD, Shults J.
Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, United States. jamsterd@mail.med.upenn.edu
OBJECTIVE: Tachyphylaxis often refers to the loss of antidepressant efficacy during long-term treatment. However, it may also refer to the gradual loss of efficacy after repeated antidepressant exposures over time. The aim of this study was to examine the phenomenon of tachyphylaxis in patients with Bipolar II major depression treated with either venlafaxine or lithium. We hypothesized that a greater number of prior antidepressant exposures would result in a reduced response to venlafaxine, but not lithium, therapy. METHODS: 83 patients were randomized to treatment with either venlafaxine (n=43) or lithium (n=40). The primary outcome was a >or= 50% reduction in baseline Hamilton Depression Rating score. A detailed history of prior drug therapy was obtained. Logistic regression was used to test the hypothesis that prior antidepressant exposure was associated with reduced response to venlafaxine therapy. RESULTS: The mean number of prior antidepressant and mood stabilizer exposures was significantly higher in venlafaxine non-responders versus responders (p=0.02). There was no significant association between response to lithium and the number of prior antidepressant and mood stabilizer exposures (p=0.38). The odds of responding to venlafaxine or lithium therapy decreased with an increasing number of prior antidepressant exposures (p=0.04). Response was not significantly affected by the number of prior mood stabilizer exposures (p=0.30). Adjustment for clinical and demographic covariates sharpened the estimated impact of prior antidepressant exposure on treatment outcome. LIMITATIONS: This study was a post hoc exploratory analysis. The study was not specifically powered to test the hypothesis of an association between number of prior antidepressant drug exposures and response to venlafaxine or lithium therapy. CONCLUSION: These observations support earlier findings suggesting the presence of tachyphylaxis occurring after repeated antidepressant drug exposures. Possible mechanisms of tachyphylaxis may include genetic predisposition for non-response, physiological adaptation after repeated antidepressant exposures, and inherent illness and pharmacokinetic heterogeneity
----------------------------------------------------
: Am J Psychiatry. 1992 Dec;149(12):1727-9.Click here to read LinksComment in:
Am J Psychiatry. 1993 Nov;150(11):1756.
Am J Psychiatry. 1994 Oct;151(10):1522.Lithium-discontinuation-induced refractoriness: preliminary observations.
Post RM, Leverich GS, Altshuler L, Mikalauskas K.Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.
The authors used a systematic life-chart methodology to observe four patients with bipolar disorder in whom long periods (6-15 years) of effective lithium prophylaxis were followed by relapses on lithium discontinuation. Once the drug was reinstituted, it was no longer effective. The incidence, predictors, and mechanisms underlying this phenomenon all require further systematic study. The current preliminary observations suggest an additional reason for caution when lithium discontinuation in the well-maintained patient is considered.
----------------------------------------------------
Posted by Sunbath on August 27, 2009, at 6:30:17
In reply to Re: Post SSRI Sexual Dysfunction, posted by SLS on August 25, 2009, at 16:43:19
Hi,
I also had those physical arousal problems after I had been on paxil for 2 years.. when I quit paxil and all the other meds I'd been taking, the ability to actually feel an orgasm returned, but it wasn't NEARLY the same as before starting my med (sri) career (which I didn't realize at that time)..
Since my problems were nearly gone I had a medication free period of about 1-2yrs..
After that the problems started which I still have now.
Soon, at the beginning, when my problems got worse and I realized that I needed to visit my pdoc again, I wanted to try something completely different and went on tianeptine. Tianeptine acutely lowered my feelings of being stressed and I thought it would work (which it didn't in the long run.. only helped acutely) and was very excited about it.
But what I wanted to tell you is that about 1-2 weeks after starting my tianpetine therapy, I noticed that my ability to reach orgasm fast and its intensities GREATLY increased!!Also physical arousability was absolutely GREAT! Something I hadn't experienced for years..
It was such a difference to before that I then realized what the ssris had obviously done to me!I don't know if it would have lasted past the tianeptine trial but it certainly felt as if it would have.. but I don't know since -feeling very desperate- I started lexapro after that...
currently I'm on sertraline + trazodone + nortriptyline.
It would be great to know if someone other than me experienced similar..
BTW: I'm male :)
Good luck to you!!
Posted by Brainbeard on August 27, 2009, at 10:54:46
In reply to Tianeptine resolved it for me, posted by Sunbath on August 27, 2009, at 6:30:17
Thanks for sharing your experience.
I have been taking tianeptine myself. It definitely boosted my libido, but I'm not sure if it helped with the ejaculator anhedonia - simply because I've never connected the two before.
Tianeptine is known to potentially facilitate brain plasticity. Still, I don't get the impression that there is a crowd out there who had their post-SSRI problems fixed with tianeptine.
What I didn't mention was that ever since my Paxil adventure, my erections haven't been nearly as hard. Again, I used to think it was age. But I'm only 33!! So now I definitely see the connection with the SSRI.
I'd like to add that clomipramine (aka Anafranil), the tricyclic antidepressant that is about as strong an SRI as Paxil, gave me far worse sexual dysfunction than Paxil or Luvox or Prozac or Zoloft ever gave me. (Luvox, in fact, hardly gave me any sexual dysfunction whatsoever).
Clomipramine really made me wonder what the hell I was doing while having sex.
Posted by zana on August 28, 2009, at 10:26:36
In reply to Re: Tianeptine resolved it for me, posted by Brainbeard on August 27, 2009, at 10:54:46
How come I can't find tianeptine in my drug index? What other names does it go by?
So what's the take away? Using ADs ruins your sex life permanently? What a grim thought. Makes me want to throw out the whole drawerful of meds I'm taking. If only I could.
Thanks,
Zana
Posted by Sunbath on August 28, 2009, at 11:23:07
In reply to Re: Tianeptine resolved it for me, posted by Brainbeard on August 27, 2009, at 10:54:46
Yes, sd really sucks and it's so hard to do anything against it.. I'm currently thinking of going completely off meds and trying some alternatives it's just so frustrating... I'd try tianeptine again, but it just didn't help me in the long run and made me very tired whole day..
Good luck to you Brainbeard!
Posted by Sunbath on August 28, 2009, at 11:26:48
In reply to Re: Tianeptine resolved it for me, posted by zana on August 28, 2009, at 10:26:36
Hi Zana,
Tianeptine's brandname is Stablon.. I think it's not available in the US and many other countries.. maybe that's why you cannot find it.. there are some REALLY interesting studies around this substance, that's why I originally wanted to give it a try..
some infos other than pubmed:
http://en.wikipedia.org/wiki/Tianeptine
http://www.tianeptine.com/
Posted by Brainbeard on August 28, 2009, at 15:04:52
In reply to Re: Tianeptine resolved it for me, posted by zana on August 28, 2009, at 10:26:36
> So what's the take away? Using ADs ruins your sex life permanently? What a grim thought. Makes me want to throw out the whole drawerful of meds I'm taking. If only I could.
> Thanks,
> ZanaNo, saying that AD's ruin your sex life permanently would be hyperbolic.
They don't cause some kind of genital lepra or anything.It's just a fact of life that taking mind-altering substances can cause long-lasting or permanent changes in the brain that may negatively affect you - sexually, for instance.
Being drug-naive may be a desirable state.On the other hand, certain experiences as well as certain toxins might modify brain functioning in such a negative way that some farmacotherapeutical measures are in place to handle the consequences. It's all just a matter of what's worse, the cure or the disease.
Big Pharma is not interested in that fine line - they have the ethical standard of a candy industry.
Posted by desperately seeking on March 25, 2010, at 15:08:50
In reply to Post SSRI Sexual Dysfunction, posted by Brainbeard on August 25, 2009, at 4:53:57
Hi,I know you wrote this post on sexual dysfunction a long time ago...but I'm curious to know- how have you been faring since then?
I was on SSRIs (Zoloft, Effexor, Prozac) for 6 years. Then I switched to Tianeptine for a year. I recently stopped all drugs few months ago. But for the last year and a half (even whilst on Tianeptine) I noticed the same symptoms you had- no pleasure or reward from excercising. So I know exactly what you mean- you are not alone. Has that area improved for you?
As far as the sexual dysfunction and other things are concerned, based on what I've read all over the internet, I know I have at least 6 more years to go before any hope of being "normal"... I raged and raged and grieved and I'm still grieving. But part of the process is just recognizing that you'll never be the same person you were again and move on with time...
What doesn't kill you makes you stronger, right?
Posted by Brainbeard on March 26, 2010, at 14:09:32
In reply to Re: Post SSRI Sexual Dysfunction, posted by desperately seeking on March 25, 2010, at 15:08:50
> What doesn't kill you makes you stronger, right?
I think that's a good way of dealing with it. Even what (metaphorically) kills you can make you stronger, if I've understood the apostle Paul correctly. But let's not have this topic removed to 'Faith'.
How I'm faring now.. Well, I have been experimenting with meds a lot in the past couple of years, and have been on several SSRI's, although mostly in low doses. Somehow, it seems that my sex life is BETTER when I've got just enough SRI going on to delay my orgasm but not kill my libido. Oddly, (S)SRI's stimulate my mental libido, and my body follows, at least that's what I think. Apart from sex and libido, I sometimes have the feeling that restarting (S)SRI therapy can be a way of improving post-SSRI dysfunctions.
However that may be, the angle of my erections seems to have been changed forever to a lesser degree.
I also discovered recently that tinnitus, hyperacusis and even hearing loss can be a (post-)SSRI side-effect. I have tinnitus and hyperacusis
- and it became much worse after quitting Paxil. I never related the two. I alo wonder now if my chronic pains may be a post-SSRI side-effect, since they also emerged soon after quitting Paxil.What is odd is that while on 25mg of Zoloft (sertraline) and a couple of TCA's, my sex drive/life was pretty fine, while my libido seemed to have totally disappeared after quitting these meds.
I'm on Lexapro now, don't ask me how and why, 10mg, and initially it boosted my libido, but now I'm not sure what the state of my libido actually is, which is a bad sign in itself, although I still have plenty of thoughts about sex. I seem to have less of a drive to put these thoughts into actions, even while I have a willing partner. Yeah, I do think I have reduced libido, now that I listen to myself.
I'm hoping to get low dose flupenthixol (brand name Fluanxol) prescribed soon and/or Ritalin (methylphenidate) - both may boost libido.
Posted by ed_uk2010 on March 26, 2010, at 18:26:22
In reply to Re: Post SSRI Sexual Dysfunction, posted by Brainbeard on March 26, 2010, at 14:09:32
>I'm hoping to get low dose flupenthixol (brand name Fluanxol) prescribed soon
Flupenthixol elevates prolactin. It is likely to reduce your libido and sexual function in the long run.
Posted by Brainbeard on March 27, 2010, at 7:55:16
In reply to Re: Post SSRI Sexual Dysfunction » Brainbeard, posted by ed_uk2010 on March 26, 2010, at 18:26:22
> >I'm hoping to get low dose flupenthixol (brand name Fluanxol) prescribed soon
>
> Flupenthixol elevates prolactin. It is likely to reduce your libido and sexual function in the long run.
>
>Well, it elevates prolactin a lot less than amisulpride, and elevated prolactin doesn't necessarily reduce libido and/or sexual function, especially not if you've got extra dopamine transmission going on.
If I remember correctly, one study showed that amisulpride raised prolactin levels about tenfold, whereas flupentixol raised them two- or threefold. For both drugs, prolactin levels would settle on a slightly lower level after long-term use.
Posted by sukarno on April 1, 2010, at 16:16:18
In reply to Re: Post SSRI Sexual Dysfunction, posted by Brainbeard on March 27, 2010, at 7:55:16
I have a friend who had sexual dysfunction that persisted after going off SSRIs. He thought his life was ruined until his psychiatrist prescribed methylphenidate (Ritalin) and later dextroamphetamine. He said that restored all his energy, eliminated his depression and his libido was higher than ever before.
He's been on it for two years and still feels energetic and with good libido. I thought amphetamines would poop out with long term use, but he says it is still working.
Some doctors have had luck with ropinirole (Requip) or pramipexole (Mirapex). Requip is far more sedating or drowsiness-inducing though.
Posted by Amber80 on August 8, 2010, at 9:07:04
In reply to Re: Post SSRI Sexual Dysfunction » Phil, posted by SLS on August 25, 2009, at 13:27:19
I am experiencing something very similar to this after discontinuation of Seroquel (which I know is not an SSRI.) I had only been taking it for about 10 months; it was prescribed to me for insomnia at 50 mg. I slowly decreased it as it made me so fatigued and zombie-like. While on it, my sex drive was not affected, although at the higher levels it took me a long time to orgasm. At about 12.5 mg I was normal, but when I stopped taking it (after tapering) I literally felt my sex drive disappear like a candle blown out. It's hard to describe but I knew right away that it was gone, even with the abscense of any sexual stimuli! It has now been two months and I have no sex drive.Anybody else experienced this? I wish I had more information on how Seroquel works on the brain, as I know that Seroquel isn't technically an "SSRI." All I can find online is "Seroquel works on various chemicals" which is infuriating as they make it seem so casual and unimportant. This is our brain!
Posted by conundrum on August 11, 2010, at 15:10:25
In reply to Re: Post SSRI Sexual Dysfunction, posted by Amber80 on August 8, 2010, at 9:07:04
an active metabolite of seroquel is norquetiapine which is a norepinephrine reuptake inhibitor. For some people increases norepinephrine, increases sex drive. I found increased sensitivity on pristiq which is an SNRI. Of course dopamine could be involved as well. If you were on a low dose it might be the dopamine.
Posted by marilynn on April 23, 2011, at 14:23:43
In reply to Re: Post SSRI Sexual Dysfunction, posted by desperately seeking on March 25, 2010, at 15:08:50
I am a woman who has been on Prozac for 12 years, first 40 mg then 20mg. Noticed this year an almost complete inability to orgasm. Stopped taking the meds and it made no difference, and my mood was bad. So now I'm in a bad mood and can't orgasm. This is what Prozac has done to me..... I'm in worse shape than when I ever started! Any suggestions for women? I still have my libido, just can't orgasm. Sad.
Posted by bearfan on April 25, 2011, at 16:42:40
In reply to Post SSRI Sexual Dysfunction, posted by marilynn on April 23, 2011, at 14:23:43
I have the same problem, although I am male. Its takes 6 weeks for it to get out of your system completely, but it should come back after about 3 months. There is a new drug Viibryd, which is a new SSRI that is not suppose to hinder sexual dysfunction or cause weight gain. Maybe you should try this to help mood. It is available in June.
Posted by henryo on April 27, 2011, at 5:13:00
In reply to Re: Post SSRI Sexual Dysfunction, posted by bearfan on April 25, 2011, at 16:42:40
Don't freak out. Definitely give it some time, like months. It took me quite a while to recover from Neurontin (Gabapentin) ten years ago. Also I think it is important after the appropriate wait to try to orgasm. Sounds kinda weird but hey. Also try Viagra no lie. I'm not trying to be funny. For some people M/F it gets the blood going where it needs to go. Best of luck with that, it is an evil feeling when it just won't happen. There are meds out thee that do work for depression and don't crush your sexuality or make you gain weight. Keep looking. The whole game is to get the result you want without the side effects you don't want. It is out there.
This is the end of the thread.
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