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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Tusco on April 9, 2012, at 14:54:12
I have a long term problem of depression, I have tried many medications and talk
therapies with limited or temporary successes. I did well on a cocktail of
mirtazapine and sertraline but I discontinued it because of sexual and
non-sexual side effects. Duloxetine worked too but made me impotent, thankfully
that was reversed when I discontinued the medication.
I am fed up with medications and I am looking into transcranial magnetic
stimulation and even ECT, electroconvuslive therapy.
Nevertheless at the moment I really need medication and I am on agomelatine 50mg
but my psychiatrist wants me on nortriptyline too because I am just too unwell.
Nortryptiline is a tricyclic antidepressant, an old type, pre-ssri,
antidepressant.
I can already see already that diminishes my libido and makes harder for me to
achieve erections, my doc suggests me to keep using it saying that sexual side
effects could diminish with time, but I don't believe that, because in my
experience with previous ADs that never happened. In any case he suggests I
could use levitra or cialis.
I am in two minds, I really need to improve my depression because I am suicidal
but I don't want to have sexual problems. Also I fear that tricyclics too, like
SSRIs could cause long term sexual issues.
Do you have any advice? Thanks
Posted by tensor on April 9, 2012, at 15:04:34
In reply to advice needed, posted by Tusco on April 9, 2012, at 14:54:12
> I have a long term problem of depression, I have tried many medications and talk
> therapies with limited or temporary successes. I did well on a cocktail of
> mirtazapine and sertraline but I discontinued it because of sexual and
> non-sexual side effects. Duloxetine worked too but made me impotent, thankfully
> that was reversed when I discontinued the medication.
> I am fed up with medications and I am looking into transcranial magnetic
> stimulation and even ECT, electroconvuslive therapy.
> Nevertheless at the moment I really need medication and I am on agomelatine 50mg
> but my psychiatrist wants me on nortriptyline too because I am just too unwell.
> Nortryptiline is a tricyclic antidepressant, an old type, pre-ssri,
> antidepressant.
> I can already see already that diminishes my libido and makes harder for me to
> achieve erections, my doc suggests me to keep using it saying that sexual side
> effects could diminish with time, but I don't believe that, because in my
> experience with previous ADs that never happened. In any case he suggests I
> could use levitra or cialis.
> I am in two minds, I really need to improve my depression because I am suicidal
> but I don't want to have sexual problems. Also I fear that tricyclics too, like
> SSRIs could cause long term sexual issues.
> Do you have any advice? Thanks
>
>
>I have found that mirtazapine reverses SSRI-induced sexual dysfunction. What doses were you on? There is also bupropion/Wellbutrin, have you tried it? It can also reverse AD-induced sexual problems. An idea is to take Wellbutrin with Zoloft, a well-known combo that often works well. You could add mirtazapin to either agomelatine or nortriptyline. As long as you don't take too high dose of nortriptyline, there would be minimal sexual problems.
/t
Posted by Tusco on April 10, 2012, at 15:46:07
In reply to Re: advice needed » Tusco, posted by tensor on April 9, 2012, at 15:04:34
I was on mirtazapine 30 mg for a long time, about 4 years. First for about 2 years mirtazapine was taken combined with setraline, then on its own and eventually with lithium.
I have tried buproprion too but not at an higher dose than 300mg. I don't think that I have post-ssri sexual dysfunction because my sexual issues started with my first episode of major depression, before I tok any medication, and then at times things were better or worse but I never regained the pre-major depression sexual standard. I just don't want to make things worse with ADs. I think I will ask my psychiatrist what he thinks of combining agomelatine with buproprion at 450mg, but he's a stubborn type so I guess he'll ask me to keep taking nortriptyline...I will see what to do.> > I have a long term problem of depression, I have tried many medications and talk
> > therapies with limited or temporary successes. I did well on a cocktail of
> > mirtazapine and sertraline but I discontinued it because of sexual and
> > non-sexual side effects. Duloxetine worked too but made me impotent, thankfully
> > that was reversed when I discontinued the medication.
> > I am fed up with medications and I am looking into transcranial magnetic
> > stimulation and even ECT, electroconvuslive therapy.
> > Nevertheless at the moment I really need medication and I am on agomelatine 50mg
> > but my psychiatrist wants me on nortriptyline too because I am just too unwell.
> > Nortryptiline is a tricyclic antidepressant, an old type, pre-ssri,
> > antidepressant.
> > I can already see already that diminishes my libido and makes harder for me to
> > achieve erections, my doc suggests me to keep using it saying that sexual side
> > effects could diminish with time, but I don't believe that, because in my
> > experience with previous ADs that never happened. In any case he suggests I
> > could use levitra or cialis.
> > I am in two minds, I really need to improve my depression because I am suicidal
> > but I don't want to have sexual problems. Also I fear that tricyclics too, like
> > SSRIs could cause long term sexual issues.
> > Do you have any advice? Thanks
> >
> >
> >
>
> I have found that mirtazapine reverses SSRI-induced sexual dysfunction. What doses were you on? There is also bupropion/Wellbutrin, have you tried it? It can also reverse AD-induced sexual problems. An idea is to take Wellbutrin with Zoloft, a well-known combo that often works well. You could add mirtazapin to either agomelatine or nortriptyline. As long as you don't take too high dose of nortriptyline, there would be minimal sexual problems.
>
> /t
Posted by bleauberry on April 13, 2012, at 7:29:01
In reply to advice needed, posted by Tusco on April 9, 2012, at 14:54:12
Before I talk about meds, or before you move forward with any more meds, I think you would be wise to take a look at rhodiola rosea first. It stands a decent chance of being an excellent antidepressant for you. In a worst case scenario if it isn't magical, it will at a minimum set the stage for everything else you try to work better.
Nortriptyline is a good choice, but only if combined with an ssri, first choice zoloft second choice prozac. It's the balanced serotonin vs norepinephrine mechanism you want....which has been missing from every other med you've tried. Another excellent choice would be Savella straight up.
Here's something most doctors don't see. If the side effects are too much, guess what, the dose is too high! Duhh. In their generally accepted practices, only normal doses stated in literature can be therapeutic, right? That is wrong. Even tiny miniscule doses can work great....but then not great when increased to a normal dose. Before abandoning any med due to side effects, I think it is important to first try it at really small doses....much less than the starting dose....just to see what happens. At a dose where things are tolerable it allows the time necessary to have the med make some brain adjustments. If the low dose thing turns out to not be promising, then the only other choice is to switch meds completely. Hey I got very bad sexual side effects from all the ssris but only mimimum minor side effects from prozac....so it's hard to predict.
Posted by Tusco on April 13, 2012, at 12:20:37
In reply to Re: advice needed, posted by bleauberry on April 13, 2012, at 7:29:01
Thanks. I was taking nortriptyline at the minimal dosage of 10mg per day but my psycdoc surprisingly decided to suspend it. He said that I am showing to be too sensitive to side effects right now, being them psychological or real, so he wants me to stay on agomelatine only which I am taking at 50mg and he wants me to do a CBT with him instead. I will consider Rodhiola but I know nothing about it. Is it compatible with agomelatine?
> Before I talk about meds, or before you move forward with any more meds, I think you would be wise to take a look at rhodiola rosea first. It stands a decent chance of being an excellent antidepressant for you. In a worst case scenario if it isn't magical, it will at a minimum set the stage for everything else you try to work better.
>
> Nortriptyline is a good choice, but only if combined with an ssri, first choice zoloft second choice prozac. It's the balanced serotonin vs norepinephrine mechanism you want....which has been missing from every other med you've tried. Another excellent choice would be Savella straight up.
>
> Here's something most doctors don't see. If the side effects are too much, guess what, the dose is too high! Duhh. In their generally accepted practices, only normal doses stated in literature can be therapeutic, right? That is wrong. Even tiny miniscule doses can work great....but then not great when increased to a normal dose. Before abandoning any med due to side effects, I think it is important to first try it at really small doses....much less than the starting dose....just to see what happens. At a dose where things are tolerable it allows the time necessary to have the med make some brain adjustments. If the low dose thing turns out to not be promising, then the only other choice is to switch meds completely. Hey I got very bad sexual side effects from all the ssris but only mimimum minor side effects from prozac....so it's hard to predict.
Posted by sigismund on April 13, 2012, at 23:08:51
In reply to Re: advice needed, posted by Tusco on April 13, 2012, at 12:20:37
>I will consider Rodhiola but I know nothing about it. Is it compatible with agomelatine?
Well yes, I think so, but they are both dopaminergic and you may end up with more of that than you need.
If agomelatine is no longer helping you with your sleep I would consider reducing it.
I only say this because it happened to me.
Posted by Tusco on April 15, 2012, at 8:49:25
In reply to Re: advice needed » Tusco, posted by sigismund on April 13, 2012, at 23:08:51
I am taking agomelatine for depression rather than my sleep. I fear that If I reduce it, I might end up worse off in terms of mood. I haven't read much about agomelatine but as far as I understood its action as dopaminergic agent, if there's any, it is minimal.
I have started taking L-tyrosine which seems to help a little bit my depression but does nothing for my low libido.
I don't want to mess up too much with neurotransmission but I can't ask my psychiatrist advice because he knows nothing outside approved antidepressants and he would not be willing to discuss supplements and herbs.
At this stage I am on this regime: 50mg of agomelatine, 1500mg of L-Tyrosine, 1600 of L-arginine plus vitamins. I might add Rhodiola to the mix and hope of the best!
If you think that I am doing something silly please let me know thanks.
> >I will consider Rodhiola but I know nothing about it. Is it compatible with agomelatine?
>
> Well yes, I think so, but they are both dopaminergic and you may end up with more of that than you need.
>
> If agomelatine is no longer helping you with your sleep I would consider reducing it.
> I only say this because it happened to me.
This is the end of the thread.
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