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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Stm on August 26, 2016, at 16:42:06
Hello. Long story short, for 8 years i have been on most ssris and 1 tca, clomipramine. I am sensitive in ssris, they tend to worsen my anxiety a lot, and the only one that actually worked was paxil, but the sexual side effects were severe and i had a lot of trouble in changing to another med, the withdrawals from this were horrid. The last med i tried is clomipramine, which worked very good, but it completely obliterated my sexual drive. It wasn't good since i started taking ads, but now i feel like a eunuch. Clomipramine is better than ssris for me becuase it isn't that selective as the ssris are, so i actually have fewer side effects, and almost no anxiety.
But, from what i have seen the stronger the med is on serotonin the worse the sexual side effects are. And clomipramine is a very strong inhibitor for serotonin. Since i mainly have ocd the choice was an ad that affected serotonin, but i want my sex drive back, so i told my doctor to find a tca or similar med that doesn't affect serotonin much. I have tried wellbutrin and remeron during the years but couldn't tolerate them due to various reasons. So, he proposed ludiomil (maprotiline), which is a tetracyclic.
I know ludiomil isn't preferred anymore, but for me ssris are a no anyway. So i am hoping that it will be much better for my sex drive which for the last 8 years is pretty much missing. Does anyone have any experiences with this med? It is very frustrating that the meds that work for ocd and anxiety are mainly heavy in serotonin, but serotonin is also the reason for my sex drive to go down. Or at least that is what i think is happening from my experiences and things that i have read. I have tried almost everything in the book for the sexual side effects from antidepressants, and in the case of clomipramine nothing works, it seems to be overshadowing everything, even wellbutrin as an addition, it did nothing after 3 weeks. So now i am trying ludiomil, this forgotten med that i hope could be the answer.
Posted by linkadge on August 26, 2016, at 17:19:04
In reply to Ludiomil vs ssri and tca sexual side effects, posted by Stm on August 26, 2016, at 16:42:06
Hey,
Maprotiline is very strong on norepinephrine reuptake. It may benefit you, or you may need something a bit more 'balanced' to serotonin and norepinephrine. Imipramine, or amitriptyline are decent options.
There is nothing wrong with maprotiline, it's probably worth a shot. Depending how you respond however, you may need to combine it with something serotonergic.
One thing to keep in mind, is that although clomipramine is primarily a SSRI, it's metabolite is primarily an NRI. Over time, you tend to get a more balanced reuptake.Linkadge
Posted by Stm on August 26, 2016, at 18:49:18
In reply to Re: Ludiomil vs ssri and tca sexual side effects, posted by linkadge on August 26, 2016, at 17:19:04
Thank you. Clomipramine has made my libido non existent so i have to try something else. I think imipramine is also kind of strong on serotonin, although not as much. The whole idea of avoiding a med that inhibits serotonin heavily is that it also obliterates my sex drive. That is why i went with ludiomil (2nd day now). Though i've read that it has a higher rate for seizures (i am not epileptic), and that it has caused some to people with no epilepsy history, and that made me concerned. I cannot find further info on the net, other than it may happen if you go up in dose quickly or the risk is higher in higher doses. I hope it's going to be ok.
Posted by linkadge on August 27, 2016, at 8:02:25
In reply to Re: Ludiomil vs ssri and tca sexual side effects, posted by Stm on August 26, 2016, at 18:49:18
Many of the TCAs can cause seizures, but I think the overall risk is fairly low.
Ludiomil, nortriptyline, desipramine and protriptyline are fairly selective towards norepinephrine. Some people do very well on these meds.
I found that nortriptyline was pretty good, I actually wish I was back on some as I have incredible fatigue (nortriptyline was good for that).
However, I personally seem to benefit from some degree of serotonin reuptake inhibition.
Linkadge
Posted by Stm on September 18, 2016, at 13:49:34
In reply to Ludiomil vs ssri and tca sexual side effects, posted by Stm on August 26, 2016, at 16:42:06
Ok, it didn't go that well after all with ludiomil. While it has somewhat helped my libido to partially come up again, but not all the way, it has undesirable side effects. Some of the ocd has gone up again, and it is causing me fear during sleeping, bad dreams, and anxiety. Also, i have woken up several times with some kind of hallucination, like a sound or something touching me and waking up immediately. So i am stopping it. Going back to clomipramine until i find something else, because it is for certain now that serotonin is what affects my libido for the most part.
And it is also serotonin that helps with the ocd, but i prefer having some ocd and managing it, while having a higher libido. So, i am looking up at tcas that are either balanced or mostly have to do with norepinephrine, but are not sedating. Because the meds that i have tried that are sedating, ludiomil, and mirtazapine in the past, have caused me nightmares and night terrors. Of course i don't want it to be too much activating, cause it will be bad for my anxiety. Oh well, i don't know, i would do a washout of meds but i don't feel ready yet. So, on to finding something that will allow my sex drive to be up. Maybe i could try wellbutrin again as an adjunct, but not with clomipramine cause it did absolutely nothing.
Amitriptyline could be the next choice but i read that it is a strong inhibitor for serotonin, not as much as clomipramine, but still i don't know how much it will affect my libido. Waiting for my doc to suggest something.
This is the end of the thread.
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