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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Jay2112 on August 20, 2021, at 19:47:35
I have been coming across many studies on Pubmed showing that Abilify can work for ED. In fact, hypersexuality is listed as a possible side effect. A few studies have shown Abilify + bromocriptine (dopamine agonist) works excellent for ED. I am presuming the partial dopamine agonist activity of Abilify is responsible for this. So...I am on a quest..an experiment...with 10mg of Abilify and, hoping to taper, up to 10mg of bromocriptine. I am on 2.5mg of bromo right now..my pdoc won't let me start at 10mg.
A couple of questions...1) Would higher dose Abilify work better for ED? (i.e. 30mg?) 2) Does the dopamine agonism of Abilify eventually downregulate the dopamine receptors? 3) What would be the best SRI to augment with for a bit more antidepressant qualities, while the bromo and Abilify address the ED problem? I am thinking low dose Prozac or Zoloft.
Thanks for your help... :)
Jay
Posted by undopaminergic on August 21, 2021, at 2:26:55
In reply to Abilify for Erectile Dysfunction?, posted by Jay2112 on August 20, 2021, at 19:47:35
> I have been coming across many studies on Pubmed showing that Abilify can work for ED. In fact, hypersexuality is listed as a possible side effect. A few studies have shown Abilify + bromocriptine (dopamine agonist) works excellent for ED. I am presuming the partial dopamine agonist activity of Abilify is responsible for this. So...I am on a quest..an experiment...with 10mg of Abilify and, hoping to taper, up to 10mg of bromocriptine. I am on 2.5mg of bromo right now..my pdoc won't let me start at 10mg.
>With bromocriptine, an ergoline-based drug, you should watch out for heart valvulopathy and fibrosis. Why not use pramipexole (Sifrol, Mirapex) or ropinirole (Requip)?
> A couple of questions...1) Would higher dose Abilify work better for ED? (i.e. 30mg?)
>Absolutely not. Abilify is an agonist-antagonist, a dopamine partial agonist, and at low doses, it stimulates dopamine receptors but in higher doses, the net effect is to antagonise them -- that is why Abilify is used for schizophrenia and other psychoses. So more is not merrier with Abilify.
I wonder why you'd need Abilify as a dopamine *agonist* when you are already taking one in the form of bromocriptine?
> 3) What would be the best SRI to augment with for a bit more antidepressant qualities, while the bromo and Abilify address the ED problem? I am thinking low dose Prozac or Zoloft.
>SRIs have sexual side effects. I think it is called anorgasmia. I think Prozac is less liable to this effect than Zoloft.
-undopaminergic
Posted by SLS on August 21, 2021, at 8:51:07
In reply to Re: Abilify for Erectile Dysfunction?, posted by undopaminergic on August 21, 2021, at 2:26:55
I have only recently developed a loss of sex drive and ED. My depression is much improved, so something is wrong. Usually, one of the first things that happens when I begin to respond to treatment is an increase in libido. This occurs before there is a significant improvement in depression.
Something is definitely wrong, and I am beginning to suspect low testosterone produced as a side effect of rosuvastatin (Crestor) treatment as the culprit.
Does anyone have any ideas?
I am currently taking:
Nardil - 90 mg/day
nortriptyline - 75 mg/day
Lamictal - 300 mg/day
lithium - 300 mg/dayI stopped taking rosuvastatin earlier this week.
I haven't tried Viagra, or any other vasodilator that enhances nitric oxide (NO).Does anyone know if Viagra can enhance an erection when there are no vascular issues?
Thanks.
- Scott
Posted by Jay2112 on August 21, 2021, at 11:17:24
In reply to Re: Abilify for Erectile Dysfunction?, posted by undopaminergic on August 21, 2021, at 2:26:55
> >
>
> With bromocriptine, an ergoline-based drug, you should watch out for heart valvulopathy and fibrosis. Why not use pramipexole (Sifrol, Mirapex) or ropinirole (Requip)?
>Well, I have tried both Requip and Mirapex. They just didn't do anything for my ED. The bromocriptine is actually starting to help. I honestly think, as with most drugs, it has to do with genetic enzymes, and the processing in the body.
> > A couple of questions...1) Would higher dose Abilify work better for ED? (i.e. 30mg?)
> >
>
> Absolutely not. Abilify is an agonist-antagonist, a dopamine partial agonist, and at low doses, it stimulates dopamine receptors but in higher doses, the net effect is to antagonise them -- that is why Abilify is used for schizophrenia and other psychoses. So more is not merrier with Abilify.
>> I wonder why you'd need Abilify as a dopamine *agonist* when you are already taking one in the form of bromocriptine?There are a few reasons I am going this route. 1) I do need an antipsychotic, as I am bipolar II, and have had some psychotic episodes. All other antipsychotics just make me feel so tired, majorly apathetic, and at times, suicidal. I really am a vegetable on these, and Abilify completely changed that, and it seems my lithium greatly prevents the irritation of dopamine agonism with Abilify. 2) Suprisingly, the bromo feels very smooth, to me.
>
> > 3) What would be the best SRI to augment with for a bit more antidepressant qualities, while the bromo and Abilify address the ED problem? I am thinking low dose Prozac or Zoloft.
> >
>
> SRIs have sexual side effects. I think it is called anorgasmia. I think Prozac is less liable to this effect than Zoloft.Well, I just think I will stick with my Effexor for now. It is pretty much like an SRI.
I may also consider trying/adding the Mirapex in this combo. I have type II diabetes, which also contributes to the ED. But, I am on the right road.
> -undopaminergic
>
Thanks so kindly...
Jay
Posted by Lamdage22 on August 21, 2021, at 11:42:27
In reply to Re: Abilify for Erectile Dysfunction?, posted by SLS on August 21, 2021, at 8:51:07
Yep, get your free testosterone measured. Can't you order any blood test you want in the US without a doctor? A dream come true
> Something is definitely wrong, and I am beginning to suspect low testosterone produced as a side effect of rosuvastatin (Crestor) treatment as the culprit.
>
> Does anyone have any ideas?
Posted by undopaminergic on August 21, 2021, at 11:55:31
In reply to Re: Abilify for Erectile Dysfunction?, posted by SLS on August 21, 2021, at 8:51:07
> I have only recently developed a loss of sex drive and ED. My depression is much improved, so something is wrong. Usually, one of the first things that happens when I begin to respond to treatment is an increase in libido. This occurs before there is a significant improvement in depression.
>
> Something is definitely wrong, and I am beginning to suspect low testosterone produced as a side effect of rosuvastatin (Crestor) treatment as the culprit.
>From what I've read, the statins block the synthesis of co-enzyme Q10, so you should supplement it. But if you've stopped it, never mind.
>
> I haven't tried Viagra, or any other vasodilator that enhances nitric oxide (NO).
>
> Does anyone know if Viagra can enhance an erection when there are no vascular issues?
>Viagra helps with the "technical" part of an erection, but does not enhance sex drive.
-undopaminergic
Posted by undopaminergic on August 21, 2021, at 12:03:54
In reply to Re: Abilify for Erectile Dysfunction? » undopaminergic, posted by Jay2112 on August 21, 2021, at 11:17:24
> >> I wonder why you'd need Abilify as a dopamine *agonist* when you are already taking one in the form of bromocriptine?
>
> There are a few reasons I am going this route. 1) I do need an antipsychotic, as I am bipolar II, and have had some psychotic episodes. All other antipsychotics just make me ...
>Did you try amisulpride, sulpiride, lurasidone, or ziprasidone? If you like Abilify, you might like cariprazine, which is a "workalike"; brexpiprazole is another.
-undopaminergic
Posted by Jay2112 on August 21, 2021, at 18:06:05
In reply to Re: Abilify for Erectile Dysfunction?, posted by SLS on August 21, 2021, at 8:51:07
> I have only recently developed a loss of sex drive and ED. My depression is much improved, so something is wrong. Usually, one of the first things that happens when I begin to respond to treatment is an increase in libido. This occurs before there is a significant improvement in depression.
>
> Something is definitely wrong, and I am beginning to suspect low testosterone produced as a side effect of rosuvastatin (Crestor) treatment as the culprit.
>
> Does anyone have any ideas?
>
> I am currently taking:
>
> Nardil - 90 mg/day
> nortriptyline - 75 mg/day
> Lamictal - 300 mg/day
> lithium - 300 mg/day
>
> I stopped taking rosuvastatin earlier this week.
>
>
> I haven't tried Viagra, or any other vasodilator that enhances nitric oxide (NO).
>
> Does anyone know if Viagra can enhance an erection when there are no vascular issues?
>
> Thanks.
>
>
> - ScottHi Scott:
Well, you should get all of your testosterone measured by your doctor, especially free testosterone levels. I have quite a bit of experience with testosterone replacement therapy. I was on androgel from age 36-40. My testosterone levels plummeted by 36 (likely from very chronic, high dose use of Prozac), and an MRI revealed my pituitary gland in my brain had stopped producing luteinizing hormone and follicle stimulating hormone. Both are needed to stimulate and facilitate testosterone production in men.
Now, I am not saying this is your case, just that it can be complicated. So, now my doctor has said my testosterone levels are normal. AND, as a guy over 50, I am deeply afraid of the strong co-relation between testosterone replacement and prostate cancer. HOWEVER, you can bypass that route, increase bloodflow to the genitals, and slightly increase testosterone, through dopamine agonism. (Everything from pramipexole to bromocriptine.)As well, the amino acids d-aspartic acid and l-tyrosine have been shown to increase testosterone. These things bypass the very powerful effects of supplemental testosterone on PSA, in particular in us men over 50.
I am unsure about Viagra. In low testosterone, anti-depressant induced, and diabetic induced ED, the results are very mixed for Viagra use. I tried Viagra and Cialis, numerous times, and zilch...no go. But, we are all different..so maybe ask your doctor for samples and try?
Best of luck...keep us posted. I too am dealing with the situation. (p.s. It appears that very, very small doses of dopamine agonists prevent the downregulation of dopamine receptors, over much larger doses.)
Very best,
Jay :)
Posted by SLS on August 22, 2021, at 3:35:57
In reply to Re: Abilify for Erectile Dysfunction? » SLS, posted by undopaminergic on August 21, 2021, at 11:55:31
Hi.
Thanks for your input.
> From what I've read, the statins block the synthesis of co-enzyme Q10, so you should supplement it. But if you've stopped it, never mind.
Does that affect testosterone at all?
> > I haven't tried Viagra, or any other vasodilator that enhances nitric oxide (NO).
> >
> > Does anyone know if Viagra can enhance an erection when there are no vascular issues?
> Viagra helps with the "technical" part of an erection, but does not enhance sex drive.I'll worry about the sex drive later. I just want to get laid.
Huh?
It still makes for a loving experience.
- Scott
Posted by SLS on August 22, 2021, at 4:07:56
In reply to Re: Abilify for Erectile Dysfunction? » Jay2112, posted by undopaminergic on August 21, 2021, at 12:03:54
> > >> I wonder why you'd need Abilify as a dopamine *agonist* when you are already taking one in the form of bromocriptine?
With amisulpride, the variability of the net effect on dopamine activity is established by the ratio of presysnaptic occupancy as a pure antagonist versus its occupancy on the postsynaptic receptors, also as a pure antagonist. If I remember correctly, presynaptic receptors have a higher binding affinity to dopamine than postsynaptic receptors. Amisulpride acts to stimulate more potently presynaptic receptors than postsynaptic receptors. This reinforces the negative feedback loop, and reduces the manufacture and release of dopamine. However, as the dosage of amisulpride is increased, the blocking of postsynaptic receptors by amisulpride becomes the driving therapeutic mechanism. The bottom line is that at low dosages, amisulpride has an antidepressant effect while high dosages have an antipsychotic effect.Amisulpride is probably the best antipsychotic to treat the negative symptoms of schizophrenia.
- Scott
Posted by SLS on August 22, 2021, at 4:20:52
In reply to Re: Abilify for Erectile Dysfunction? » SLS, posted by Jay2112 on August 21, 2021, at 18:06:05
Thanks, Jay!
New information for me.
I had wanted to have my testosterone tested on Monday, while still taking Crestor (rosuvastatin) to compare it to the levels arrived at weeks after discontinuing it. Unfortunately, I had become too involved wtih family predicaments to have time to take them. So, I'll rely on empirical observation. All I care about is that my sexual appetite and genital functions return. During the time since I began taking Crestor, I have lost a great deal of muscle mass and strength, along with the disappearance of pimples that always existed on my chest. Too many things point to the putative lowering of testosterone levels by Crestor. I find my eyes lingering longer on females now. It is totally involuntary. This could be the calm before the storm. <smile>
- Scott
>
> Hi Scott:
>
> Well, you should get all of your testosterone measured by your doctor, especially free testosterone levels. I have quite a bit of experience with testosterone replacement therapy. I was on androgel from age 36-40. My testosterone levels plummeted by 36 (likely from very chronic, high dose use of Prozac), and an MRI revealed my pituitary gland in my brain had stopped producing luteinizing hormone and follicle stimulating hormone. Both are needed to stimulate and facilitate testosterone production in men.
>
> Now, I am not saying this is your case, just that it can be complicated. So, now my doctor has said my testosterone levels are normal. AND, as a guy over 50, I am deeply afraid of the strong co-relation between testosterone replacement and prostate cancer. HOWEVER, you can bypass that route, increase bloodflow to the genitals, and slightly increase testosterone, through dopamine agonism. (Everything from pramipexole to bromocriptine.)As well, the amino acids d-aspartic acid and l-tyrosine have been shown to increase testosterone. These things bypass the very powerful effects of supplemental testosterone on PSA, in particular in us men over 50.
>
> I am unsure about Viagra. In low testosterone, anti-depressant induced, and diabetic induced ED, the results are very mixed for Viagra use. I tried Viagra and Cialis, numerous times, and zilch...no go. But, we are all different..so maybe ask your doctor for samples and try?
>
> Best of luck...keep us posted. I too am dealing with the situation. (p.s. It appears that very, very small doses of dopamine agonists prevent the downregulation of dopamine receptors, over much larger doses.)
>
> Very best,
> Jay :)
>
>
Posted by undopaminergic on August 22, 2021, at 5:02:32
In reply to Re: Abilify for Erectile Dysfunction? » SLS, posted by Jay2112 on August 21, 2021, at 18:06:05
>
> ... an MRI revealed my pituitary gland in my brain ...The pituitary is not part of the brain, but is a separate organ just *next* to the base of the brain.
-undopaminergic
Posted by undopaminergic on August 22, 2021, at 5:21:37
In reply to Re: Abilify for Erectile Dysfunction? » undopaminergic, posted by SLS on August 22, 2021, at 4:07:56
> > > >> I wonder why you'd need Abilify as a dopamine *agonist* when you are already taking one in the form of bromocriptine?
>
>
> With amisulpride, the variability of the net effect on dopamine activity is established by the ratio of presysnaptic occupancy as a pure antagonist versus its occupancy on the postsynaptic receptors, also as a pure antagonist. If I remember correctly, presynaptic receptors have a higher binding affinity to dopamine than postsynaptic receptors. Amisulpride acts to [block]* more potently presynaptic receptors than postsynaptic receptors. This reinforces the negative feedback loop, and reduces the manufacture and release of dopamine. However, as the dosage of amisulpride is increased, the blocking of postsynaptic receptors by amisulpride becomes the driving therapeutic mechanism. The bottom line is that at low dosages, amisulpride has an antidepressant effect while high dosages have an antipsychotic effect.
>(*) you wrote "stimulate"
You are right, although we were speaking of Abilify, not amisulpride.
The pre-synaptic / autoreceptors are peculiar. The initial dopamine rush produced by a low dose of a drug like amisulpride or sulpiride subsides in maybe just a few days, and the effect does not come back even after a break in treatment. I noticed, however, that selegiline (a trace amine-like substance in itself or at least through its amphetamine metabolites) seems to re-sensitise the autoreceptors, so that the sulpiride (or amisulpride) will produce a stimulant effect again. It appears that unlike post-synaptic dopamine receptors, the autoreceptors are de-sensitised by antagonists and sensitised by agonists.
Note that that is just my experience and my theory.
My experience was also that sulpiride was a more powerful stimulant at first than methylphenidate.
> Amisulpride is probably the best antipsychotic to treat the negative symptoms of schizophrenia.
>I agree.
-undopaminergic
Posted by undopaminergic on August 22, 2021, at 5:25:06
In reply to Re: Abilify for Erectile Dysfunction?, posted by SLS on August 22, 2021, at 3:35:57
>
> > Viagra helps with the "technical" part of an erection, but does not enhance sex drive.
>
> I'll worry about the sex drive later. I just want to get laid.
>
> Huh?
>
> It still makes for a loving experience.For an erection, you need the sexual arousal which requires a sex drive (ie. sexual *interest*). At least that is my experience.
-undopaminergic
Posted by undopaminergic on August 22, 2021, at 5:32:44
In reply to Re: Abilify for Erectile Dysfunction?, posted by SLS on August 22, 2021, at 3:35:57
> Hi.
Hi.
> Thanks for your input.
It's a pleasure.
> > From what I've read, the statins block the synthesis of co-enzyme Q10, so you should supplement it. But if you've stopped it, never mind.
>
> Does that affect testosterone at all?I have to say I have no idea.
-undopaminergic
Posted by Jay2112 on August 22, 2021, at 16:33:45
In reply to Abilify for Erectile Dysfunction?, posted by Jay2112 on August 20, 2021, at 19:47:35
I have one main concern about dopamine agonists. That is, downregulation of receptors, and development of TD. Most DA agonists carry a warning in pharmaceutical literarure about this...the development of td after some long-term use.
Now, I ABSOLUTELY do not want my DA receptors plowed down. (Some context: When I was a young child, I had a major learning disability, including reading comprehension, math, and spelling. I also had physical co-ordination problems, like balance, doing very basic gymnastics, etc.) These things were in the early 70's, when Ritalin and such were rarely used.
Now, I caught up, mostly. In college, I got two degrees,all on the Dean's honour list. I am now working on my third degree, in some areas, just for interest.But, I have been on Dexedrine, then Vyvanse, since 1995, when I was 25. That dopamine awakening REALLY made me excel in college, and I didn't feel 'jacked up', just a normal sense of concentration, and a bit of reduction in my shyness. And, I felt much more physically in control of my body.
So, I do definitely do believe there is a strong dopaminergic (Hi UD! :) component, with a possible
lack of DA receptor sensitivity...or something along those lines. My Neurologist suggested I have both overactive parts of the brain and underactive parts, in particular in the left hemisphere. That last part, I don;t quite understand. Very small amounts of SRI's help (like micro-doses), but regular amounts make me feel like crap. SNRI's make me feel like crap, and NDRI's, I have a small partial response to.Thanks for reading,
Jay
Posted by undopaminergic on August 23, 2021, at 2:00:10
In reply to Re: Dopamine agonists downreg/SLS/UD/Linkadge/all?, posted by Jay2112 on August 22, 2021, at 16:33:45
> I have one main concern about dopamine agonists. That is, downregulation of receptors, and development of TD.
>I'm afraid there is no way to eat the cake and have it too. When you use dopamine agonists (direct (like pramipexole, bromocriptine) or indirect (like amphetamines and methylphenidate)), you are taking a risk of downregulation.
If you use dopamine *ant*agonists, you are taking a risk of sensitation (leading to TD).
> Most DA agonists carry a warning in pharmaceutical literarure about this...the development of td after some long-term use.
>I think you mean antipsychotics. DA agonists do not cause TD (Tardive Dyskinesia), antipsychotics do, especially the old (first generation) ones.
-undopaminergic
Posted by linkadge on August 23, 2021, at 8:15:13
In reply to Re: Dopamine agonists downreg/SLS/UD/Linkadge/all?, posted by undopaminergic on August 23, 2021, at 2:00:10
Abilify acts as a mixed agonist antagonist. Supposedly it predominantly activates presynaptic autoreceptors which would slow dopamine firing. Abilify can cause TD, but I'm not sure about how the rate compares with other antipsychotics.
Technically speaking, Vyvanse / Dexedrine are dopamine agonists, but they are not associated with TD.
I think that TD is more related to dopamine receptor upregulation (as seen with traditional antipsychotics).
Linkadge
Posted by undopaminergic on August 24, 2021, at 1:56:36
In reply to Re: Dopamine agonists downreg/SLS/UD/Linkadge/all?, posted by linkadge on August 23, 2021, at 8:15:13
> Abilify acts as a mixed agonist antagonist. Supposedly it predominantly activates presynaptic autoreceptors which would slow dopamine firing.
>I thought it targeted post-synaptic receptors, with high affinity but with a low efficacy, meaning it is predominantly an (modest) agonist at low doses, and because it binds tightly to the receptors, it prevents (endogenous) dopamine from binding to the receptors at higher doses.
-undopaminergic
Posted by linkadge on August 24, 2021, at 7:17:23
In reply to Re: Dopamine agonists downreg/SLS/UD/Linkadge/all?, posted by undopaminergic on August 24, 2021, at 1:56:36
Well, as a presynaptic agonist, it blocks dopamine release (i.e. a functional antagonist properties). But it can also activate or block post synaptic receptors to some degree as you mention depending on the circumstance. I'm not really up on this, however.
Wikipedia says:
It appears to show predominantly antagonist activity on postsynaptic D2 receptors and partial agonist activity on presynaptic D2 receptors,[53] D3,[45][54][55] and partially D4
and
Since the actions of aripiprazole differ markedly across receptor systems aripiprazole was sometimes an antagonist (e.g. at 5-HT6 and D2L), sometimes an inverse agonist (e.g. 5-HT2B), sometimes a partial agonist (e.g. D2L), and sometimes a full agonist (D3, D4). Aripiprazole was frequently found to be a partial agonist, with an intrinsic activity that could be low (D2L, 5-HT2A, 5-HT7), intermediate (5-HT1A), or high (D4, 5-HT2C). This mixture of agonist actions at D2-dopamine receptors is consistent with the hypothesis that aripiprazole has 'functionally selective' actions.[61]
Linkadge
Posted by Jay2112 on August 26, 2021, at 12:09:20
In reply to Re: Dopamine agonists downreg/SLS/UD/Linkadge/all?, posted by undopaminergic on August 23, 2021, at 2:00:10
> > I have one main concern about dopamine agonists. That is, downregulation of receptors, and development of TD.
> >
>
> I'm afraid there is no way to eat the cake and have it too. When you use dopamine agonists (direct (like pramipexole, bromocriptine) or indirect (like amphetamines and methylphenidate)), you are taking a risk of downregulation.
>
> If you use dopamine *ant*agonists, you are taking a risk of sensitation (leading to TD).
>
> > Most DA agonists carry a warning in pharmaceutical literarure about this...the development of td after some long-term use.
> >
>
> I think you mean antipsychotics. DA agonists do not cause TD (Tardive Dyskinesia), antipsychotics do, especially the old (first generation) ones.
>Yes...you are right. I was looking at the literature on people with Parkinson's, using an agonist. Especially, using levodopa. Interesting they are finding using agonists like Neupro and Mirapex as first line in Parkinson's instead of l-dopa, actually lessens the on/off switch in the illness for a longer period of time.
I believe all of the DSM-V illness' actually run on a spectrum, like Autism does. (I've worked with Autistic kids and young adults for over 25 years.) I am no pharmacological or psycho-biological expert, but my psychiatrist mentioned this to me when I was his first patient. So many meds are shared in the treatment of psychiatric disorders.
~Jay
Posted by Jay2112 on August 26, 2021, at 12:21:58
In reply to Re: Dopamine agonists downreg/SLS/UD/Linkadge/all?, posted by linkadge on August 23, 2021, at 8:15:13
Yes, as I mentioned to UD above, I was looking at people with Parkinson's...and I had a blond moment and didn't realize it..lol!
As well, there are also many who get major agitation from Abilify (I had it, bad!!), and appears to be due to it's partial dopamine agonism.
Inverse agonists are interesting...they seem to have similar properties of antagonists, and also suppressing spontaneous receptor signaling. Latuda has some 5-ht2 inverse agonism.
~Jay
Posted by Lamdage22 on August 27, 2021, at 3:22:04
In reply to Re: Dopamine agonists downreg/SLS/UD/Linkadge/all? » linkadge, posted by Jay2112 on August 26, 2021, at 12:21:58
Maybe it will cause you to gamble compulsively and you'll make alot of money :) If you detect sarcasm it may be because it was intended. You have to be careful with sarcasm here...
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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