Posted by Cindy on April 24, 2000, at 22:04:07
In reply to Explicit Discussion of Sex and Meds Anyone?, posted by Mark H. on April 24, 2000, at 20:31:26
> There are just some things you can't look up in a book, and our doctors often don't have a clue. So even though sex and meds have been discussed on Psycho-Babble countless times before (I'm sure), I'd really appreciate an ultra-honest exposition of people's experiences in this area. I thank Heather and Sarah for the frankness of their postings about delayed orgasm and Effexor, above.
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> I'll start with this: I'm male, 50, married for 16 years, monogamous, taking psych meds for 7 years, took 4 years and more than 25 different ADs and adjunctives to find the right mix for my depression. Bipolar II and refractive/atypical. Gaining weight but still not heavy. Fast metabolism, naturally "speedy" but pathologically sleepy as I've gotten older and more depressed (hypersomnolent). Take Effexor, Ritalin, Pindolol, Cytomel (thyroid) for depression and too much adrenalin; Clonazepam for PLMD and REM-breakthroughs during sleep. Occasionally take Xanax, Valium, Ativan or Compazine as needed (fairly rarely).
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> Erections and blood flow to penis: as men sleep, they cycle through a phase (usu in early morning) when they have erections. These are a good indication whether so-called erectile dysfunction (formerly called impotence) is biological or psychological. If a man is having difficulty achieving and maintaining an erection with his partner, but gets good, firm, lasting erections in the early morning sleep cycle, then there are probably some psychological issues rather than medical issues involved with the partner or with having sex in general (I'm sure if I've said this incorrectly, other more erudite posters will add to and refine my over-simplified explanation.)
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> Likewise, when a man exercises his pelvic muscles (tightens his anus and/or cuts off the flow of urine), generally blood is forced into the penis. A man can thus both increase and pulsate his erection in this manner, which also stimulates his prostate gland, just as a woman can tighten the muscles in the vagina to increase pleasure and sensation for herself and her partner, utlizing the same basic set of muscles. For a man, the presence or absence of momentary "pulsing" or enlarging of the penis when tightening the pelvic floor is also an indication as to whether the absence or difficulty in sustaining erections is psychological or physical.
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> A man's orgasm, though certainly more complex neurologically than I understand, involves ejaculation, which is a more-or-less involuntary and rapid tightening of the muscles (?) of the prostate gland, causing forceful ejection of sperm-laden semen through the urethra. Ejaculation can be caused by stimulation of the penis during sex or masturbation, or even just by thoughts and sufficient mental stimulation (as in a dream of having sex that results in orgasm and ejaculation, often called a "wet dream") or as an "accident" when kissing and fondling. It can be mechanical or mental/emotional, but is usually a combination of both.
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> My experience with Effexor, in particular, and the Pindolol and Ritalin tend to add to the effects, is that not only is the ability to reach orgasm impaired completely or greatly delayed, but also that it is not possible to obtain a full, firm and long-lasting erection, whether in the presence of sexual stimulation or during the erection phase of the sleep cycle. Likewise, the tightening of the pelvic floor indicates a much-reduced or absent flow of blood to the penis. The overall effect is similar to but somewhat different than losing libido altogether -- sex moves up to my head as an emotional and mental interest, but it doesn't seem to be very well grounded in my body, and I find weeks slip away in which my wife and I don't make time to make love, especially during particularly stressful times of year for us (work-wise). Effexor also seems to cut the intensity, both physically and emotionally, of my orgasm as well.
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> What works for us is basically planned sex, although that may sound worse to younger people than it actually is in practice at our age. If I take my meds early Saturday morning, or take a slightly reduced dose, then by Sunday late morning, the meds have worn off enough for us to enjoy making love. Likewise, Viagra is a great help -- a true miracle drug -- in obtaining and maintaining a firm erection. In fact, my wife and I laughed all afternoon after the first time we tried it -- we just about wore each other out, which we hadn't done in many, many years. Also, a reasonably delayed orgasm, for a man, is not a hindrance in itself, since it can give his partner more time to have several nice orgasms to his one. (As men age, in general, their ability to recycle and perform sex again after a brief rest period diminishes considerably.)
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> However, beyond a point, I find that delayed orgasm subtly increases my wife's anxiety much more than mine. I am often satisfied to share her intensely wonderful orgasms and just let the boundaries of what's mine and what's hers blur; but at some level she really wants to get me off, and it can be an awful lot of work when I'm on Effexor.
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> OK, now the other side -- Effexor withdrawal. The first year I was on Effexor, I had to take an ever-increasing dose. This was before we discovered the potentiating qualities of Ritalin and Pindolol. By the time I stopped taking it (during an "up" part of my cycle), the withdrawal effects were as intense sexually as the inhibiting effects had been.
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> When I quit taking Effexor, I became overwhelmingly stimulated with regards to everyone and everything. I wanted to have sex with beautiful flowers, a great sunrise, and every woman I met! Music would practically bring me to orgasm. Erections became almost painfully strong and hard and lasted embarrassingly long times (not to the point of priapism, but enough that I was glad I was wearing fairly loose-fitting pants at work). I had wet dreams for the first time since I was a teenager, and I even urinated on myself a couple of times while sleeping (not enough to wet the bed, but enough to wake myself up). I assume the latter is an anti-cholinergic rebound, although Effexor never made it particularly hard to pee, as other ADs had. I could easily have four or five orgasms a day for awhile, as opposed to two or three a month while taking the drugs. I was passionate about everything -- I couldn't stop to shave or bathe or put on decent clothes, everything seemed sexy and wonderful and like it all moved too slowly, and just the brushing touch of a loving hand or the slightest trace of a woman's sexual scent would bring me close to orgasm. It was as though I were having a sex-specific form of mania as I withdrew.
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> I also should mention that I had six weeks of flu-like symptoms getting off of Effexor -- I've never experienced anything so tough to get off of before or since.
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> I would not portray the profound sexual side effects of anti-depressants as an entirely negative experience, even though they are generally annoying for me. For one thing, my sense of and appreciation for sexuality has changed to include a new level that I suspect only much older men appreciate and enjoy (perhaps in their 60s or 70s?). I can fully take in and appreciate a younger woman's sexuality without the slightest intention or desire to exploit it -- in fact, quite the opposite. I almost can't find the right words for this. How can I say that I can be completely enchanted with and aware of the sexual power and beauty of a full-blown, sexually open and active 24-year old and still say with a straight face that I don't "want" her? It is analogous to seeing a great painting by Van Gogh and being moved to tears, yet not wanting to own it or have it hanging on my living room wall. I have it already in my mind, in my senses, fully, completely, without taking anything from it, without wanting anything for myself except the joy of being in its presence occasionally. The sexually inhibiting qualities of Effexor and the other drugs I take have given me this great gift of sexual inclusiveness and equanimity, even generosity, along with the more obvious and less subtle curses that we more frequently read about.
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> If you've read this far, you're either a patient saint or your interest in this topic is as intense as mine.
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> Please share your experiences -- I want to know all the similarities and differences that we have.
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> With kind regards,
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> Mark H.Mark, I admire your honesty and candor! Am almost 50 and monogamous.I've been taking Effexor-XR for 5 months, with some impairment in ability to reach orgasm (through practicing solo; my s.o. is not available due to geographical distance). I've tried Prozac (complete shutdown), Luvox (total shutdown of desire, arousal, and ability to reach orgasm), Zoloft (desire still there but impossible to climax), and Serzone (no interference with sexual desire, arousal, or ability to reach orgasm, but no effect on OCD, although it did decrease my depression and my social anxiety and helped me to sleep better). When I say interfered with orgasm, I mean, even after four hours of trying, I couldn't reach orgasm! With Luvox and Prozac, lubrication was much less; with Zoloft, the lubrication was there, but the plateau just didn't progress to orgasm. Effexor-XR slows down the whole process (at higher doses but not lower doses, in my experience), but at least it's still possible to get there! I think it's time the drug companies admitted that SSRI's regularly affect people's sexual functioning adversely, and hopefully, the more candor people can use in explaining this to their pdoc's, the more people will start to take this problem seriously. Hope things get better (Effexor-XR 375 mg/day is the closest I've been able to get to an effective yet minimally-interfering medication for OCD and depression, after taking various meds including tricyclics for 20+ years). I have friends who've tried Viagra, but apparently the erection is there but no desire to do anything with it. Hopefully someone will come up with a real alternative medication which either doesn't impact sexual functioning or if it does, can be augmented with something that improves sexual functioning without removing the beneficial effects on depression and OCD. BTW, intensity of orgasm also varies on different meds (probably highly individual response here). On Effexor-XR, the intensity was MUCH greater than with Prozac, Luvox, and Zoloft (when I got there at all, on much lower doses of the medication) or Serzone. On Effexor-XR, I'm happy with one climax, while on other meds in the past I was never happy because the intensity was so much less and I just wanted another one. I don't know if this is a function of the medication or decreased depression or increased energy or what, but is pretty constant. Best wishes and thank you for your honest sharing with us!
poster:Cindy
thread:31188
URL: http://www.dr-bob.org/babble/20000420/msgs/31197.html