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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Melanie on September 15, 1999, at 12:53:09
My husband has been taking Effexor for several months with great success (much less anxiety and depression. However, he is now having trouble ejaculating, where that was never a problem before. I know that is a side effect of the medication, but has anybody else experienced this, and was anything helpful? Did it require coming off the meds completely? And if so, what did you try next? Thanks for the help.
Posted by Bob on September 15, 1999, at 15:03:27
In reply to Effexor and male ejaculatory difficulties, posted by Melanie on September 15, 1999, at 12:53:09
> My husband has been taking Effexor for several months with great success (much less anxiety and depression. However, he is now having trouble ejaculating, where that was never a problem before. I know that is a side effect of the medication, but has anybody else experienced this, and was anything helpful? Did it require coming off the meds completely? And if so, what did you try next? Thanks for the help.
Well, it sounds like the desire is there, so why not try Viagra? To get it covered by your insurance (otherwise, its about $10 a pill!), you will probably need prior approval with his pdoc talking to your prescription plan people to let them know this is a necessary medication to counteract the side-effects of another med. It takes about 45-60 minutes to kick in. From what you described, it sounds like that should take care of matters.
Then again, some other folks out there might have different takes on Viagra....
Cheers,
Bob
Posted by Melanie on September 15, 1999, at 18:37:14
In reply to Re: Effexor and male ejaculatory difficulties, posted by Bob on September 15, 1999, at 15:03:27
> Well, it sounds like the desire is there, so why not try Viagra? To get it covered by your insurance (otherwise, its about $10 a pill!), you will probably need prior approval with his pdoc talking to your prescription plan people to let them know this is a necessary medication to counteract the side-effects of another med. It takes about 45-60 minutes to kick in. From what you described, it sounds like that should take care of matters.
>
> Then again, some other folks out there might have different takes on Viagra....
>
> Cheers,
> BobThe problem is not achieving an erection, but being able to ejaculate. Desire is there, as is the ability to attain erection, but the time it takes to actually ejaculate has substantially increased (not necessarily pleasurable!) We have had to discontinue intercourse due to his inability to ejaculate. Although this may sound like a guy's dream come true, evetually all good things must come to an end!!! :-) Any thoughts?
Posted by Bob on September 15, 1999, at 20:55:59
In reply to Re: Effexor and male ejaculatory difficulties, posted by Melanie on September 15, 1999, at 18:37:14
> The problem is not achieving an erection, but being able to ejaculate. Desire is there, as is the ability to attain erection, but the time it takes to actually ejaculate has substantially increased (not necessarily pleasurable!) We have had to discontinue intercourse due to his inability to ejaculate. Although this may sound like a guy's dream come true, evetually all good things must come to an end!!! :-) Any thoughts?
Again, he might want to try Viagra. The physiological effect it has can also increase sensitivity, leading to a greater state of arousal. My pdoc actually had some free samples sent to him, and he passed a pack on to me. One pill and I was able to climax for the first time in two years. It's worth a shot -- if Pfizer is sending these out to pdocs to promote it (as if Viagra needs any promotion), maybe your husband should check with his and see.
Now, if they could only develop a pill to deal with my psychological hangups in the same sphere of human activity .... 8^P ;^)
Cheers,
Bob
Posted by Steve on September 15, 1999, at 21:47:20
In reply to Re: Effexor and male ejaculatory difficulties, posted by Bob on September 15, 1999, at 20:55:59
I take Effexor and have this problem as well. It pretty common with any antidepressant that increases seritonin levels. The only remedy that I know of is to take a "drug holiday"- that is, don't take the medication for a day or two... but even this is far from perfect.
Posted by Racer on September 16, 1999, at 1:54:50
In reply to Re: Effexor and male ejaculatory difficulties, posted by Steve on September 15, 1999, at 21:47:20
I take Effexor, and have the female version of this problem. I can get aroused (after the depression robbed me of that, you better believe it feels good to be climbing the walls again!), but it takes forever to achieve orgasm. The best help I've found is an anti-histamine called cyproheptidine, or Periactin. Not only can I scream with delight again, but everything leading up to it feels better than ever, too. I take one pill about two hours before I want my orgasm, and everything works perfectly.
Obviously, this is a woman's take, but the plumbing works the same even if it looks different. Homologous effects, after all...
Good luck!
Posted by dj on September 16, 1999, at 16:19:10
In reply to Re: Effexor and male ejaculatory difficulties, posted by Racer on September 16, 1999, at 1:54:50
I can hear you howling from Vancouver, Racer ; ) --- go grrrrrrlllllllllllll
>Not only can I scream with delight again, but everything leading up to it feels better than ever, too. I take one pill about two hours before I want my orgasm, and everything works perfectly.
Posted by Janice on September 16, 1999, at 22:05:26
In reply to Re: Effexor and male ejaculatory difficulties, posted by dj on September 16, 1999, at 16:19:10
Having wild sex somewhere?
dj did a post looking for you (in the latest achives). Many of us were worried about you, or at least wondering about you.
Welcome back! How have you been doing? I've missed your postings. Janice
Posted by Rick on September 19, 1999, at 14:38:03
In reply to Re: Effexor and male ejaculatory difficulties, posted by Steve on September 15, 1999, at 21:47:20
> I take Effexor and have this problem as well. It pretty common with any antidepressant that increases seritonin levels. The only remedy that I know of is to take a "drug holiday"- that is, don't take the medication for a day or two... but even this is far from perfect.
Hey, at least Effexor allows holidays. After I stopped using Nardil, the 100% lack of orgasm ability lasted for 3 1/2 weeks! Forget "holiday", I was beginning to wonder if I had been sentenced to permanent incarceration (sexually speaking) in Phenelzine Penitentiary!
Perhaps, in addition to dosage, the condition being treated (and thus brai chemistry) affects the amount of time until orgasm ability returns. I was using Nardil strictly for Social Phobia
Posted by jonathan on September 30, 1999, at 11:47:28
In reply to Effexor and male ejaculatory difficulties, posted by Melanie on September 15, 1999, at 12:53:09
As long as your husband is on an SSRI or "SSRI-like" drug, he will likely experience some degree of sexual dysfunction. Sexual dysfunction, by the way, is probably the most underreported side effect of anti-depressants. Most psychdocs don't ask about it, and most patients don't want to talk about it. The effects can be (1) lack of desire, (2) erectile difficulties, (3) delayed ejaculation/orgasm, and/or (4) anorgasmia (inability to achieve orgasm). Some psychdocs try various augmentation strategies with drugs such as bupropion, but this must be very cautiously approached. Viagra is indicated for erectile problems, so it likely would not help with your husbands inability to achieve orgasm. He might want to swith to another SSRI, something more specific such as Celexa may alleviate the problem.
Good luck to both of you.
Posted by Spike on May 7, 2001, at 13:26:31
In reply to Yes - sexual dysfunction take variety of forms, posted by jonathan on September 30, 1999, at 11:47:28
gosh...there are so many that have this ejaculatory problem. My partner and I try to have sex everyevening and it just upsets me that i cant have that final climax. Talk about being edgy...i thought effexor was saposed to releive my depression...and now it has created a new form of depression...i am going to talk with my doc about it and hopefully post my results very soon. Keep you posted! Very frustrated!
Posted by SalArmy4me on May 7, 2001, at 13:46:45
In reply to Re: Yes - sexual dysfunction take variety of forms, posted by Spike on May 7, 2001, at 13:26:31
There is talk about using mirtazapine for sexual dysfunction
http://www.dr-bob.org/tips/split/Mirtazapine-for-SSRI-ADRs.htmlFrom: M. Kirsten Miller, M.D., M.P.H. < [email protected] >
Date: Sun, 5 Apr 1998 23:20:01 EDT
Subject: Mirtazapine to counteract side-effects of SSRIsI have found Paxil (paroxetine) and Wellbutrin (bupropion) to be very helpful in combination with Remeron (mirtazapine). I've used Remeron fairly often:
for Wellbutrin induced "activation"
for SSRI induced sexual dysfunction -- with or without Wellbutrin.
Posted by Pharma on May 12, 2001, at 6:08:20
In reply to Re: Yes - sexual dysfunction take variety of forms, posted by Spike on May 7, 2001, at 13:26:31
> gosh...there are so many that have this ejaculatory problem. My partner and I try to have sex everyevening and it just upsets me that i cant have that final climax. Talk about being edgy...i thought effexor was saposed to releive my depression...and now it has created a new form of depression...i am going to talk with my doc about it and hopefully post my results very soon. Keep you posted! Very frustrated!
The difficulting of ejaculating when taking Efexor is pretty strong. However while I was taking it, I thought it was quite a desirable effect and that it was one of the few desirable effects of the drug. Aurorix is a good drug for patients that list seual dysfunction as a major effect of depression.
Posted by SLS on May 12, 2001, at 11:02:29
In reply to Re: Yes - sexual dysfunction take variety of forms, posted by Pharma on May 12, 2001, at 6:08:20
I forget where I stole this from.
The dosages and reported beneficial effects might not match well with the real-life experiences of Psycho-Babble participants, but it makes for a pretty good basic list.
******************************************************
- Interventions for Sexual Side Effects -There are several ways to manage sexual side effects attributed to antidepressants. The choice of management needs to be tailored to the individual patient and may change throughout the course of treatment. General management strategies include waiting for the side effect to diminish over time if it is mild and/or intermittent; reducing the dose of the antidepressant to a minimal effective dose; using pharmacologic antidotes; or switching to another antidepressant that is not associated with sexual dysfunction.
Pharmacologic antidotes can be a useful strategy to manage sexual side effects during antidepressant treatment. The following are pharmacologic antidotes for antidepressant associated sexual dysfunction (Table 4): stimulants, Ginkgo biloba, cholinergic enhancers, estrogen creams or lubricants, and amantadine. There has been a lack of controlled trials regarding the true efficacy and safety of these strategies. Most of the literature is based on case reports or noncontrolled trials. The choice of antidote for a particular patient should take into account several factors, including:
- The overall efficacy of the primary antidepressant
- Potential medication interactions
- Potential additive side effects
- Potential antidepressant-enhancing effects
- Potential effects on managing any other side effects
- Cost
- Overall adherence to taking additional medication.
- Daily standing doses are recommended for most of the antidotes because little is known about how long it takes for them to become effective.* One exception is sildenafil, which can be prescribed on an as-needed basis, similar to prescribing instructions for male erectile disorder.
------------------------------------------------------Table 4. Pharmacologic Antidotes for Antidepressant-Associated Sexual Dysfunction
5-HT3 = serotonin-3
MAOI = monoamine oxidase inhibitor
SSRI = selective serotonin reuptake inhibitor
TCA = tricyclic antidepressant* Reported Effects: The sexual phases that the antidote is reportedly effective in treatment out of 3 possible phases that may be affected by the antidepressant.
† non-FDA-approved use.
---------------------------------Format:
Antidote
- Dosage
- Comments
- Reported Beneficial Effects *---------------------------------
Methylphenidate †
- 5-40 mg/d
- For SSRIs or venlafaxine
- Libido, arousal, orgasmDextroamphetamine †
- 5-40 mg/d
- Avoid night dosing (insomnia)
- Libido, arousal, orgasmPemoline †
- 18.75-75 mg/d
- Check liver function
- Libido, arousal, orgasmGinkgo biloba extract †
- 180-240 mg/d, tid, divided doses
- Potential increased clotting time, possible flatulence
- Libido, arousal, orgasmBethanechol †
- 10-50 mg prn 1 hour before sex
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalNeostigmine †
- 200 mg/d, tid divided doses
- Used for anticholinergic side effects (TCAs, paroxetine); produces cholinergic side effects
- ArousalEstrogen creams or lubricants
- As needed
- For vaginal dryness, atrophy of vaginal tissue
- ArousalAmantadine
- 100 mg bid
- Caution in patients predisposed to psychosis
- OrgasmCyproheptadine
- 4-12 mg qhs
- MAOIs, TCAs, SSRIs, venlafaxine; watch for reemergence of depressive symptoms; sedating
- OrgasmBuspirone †
- 30-60 mg/d, bid divided doses
-
- Libido, orgasmBupropion †
- 75-150 mg/d, qd or bid divided doses
- For SSRIs or venlafaxine, fluoxetine may raise bupropion levels; usual precautionary measures for bupropion
- Libido, arousal, orgasmMirtazapine †
- 15-45 mg/d
- For SSRIs, venlafaxine
- OrgasmNefazodone †
- Start 50 mg/d, up to 150 mg/d
- SSRIs, venlafaxine
- OrgasmGranisetron †
- 1 mg prn
- ? Use of other 5-HT3 antagonists
- OrgasmSildenafil
- 50-100 mg/d
- Contraindicated with nitrates
- Libido, arousal, orgasmYohimbine †
- 5.4 mg tid
- Can be anxiogenic; ? safety with MAOIs
- Libido, arousal, orgasm
5-HT3 = serotonin-3
MAOI = monoamine oxidase inhibitor
SSRI = selective serotonin reuptake inhibitor
TCA = tricyclic antidepressant* The sexual phases that the antidote is reportedly effective in treatment out of 3 possible phases that may be affected by the antidepressant.
† non-FDA-approved use.
Posted by David on January 7, 2002, at 12:19:48
In reply to Re: Effexor and male ejaculatory difficulties, posted by Melanie on September 15, 1999, at 18:37:14
I had an almost complete inability to ejaculate while on Effexor. The drug really works well for me, so I tried everything to solve the problem.
Finally my doctor decided to take what he termed a "shot in the dark". He INCREASED my dose to the level where he said dopamines are affected, (from 150mg to 225mg).
After giving it about a month it worked! I have no clue why, but now I'm pretty much normal again.
I suppose it's possible that it's just been long enough for my system to adjust to Effexor all around, (I've been on it about 3 or 4 months), and that increasing my dose was only a coincidence, but it's worth asking your doctor about.
I'm also convinced it's not some placebo effect. Just before trying this, I tried Viagra, (even though I had no E.D.). I'm sure that if I had a sike thing going and would respond to a placebo the Viagra would have done it.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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