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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Alan on February 22, 2000, at 11:33:57
I've been on Celexa 10mg. for about 2-3 weeks now and the usual sexual problems that I've had from past experimentation with SSRI's are at it again (loss of drive, ejaculatory disturbance, even impotence). I feel better on this stuff but can't see living with these side effects. I'm being treated for major depression and pretty bad anxiety.
Any experience with what to suggest to my pdoc to override these problems? I'm not willing to go the way of Viagra or similar - not spontaneous enough way to live for me.
My doc sais to try Luvox or Remeron next if the Celexa side effects don't go away...do those have a lower incidence of sexual side effects anyone?
I'm not destined to take SSRI's I guess even though they give me the much needed energy that I lack. The Trycyclics didn't work for me either - or the mood stabilizers (Neurontin, Depakote, etc.)
Any suggestions would be greatly appriciated...I see my pdoc on Friday of this week and want to be forarmed and I hope that this supportive community will offer me some practical advice.
Many Thanks
Alan
Posted by Cindy W on February 22, 2000, at 21:51:09
In reply to Celexa and sexa !!!, posted by Alan on February 22, 2000, at 11:33:57
> I've been on Celexa 10mg. for about 2-3 weeks now and the usual sexual problems that I've had from past experimentation with SSRI's are at it again (loss of drive, ejaculatory disturbance, even impotence). I feel better on this stuff but can't see living with these side effects. I'm being treated for major depression and pretty bad anxiety.
>
> Any experience with what to suggest to my pdoc to override these problems? I'm not willing to go the way of Viagra or similar - not spontaneous enough way to live for me.
>
> My doc sais to try Luvox or Remeron next if the Celexa side effects don't go away...do those have a lower incidence of sexual side effects anyone?
>
> I'm not destined to take SSRI's I guess even though they give me the much needed energy that I lack. The Trycyclics didn't work for me either - or the mood stabilizers (Neurontin, Depakote, etc.)
>
> Any suggestions would be greatly appriciated...I see my pdoc on Friday of this week and want to be forarmed and I hope that this supportive community will offer me some practical advice.
>
> Many Thanks
>
> Alan
Alan, the same thing happened to me with SSRI's (analogously, since I'm a woman not a man). Tried Prozac, Serzone, Luvox, and Zoloft...all except Serzone killed my desire, ability to become aroused, and ability to reach orgasm (even after four hours of trying!!). Serzone didn't have that side effect but unfortunately didn't help with my OCD (although it was a great antidepressant). Am now taking Effexor-XR and find that it is effective without the sexual side effects. You might ask your pdoc about taking a non-SSRI such as Serzone or Effexor-XR, or adding something to counteract the sexual side effects. Dr. Michael Jenike has written an excellent article on dealing with sexual side effects, on the www.ocfoundation.org website. Good luck to you! If you find a workable combination, please share it with the rest of us (we've all been there).--Cindy W
Posted by JohnL on February 23, 2000, at 5:24:32
In reply to Celexa and sexa !!!, posted by Alan on February 22, 2000, at 11:33:57
Unfortunately there's no easy answer to the sexual side effects issue. Sometimes a drug from the same class won't give any problems. With me I had terrible problems on Paxil, Zoloft, Celexa, and Effexor, but experienced a surprising unexpected increase of sexual desire and ability on Prozac. The first week I thought, oh no here we go again. But then wow. Prozac gives the same sexual problems as the other SSRIs to many people, but we do sporadically hear of cases where sex is actually enhanced with Prozac. We hardly ever hear those same claims with the other SSRIs. Just based on that, I would be tempted in your shoes to try Prozac before Luvox.
If you like the results from Celexa (other than the sexual problems) then it makes sense to try other drugs in the same class. A 2 to 3 week trial of each will identify a best fit, if one exists. If after 2 or 3 weeks there are enduring sexual side effects on one, move quickly to another. Explore them all in short order to identify a favorite. Then once one is found, continue with longer time trials and possibly higher doses.
The most common approach is to either augment or substitute with Wellbutrin. Adding Wellbutrin to the Celexa would be a very common approach with most GPs. Sometimes other dopamine agents, like psychostimulants, can counter the sexual side effects as well. Buspar addition is sometimes helpful, but usually in women more than men.
In the natural arena there are things like Yohimbe, L-Arginine(amino acid precursor to nitrous oxide enabling erections and desire) and other formulas containing supposed aphrodisiac herbs like muira puama, damiana, tribulus, avena sativa, and more. I've tried them all and found L-Arginine and/or Yohimbe to be more useful than the others. Yohimbe is a powerful herb and has activating side effects too uncomfortable for some people. There are some theories that SSRIs inhibit NO synthesis, so the addition of L-Arginine counteracts that. And there are clinical studies indicating longterm use of Ginkgo Biloba as being effective in countering SSRI sexual side effects (ginkgo doses about 240mg/day).
Confusing, huh? So many choices, where to go from here? Based on my own experiences, I would start by trying short trials of all the SSRIs, then move on to addition of Wellbutrin, and then stimulants. Unfortunately we can discover the best fit only through trial and error. We all respond so differently.
Posted by michael on February 24, 2000, at 13:05:43
In reply to Re: Celexa and sexa !!!, posted by JohnL on February 23, 2000, at 5:24:32
> Unfortunately there's no easy answer to the sexual side effects issue. Sometimes a drug from the same class won't give any problems. With me I had terrible problems on Paxil, Zoloft, Celexa, and Effexor, but experienced a surprising unexpected increase of sexual desire and ability on Prozac. The first week I thought, oh no here we go again. But then wow. Prozac gives the same sexual problems as the other SSRIs to many people, but we do sporadically hear of cases where sex is actually enhanced with Prozac. We hardly ever hear those same claims with the other SSRIs. Just based on that, I would be tempted in your shoes to try Prozac before Luvox.
>
> If you like the results from Celexa (other than the sexual problems) then it makes sense to try other drugs in the same class. A 2 to 3 week trial of each will identify a best fit, if one exists. If after 2 or 3 weeks there are enduring sexual side effects on one, move quickly to another. Explore them all in short order to identify a favorite. Then once one is found, continue with longer time trials and possibly higher doses.
>
> The most common approach is to either augment or substitute with Wellbutrin. Adding Wellbutrin to the Celexa would be a very common approach with most GPs. Sometimes other dopamine agents, like psychostimulants, can counter the sexual side effects as well. Buspar addition is sometimes helpful, but usually in women more than men.
>
> In the natural arena there are things like Yohimbe, L-Arginine(amino acid precursor to nitrous oxide enabling erections and desire) and other formulas containing supposed aphrodisiac herbs like muira puama, damiana, tribulus, avena sativa, and more. I've tried them all and found L-Arginine and/or Yohimbe to be more useful than the others. Yohimbe is a powerful herb and has activating side effects too uncomfortable for some people. There are some theories that SSRIs inhibit NO synthesis, so the addition of L-Arginine counteracts that. And there are clinical studies indicating longterm use of Ginkgo Biloba as being effective in countering SSRI sexual side effects (ginkgo doses about 240mg/day).
>
> Confusing, huh? So many choices, where to go from here? Based on my own experiences, I would start by trying short trials of all the SSRIs, then move on to addition of Wellbutrin, and then stimulants. Unfortunately we can discover the best fit only through trial and error. We all respond so differently.A couple of other possibilities for augmenting:
Amantadine
Stimulants (ritalin/adderall)
Bromocriptine
Granisetron
Selegiline (5-10mg) - a selective MAOII'm pretty sure that I got these from Dr. Bob's Tips section. Use the search function there, and I think you'll find a little more background/contextual info on these. I'm going to have the same discussion w/my pdoc on tuesday. (btw, I'm taking effexor xr & wellbutrin) Good Luck.
michael
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