So here's the scoop...

S/O takes Topamax (dosage unknown), Lexapro (10 mg), and Coreg (dosage unknown) to prevent daily, extremely debilitating migraines. Coreg (carvedilol) is a "combined alpha and beta blocker (usually used to treat high blood pressure). He takes Imitrex (100 mg tablets or 25 mg injections) on a fairly regular basis (couple times a week). He also takes Ambien (5-10 mg) and Seroquel (dosage unknown) for insomnia.

As best I can tell, Lexapro is the most likely culprit of the anorgasmia. It's not listed as a side effect in the PI sheets of anything else he's taking except the Coreg and it's considered an extremely rare side effect. Having been on SSRIs myself, I know how likely it is that it's being caused by the Lexapro.

If he were taking it for depression, I'd suggest he talk to his doctor about adding or switching to Wellbutrin. But it sounds like he's on it to help even out or maintain serotonin levels or something along those lines (which makes some degree of sense). Libido doesn't seem to be a problem and there's definitely no erectile dysfunction.

When I was on Cymbalta, I found that occasionally skipping a single dose did the trick with relatively little harm. But the half-life of Cymbalta (12ish hours) is a good half of Lexapro's (24+ hours), so I don't know if this would make a difference.

Any thoughts, ideas, suggestions? Is this side effect likely to be present at a lower dose (5 mg)? I'm not sure if that's an option, but it can't hurt to ask. I don't know if a different SSRI is an option (my guess is that he's on Lexapro because it's the "purest" of the SSRIs), but is this side effect less common with any of the other ones?

If he can't change the med or the dosage, what else might help? He's next doctor's appointment (neurologist at a well-renowned migraine clinic in this area) is Wednesday. Any anecdotal information anyone can provide before then would be greatly appreciated!

~Sunshine

i took paxil for years and had the same problem.

after about 6 months, my ability to orgasm slowly came back. not to previous levels, but i could anyway.

my dad (thanks for sharing, i REALLY needed to know this dad!) said he'd skip a pill when he knew action was coming his way. he didn't get a lot of action, so it wasn't a big deal to miss one here and there.

what would be bad about adding WB? i'm not a pharm expert at all, so i don't know why this would be bad for his seratonin balance. WB never helped or harmed me in this catagory.

i ended up switching off of paxil and on to wb because of the sexual side effects. i don't know if that is an option for him. he should complain to his pdoc.

5mg isn't a lot of lex. doses of lex and paxil are about equal, and at one point i took 60mg paxil

maybe try prozac? it is the mildest ssri and people do benefit, many without the harsher side effects of some of the newer SSRI drugs.

I had the exact same problem with the big O when i was on Paxil. And, i've read posts of people complaining about Lexapro having the same side effect. I'm currently taking Zoloft and it doesn't seem to affect my O ability . Maybe he could try taking Zoloft instead?

Tom

I'm not sure why Lexapro as opposed to any of the other SSRIs other than it's the purest one (it's extremely selective). In any case... a skipped dose seems to have worked. Now we are just keeping our fingers crossed that it doesn't trigger a massive migraine tomorrow. He also sees the doctor tomorrow and is planning on discussing it with him. He hasn't brought it up before because it wasn't an issue as he wasn't seeing anyone and our relationship is still relatively new.

Urrrghh, no! Prozac shut down everything. I wasn't interested; if I was, I couldn't get it up; if could, I couldn't come. But I was so detached I didn't care.

The guy's on medication to lower his blood pressure. Unless there's a really good reason to do so, a doctor's not going to prescribe Wellbutrin, Cymbalta, stimulants, or most TCAs.

That's even before trying to figure out how liver enzyme inhibition will interact with blood pressure and migraine medications. Cytochrome P450 enzyme interactions are a reason to steer clear of a number of SSRIs (Luvox, Paxil, Zoloft, Prozac are the usual culprits, IIRC). They're also an issue with bupropion/Wellbutrin/Zyban.

BTW, it looks like Coreg is metabolized by CYP 2D6, which is strongly inhibited by bupropion, and by CYP 2C9 which is inhibited by Luvox and Zoloft. I found one article online that suggested that Prozac could be prescribed with Coreg, even though it does measurably reduce clearance of that medication.

The skipped dose of Lexapro didn't seem to have any day after effects, so that's a good sign. He saw his neuro today. His regular one is on maternity leave and he saw someone new. This could have been disastrous, but he really liked the guy. He likes his regular one, too, but said it was interesting to have someone take a fresh look at things. The doc agreed that Lexapro is the likely culprit. He has a couple of ideas for dealing w/the unwanted side effect, but is questioning why he's on the Lexapro at all. So he's going to try and go off it over the next few weeks and up the Topamax. Some other things, too (but not all at once) because in general his headaches have gotten progressively worse in the last six months or so.

He also takes morphine when things are really bad. I forgot to mention that in the first post. What I didn't know then was that he had taken some recently. But everyone is still leaning towards the Lexapro as the culprit.

One curious thing... the doctor said that taking Ritalin before engaging in sexual activity would alleviate the problem. Anyone ever heard of that?? I've been on Adderall for years and the times I've been on SSRIs or Cymbalta, it sure didn't seem to help!

Thanks for all the responses and ideas. It's much appreciated. I'm a "giver" in bed, so I think this is far more frustrating for me than it is him.

Update...

His doctor (neurologist) prescribed cryproheptadine... 4 mg PRN. He takes it about an hour before and I can attest to the fact that it works like a charm. His doctor said it is typically used to treat congestion in children. Weird. A quick Google search turned up the brand name Periactin. In addition to being an antihistamine, it's also an "antiserotonergic agent." He's noticed no obvious side effects... other than it cancels out the anorgasmia side effect from the Lexapro.

As I mentioned, he's on Lexapro for migraine prevention, so I don't know if this is an option for those of you on it for depression, but I did find one Pubmed article that indicated it (cryproheptadine) "may be useful in treating a subset of patients with major depression who have a suppressible dexamethasone suppression test" (whatever that means).