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so, i have treatment-refractory variants of both panic disorder and generalized anxiety disorder and they necessitate hefty dosages of CNS depressants (900mg/day of Lyrica, 3mg/day of Klonopin, and 60mg/day of Cymbalta). This causes for sexual dysfunction and thus relationship problems when dating other guys. My doctor has been kind enough to prescribe me 10mg of Dexedrine to be taken on an as-needed basis to eroticize sexual experiences and to trigger orgasm, although I don't like taking it very often because it 1. makes me anxious and anxiety/panic is my main problem and 2. it makes my hair shed pretty severely and i'm vain haha. 

anyhow, i want to know how other gay guys who are taking psychotropics for whatever mental illnesses you are all experiencing deal with sexual side effects in the dating world. i definitely don't want to end up an old maid. 

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Only date when you are as stable as you get. Don't make your conditions a point of discussion on the first date and if it is not going to be a serious relationship perhaps never mention it.  

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1 minute ago, notloki said:

Only date when you are as stable as you get. Don't make your conditions a point of discussion on the first date and if it is not going to be a serious relationship perhaps never mention it.  

i agree with stability being imperative, however, when using online dating services, i feel like it's almost necessary to place in my profile somewhere that i have problems with anxiety that are inherent to my being and that i take medication that impairs sexual functioning to some extent. it's like, get it out there and weed through those who won't put up with it at all. obviously i'm conflicted, though, on whether i should include this information, but since gay male culture is so sexualized, i feel like i need to be very forthcoming in order to find someone who will be patient and understanding with regard to both my anxious nature and problems with sexual functioning. 

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You can tell people you have ED without telling why. ED is well known so people know about it. Have you tried any of the ED drugs ?

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30 minutes ago, notloki said:

You can tell people you have ED without telling why. ED is well known so people know about it. Have you tried any of the ED drugs ?

i don't have a problem with ED, rather, I have problems with low libido and anorgasmia/delayed ejaculation. i've had medication-induced ED in the past, however, and the PDE5 inhibitors work. 

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Posted (edited)
9 hours ago, basuraeuropea said:

i don't have a problem with ED, rather, I have problems with low libido and anorgasmia/delayed ejaculation. i've had medication-induced ED in the past, however, and the PDE5 inhibitors work. 

Do you think it would be worth retrying a PDE5 just to see if it’s helpful? Unfortunately my only med ideas could worsten anxiety which I assume is a no go 

*funny enough I wrote a term paper about this for one of my psych classes, which is why I mention other ideas... but unfortunately the answer was often that there isn’t a good answer, from the pharmacological standpoint 

Edited by Iceberg

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Posted (edited)
7 hours ago, Iceberg said:

Do you think it would be worth retrying a PDE5 just to see if it’s helpful? Unfortunately my only med ideas could worsten anxiety which I assume is a no go 

*funny enough I wrote a term paper about this for one of my psych classes, which is why I mention other ideas... but unfortunately the answer was often that there isn’t a good answer, from the pharmacological standpoint 

i have retried the pde5 inhibitors and while they provide for an erection, they definitely don't help with anorgasmia or low libido. my doctor has, though, prescribed a low-dose (5-10mg) of dexedrine as it possesses fewer peripheral side effects than adderall and thus is less likely to induce a state of panic to combat anorgasmia, and it works! i just have a problem taking the drug because it does increase anxiety despite it not triggering a panic attack and that's not very sexy. it also makes my hair shed. ugh. i might have to suck it up and take the drug, though, in order to date. 

 

drug holidays definitely do not work for me in that they make me feel like i'm going through withdrawal. they're super unpleasant and i'd rather just take dexedrine and have the transient anxiety over with in a few hours. on a side note, if i haven't had an orgasm in quite a few days, i can usually orgasm naturally, although it takes a lot of determination. 

did you have any additional ideas? wellbutrin doesn't work for me mainly because it's a panic attack in a pill as are methylphenidate and adderall. the best solution i've found thus far is dexedrine. i've also tried the dopamine agonists which just made me throw up. 

sorry if this is all too informative, but it's something that affects me greatly. 

Edited by basuraeuropea

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4 hours ago, basuraeuropea said:

i have retried the pde5 inhibitors and while they provide for an erection, they definitely don't help with anorgasmia or low libido. my doctor has, though, prescribed a low-dose (5-10mg) of dexedrine as it possesses fewer peripheral side effects than adderall and thus is less likely to induce a state of panic to combat anorgasmia, and it works! i just have a problem taking the drug because it does increase anxiety despite it not triggering a panic attack and that's not very sexy. it also makes my hair shed. ugh. i might have to suck it up and take the drug, though, in order to date. 

 

drug holidays definitely do not work for me in that they make me feel like i'm going through withdrawal. they're super unpleasant and i'd rather just take dexedrine and have the transient anxiety over with in a few hours. on a side note, if i haven't had an orgasm in quite a few days, i can usually orgasm naturally, although it takes a lot of determination. 

did you have any additional ideas? wellbutrin doesn't work for me mainly because it's a panic attack in a pill as are methylphenidate and adderall. the best solution i've found thus far is dexedrine. i've also tried the dopamine agonists which just made me throw up. 

sorry if this is all too informative, but it's something that affects me greatly. 

What dopamine agonist did you try and, if you remember, at what dose? The lower doses if taken only at bedtime (like 0.125 mg pramipexole or 0.25 mg or something) might have less chance of nausea, and could possibly even better if you take the extended release versions. If you take bromocriptine, you probably don't need even the full starting dosage for hyperprolactinemia (2.5 mg I think?). Same with cabergoline, you could probably get away with splitting the lowest dose and just taking it once a week.

Another dopaminergic medication that may or may not be of benefit to you is amantadine. It's an antiviral for flu, but it doesn't work for that anymore as all strains of flu are resistant to it. It is used now mostly for Parkinson's disease adjunct therapy, but also for other reasons like preventing weight gain of antipsychotics, depression, fatigue associated with either MS, FM. or CFS (can't remember which), and erectile dysfunction/anorgasmia associated with psychotropic medications.

Modafinil or armodafinil are other drugs that may benefit you. They are considered eugeroics or "wakefulness promoting agents," but still have somewhat of a psychostimulant property (not as strong as the methylphenidates and amphetamines though). You will have to jump through lots of hoops with your insurance to get it, especially if for an off-label indications. You will have many, many PA's to worry about getting approved with that medicine, and the possibility of being turned down. It's complete BS...

Two more meds that may help are trazodone and nefazodone. You've likely heard of trazodone, a hypnotic antidepressant with anti-anxiety properties, but nefazodone isn't used as often anymore because of chance to cause liver failure that requires you to get a liver transplant in most cases; however, the chances of that happening probably aren't near as high as they play it up to be. Cymbalta has the same issue, but probably not as bad as nefazodone. Anyway, they antagonize 5-HT2A receptors and are partial agonists of 5-HT1A receptors, which causes dopamine release downstream (5-HT1A postsynaptic stimulation does anyway).

Another could be buspirone, an anti-anxiety agent that hardly ever works for many people lol. But its off-label use for ED/anorgasmia helps many people without too many side effects. For me it made me manic AF, but I was also on a supratherapeutic dose of 90 mg... But even at 5 mg it makes me rage and throw things... lol.

Two last meds I have on the top of my mind is cyproheptadine, an antihistamine that is commonly used as an appetite stimulant, and mirtazapine, an antidepressant for with the mechanism of action differs from almost any other antidepressant on the market in the US. (It's related to mianserin, which is available in other countries.) It is a very potent antihistamine as well, but also has 5-HT2A/5-HT2C antagonism (increases dopamine and norepinephrine release), as well as α2A presynaptic autoreceptor antagonism, which also disinhibits serotonin and norepinephrine release. Low doses (7.5-15 mg) are sedating and cause more appetite increase, whereas higher (30-45 mg) doses tend to be more activating, but still have a bit of appetite stimulation.

The PDE5 inhibitors for me help me a lot with obtaining and maintaining an erection, but like you experienced, don't help me with anorgasmia.

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38 minutes ago, mikl_pls said:

What dopamine agonist did you try and, if you remember, at what dose? The lower doses if taken only at bedtime (like 0.125 mg pramipexole or 0.25 mg or something) might have less chance of nausea, and could possibly even better if you take the extended release versions. If you take bromocriptine, you probably don't need even the full starting dosage for hyperprolactinemia (2.5 mg I think?). Same with cabergoline, you could probably get away with splitting the lowest dose and just taking it once a week.

Another dopaminergic medication that may or may not be of benefit to you is amantadine. It's an antiviral for flu, but it doesn't work for that anymore as all strains of flu are resistant to it. It is used now mostly for Parkinson's disease adjunct therapy, but also for other reasons like preventing weight gain of antipsychotics, depression, fatigue associated with either MS, FM. or CFS (can't remember which), and erectile dysfunction/anorgasmia associated with psychotropic medications.

Modafinil or armodafinil are other drugs that may benefit you. They are considered eugeroics or "wakefulness promoting agents," but still have somewhat of a psychostimulant property (not as strong as the methylphenidates and amphetamines though). You will have to jump through lots of hoops with your insurance to get it, especially if for an off-label indications. You will have many, many PA's to worry about getting approved with that medicine, and the possibility of being turned down. It's complete BS...

Two more meds that may help are trazodone and nefazodone. You've likely heard of trazodone, a hypnotic antidepressant with anti-anxiety properties, but nefazodone isn't used as often anymore because of chance to cause liver failure that requires you to get a liver transplant in most cases; however, the chances of that happening probably aren't near as high as they play it up to be. Cymbalta has the same issue, but probably not as bad as nefazodone. Anyway, they antagonize 5-HT2A receptors and are partial agonists of 5-HT1A receptors, which causes dopamine release downstream (5-HT1A postsynaptic stimulation does anyway).

Another could be buspirone, an anti-anxiety agent that hardly ever works for many people lol. But its off-label use for ED/anorgasmia helps many people without too many side effects. For me it made me manic AF, but I was also on a supratherapeutic dose of 90 mg... But even at 5 mg it makes me rage and throw things... lol.

Two last meds I have on the top of my mind is cyproheptadine, an antihistamine that is commonly used as an appetite stimulant, and mirtazapine, an antidepressant for with the mechanism of action differs from almost any other antidepressant on the market in the US. (It's related to mianserin, which is available in other countries.) It is a very potent antihistamine as well, but also has 5-HT2A/5-HT2C antagonism (increases dopamine and norepinephrine release), as well as α2A presynaptic autoreceptor antagonism, which also disinhibits serotonin and norepinephrine release. Low doses (7.5-15 mg) are sedating and cause more appetite increase, whereas higher (30-45 mg) doses tend to be more activating, but still have a bit of appetite stimulation.

The PDE5 inhibitors for me help me a lot with obtaining and maintaining an erection, but like you experienced, don't help me with anorgasmia.

 hi there!

thank you so much for taking the time to write out suggestions for me! i really appreciate it! 

so, with regard to what you've written, i have taken a number of the antidotes that you have suggested. as for the antiserotonergic agents, they don't help at all because the cause of my sexual dysfunction lies with the use of lyrica which has a complicated mechanism of action that decreases the amount of excitatory neurotransmitters released, notably norepinephrine and glutamate. so, mirtazapine, trazodone, nefazodone, cyproheptadine, mianserin, and buspirone have all been trialed without success. oddly enough, while not commonly associated with sexual dysfunction, mirtazapine, mianserin, nefazodone, and trazodone all caused for anorgasmia, so there is something about some serotonin receptor's antagonism that doesn't agree with me sexually. i actually find the snris/ssris to be more sex-friendly at modest dosages. 

i have also tried ropinirole and pramipexole, which, again, only made me very nauseated or throw up. i took the medication at night but i couldn't tolerate them. i didn't stay on them for very long for obvious reasons. i don't remember the dosages that were prescribed to me. i have also trialed amantadine, although that medication did absolutely nothing for me at the highest recommended dosage by the fda. with regard to the dopamine agonists, though, i am a bit worried about damage to my dopaminergic system should these drugs be taken on a daily basis and i don't think it's advised/effective to take them prn for the treatment of medication-induced sexual dysfunction. 

what i haven't taken are modafinil and armodafinil. i'm not sure they'd work, but they're worth a shot if my doctor is willing to allow me to trial them and my insurance covers them for an off-label indication. 

that leaves the psychostimulants, which do work, and dextroamphetamine works with the fewest side effects. also noteworthy is my ability to cum naturally if i haven't orgasmed in a while. i'm not sure why this is. 

i am pretty stable on the combination of medications that i'm on right now and have toyed around with said cocktail for years without success in finding a compromise between sexual functioning and anxiolysis. that said, i definitely need to remain stable and work around the sexual side effects with an antidote, e.g., dextroamphetamine, so as not to jeopardize my stability. 

what works for you with regard to the amelioration of anorgasmia? do you experience anorgasmia still? you're on stimulants which may (or may not) counteract the effects of the antidepressant/antipsychotics you're taking. 

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25 minutes ago, basuraeuropea said:

 hi there!

thank you so much for taking the time to write out suggestions for me! i really appreciate it! 

so, with regard to what you've written, i have taken a number of the antidotes that you have suggested. as for the antiserotonergic agents, they don't help at all because the cause of my sexual dysfunction lies with the use of lyrica which has a complicated mechanism of action that decreases the amount of excitatory neurotransmitters released, notably norepinephrine and glutamate. so, mirtazapine, trazodone, nefazodone, cyproheptadine, mianserin, and buspirone have all been trialed without success. oddly enough, while not commonly associated with sexual dysfunction, mirtazapine, mianserin, nefazodone, and trazodone all caused for anorgasmia, so there is something about some serotonin receptor's antagonism that doesn't agree with me sexually. i actually find the snris/ssris to be more sex-friendly at modest dosages. 

i have also tried ropinirole and pramipexole, which, again, only made me very nauseated or throw up. i took the medication at night but i couldn't tolerate them. i didn't stay on them for very long for obvious reasons. i don't remember the dosages that were prescribed to me. i have also trialed amantadine, although that medication did absolutely nothing for me at the highest recommended dosage by the fda. with regard to the dopamine agonists, though, i am a bit worried about damage to my dopaminergic system should these drugs be taken on a daily basis and i don't think it's advised/effective to take them prn for the treatment of medication-induced sexual dysfunction. 

what i haven't taken are modafinil and armodafinil. i'm not sure they'd work, but they're worth a shot if my doctor is willing to allow me to trial them and my insurance covers them for an off-label indication. 

that leaves the psychostimulants, which do work, and dextroamphetamine works with the fewest side effects. also noteworthy is my ability to cum naturally if i haven't orgasmed in a while. i'm not sure why this is. 

i am pretty stable on the combination of medications that i'm on right now and have toyed around with said cocktail for years without success in finding a compromise between sexual functioning and anxiolysis. that said, i definitely need to remain stable and work around the sexual side effects with an antidote, e.g., dextroamphetamine, so as not to jeopardize my stability. 

what works for you with regard to the amelioration of anorgasmia? do you experience anorgasmia still? you're on stimulants which may (or may not) counteract the effects of the antidepressant/antipsychotics you're taking. 

Have you tried any of the methylphenidate stims? You said dextroamphetamine has the least side effects, but I didn’t know if that meant you’ve trialed many other stims or if your just happy with dextroamphetamine and don’t want to risk a change. I just ask because the methylphenidates can have different side effect profiles for different. People and maybe you could get around the hair loss thing.  But I’m not sure whether the methylphenadtes would help as much with the sexual function 

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Just now, Iceberg said:

Have you tried any of the methylphenidate stims? You said dextroamphetamine has the least side effects, but I didn’t know if that meant you’ve trialed many other stims or if your just happy with dextroamphetamine and don’t want to risk a change. I just ask because the methylphenidates can have different side effect profiles for different. People and maybe you could get around the hair loss thing.  But I’m not sure whether the methylphenadtes would help as much with the sexual function 

yep, but thanks for asking. methylphenidate and its derivatives are panic attacks in pill form! at least dextroamphetamine doesn't make me panic even if it does increase my basal level of anxiety temporarily. 

 

i'm definitely open to trying new things to aid in the moderate sexual dysfunction. what i'm not willing to do is change the core cocktail (listed in my signature) that's treating my anxiety disorders. i've worked so hard to maintain a level of normalcy that for me isn't easily attainable and i need to stay on these medications in order to be a productive member of society. 

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2 hours ago, basuraeuropea said:

so, with regard to what you've written, i have taken a number of the antidotes that you have suggested. as for the antiserotonergic agents, they don't help at all because the cause of my sexual dysfunction lies with the use of lyrica which has a complicated mechanism of action that decreases the amount of excitatory neurotransmitters released, notably norepinephrine and glutamate. so, mirtazapine, trazodone, nefazodone, cyproheptadine, mianserin, and buspirone have all been trialed without success. oddly enough, while not commonly associated with sexual dysfunction, mirtazapine, mianserin, nefazodone, and trazodone all caused for anorgasmia, so there is something about some serotonin receptor's antagonism that doesn't agree with me sexually. i actually find the snris/ssris to be more sex-friendly at modest dosages.

If you increase dopaminergic tone, whichever way you do it, it should increase dopamine. It won't be anywhere as near a dopamine boost as from dextroamphetamine, but it'll still do boost dopamine levels, which theoretically should help. I've never experienced sexual dysfunction from Lyrica as I've never tried it, but I have taken gabapentin (up to 1200 mg I think) and didn't get ED, but that's a fraction of the max dose of 3600 mg... lol. I'm not sure what the interactions between the glutamate and dopamine, but one thing I remember reading is that AMPAkines (nootropics and such) increase dopamine by means of stimulating AMPA glutamatergic receptors, and AMPA antagonists like topiramate decrease dopamine release.

3 hours ago, basuraeuropea said:

i have also tried ropinirole and pramipexole, which, again, only made me very nauseated or throw up. i took the medication at night but i couldn't tolerate them. i didn't stay on them for very long for obvious reasons. i don't remember the dosages that were prescribed to me. i have also trialed amantadine, although that medication did absolutely nothing for me at the highest recommended dosage by the fda. with regard to the dopamine agonists, though, i am a bit worried about damage to my dopaminergic system should these drugs be taken on a daily basis and i don't think it's advised/effective to take them prn for the treatment of medication-induced sexual dysfunction. 

Dopamine agonists and methylphenidate (and other dopamine reuptake inhibitors) I believe aren't really med of concern in regards to deleterious changes to your dopaminergic neurons. Dopamine releasing agents like amphetamines are a little harsher on your dopaminergic physiology, but not necessarily so if taken in therapeutic dosages. Methamphetamine (Desoxyn) however is neurotoxic to serotonin neurons, supposedly even at therapeutic doses (5-25 mg). Methylphenidate can actually protect against methamphetamine-induced neurotoxicity to dopamine neurons, especially in the nucleus accumbens and the substantia nigra, I believe.

If you were willing to give low, low dose dopamine agonists a try again, maybe you could take it with something like ondansetron or promethazine or something like that to keep you from getting sick from them. They can actually be pretty calming in a way (at least in low doses), probably by means of agonizing presynaptic dopamine receptors, inhibiting dopamine release (yet it's also stimulating postsynaptic receptors yielding "dopaminergic effects"). There's a newer dopamine agonist, Neupro (rotigotine transdermal system) that may be easier on you. In addition to being a dopamine agonist, it's also a 5-HT1A partial agonist and α2B antagonist.

3 hours ago, basuraeuropea said:

what i haven't taken are modafinil and armodafinil. i'm not sure they'd work, but they're worth a shot if my doctor is willing to allow me to trial them and my insurance covers them for an off-label indication.

They are somewhat dopaminergic but I think they increase histamine release in the body which is mostly what produces the wakefulness-promoting effect. I think they are also D2 dopamine agonists, but not super strong ones.

3 hours ago, basuraeuropea said:

that leaves the psychostimulants, which do work, and dextroamphetamine works with the fewest side effects. also noteworthy is my ability to cum naturally if i haven't orgasmed in a while. i'm not sure why this is.

Right when I started Adderall several years ago, it super enhanced my libido, orgasms, etc. for some reason, I guess because of having enough dopamine in my brain for the first time ever. The effect disappeared after several months.

3 hours ago, basuraeuropea said:

i am pretty stable on the combination of medications that i'm on right now and have toyed around with said cocktail for years without success in finding a compromise between sexual functioning and anxiolysis. that said, i definitely need to remain stable and work around the sexual side effects with an antidote, e.g., dextroamphetamine, so as not to jeopardize my stability.

Do you think you could get by with 30 mg or 40 mg duloxetine? Have you ever tried that dose for a while? In my experience, 60 mg didn't give me any problems either, but everyone's different. 120 mg didn't give me problems the first time, but the second time I tried it at 120 mg, it was like Effexor for me, in that I could NOT get off to save my life for like a month at a time.

3 hours ago, basuraeuropea said:

what works for you with regard to the amelioration of anorgasmia? do you experience anorgasmia still? you're on stimulants which may (or may not) counteract the effects of the antidepressant/antipsychotics you're taking. 

Unfortunately, I haven't found anything that helps my anorgasmia. I usually have to just try a lower dose of whatever serotonergic agent I'm on at the time and see if I can get by with just that. The stimulants I imagine still help to some degree, but nowhere near as much as they used to. I recently switched to Viibryd (for like the 4th time) and it doesn't seem to cause anorgasmia as bad as other antidepressants. I was on a combination of desipramine and sertraline for the longest time and didn't have any problems with anorgasmia on that combo.

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thanks again for the detailed response! i am sorry that you have to put up with anorgasmia without a remedy in sight. i think that what keeps dextroamphetamine working for me is that i take it so sparingly. if i let a few days pass between orgasms, i can still climax naturally without the aid of anything, although this is variable and usually takes A LOT of effort and time. that said, i very recently increased clonazepam from 2mg/day to 3mg/day, so we'll see how that affects me sexually. in the past clonazepam hasn't been too terribly harsh in terms of its effects upon sexual functioning, although it and pregabalin are highly synergistic which is good therapeutically speaking, but perhaps not so much so sexually speaking. anyhow, dextroamphetamine both eroticizes the experience, makes the orgasm more intense and facilitates orgasm. i don't think that i'd suffer any deleterious consequences from taking dextroamphetamine on an as-needed basis because i'm prescribed such a small amount, and i don't take the medication everyday. in fact, i usually go a few days and then go about it all naturally by putting the time and effort into achieving an orgasm. haha. i know i might feel pressured in bed, though, to perform more quickly. that, and i have a limited window during the day when i'm able to achieve orgasm which is corresponds to when the levels of medication are at their lowest in my system before having to re-dose. 

i will look into dopamine agonists once again, but don't you think that they have the potential to cause disruptions in phasic vs tonic firing of the dopaminergic system potentially leading to anhedonia? i've read some online horror stories regarding dopamine-agonist-induced anhedonia and dysphoria. i really don't want to go down that path as i quite enjoy life at the moment as my career is stable, i'm psychiatrically stable, and my interpersonal relationships, save for dating, are fulfilling. i need to go out and meet some boys, though, for sure as going about it alone can be a lonely experience!

yes, modafinil and armodafinil are slightly dopaminergic, although not terribly so, but they may help nonetheless just by way of increased arousal. i'll talk to my doctor about them during my next appointment. 

i absolutely cannot get by on a lower dosage of duloxetine. i've tried and my life is miserable. that said, duloxetine isn't causing the problem. re: pregabalin, glutamate, norepinephrine and ejaculatory latency, i think that because excitatory neurotransmission is decreased significantly, i am just too calm to orgasm quickly (or everyday). i mean, this is just a postulation, but oftentimes i do feel fatigued/sleepy due to the combination of medications i'm on, but the dosages are necessary because it's imperative that i am adequately relaxed as one of the main symptoms of both panic disorder and generalized anxiety disorder as they present in me is muscle tension which leads to dry heaving and vomiting, in turn leading to me falling malnourished and dehydrated. basically, the combination that i'm on is the minimum necessary to keep me psychiatrically and physically healthy. 

 

do you take short drug holidays from viibryd in order to have sex with your boyfriend? what happened to desipramine and zoloft? loss of efficacy?

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Posted (edited)

as an aside, you are on a lot of medication. do you deem them all medically necessary or do you think you can cut down on your intake with the help of your physician? after reading some of your blog entries, this may be a way to improve both your physical, psychological, and sexual health. 

i am on the absolute minimum amount of medication to keep me healthy and productive and while said amount doesn't come without its side effects, i've learned the hard way that stability is imperative. i've recently (within the past year) been treated at UCSD to streamline my medications and to maximize response which has resulted in psychiatric, psychological, physical, and quasi-sexual wellbeing. i'm also at a healthy weight again (after being underweight for many years) currently at 5"8" 140lbs and weight-stable. 

Edited by basuraeuropea

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19 hours ago, basuraeuropea said:

thanks again for the detailed response! i am sorry that you have to put up with anorgasmia without a remedy in sight. i think that what keeps dextroamphetamine working for me is that i take it so sparingly. if i let a few days pass between orgasms, i can still climax naturally without the aid of anything, although this is variable and usually takes A LOT of effort and time. that said, i very recently increased clonazepam from 2mg/day to 3mg/day, so we'll see how that affects me sexually. in the past clonazepam hasn't been too terribly harsh in terms of its effects upon sexual functioning, although it and pregabalin are highly synergistic which is good therapeutically speaking, but perhaps not so much so sexually speaking. anyhow, dextroamphetamine both eroticizes the experience, makes the orgasm more intense and facilitates orgasm. i don't think that i'd suffer any deleterious consequences from taking dextroamphetamine on an as-needed basis because i'm prescribed such a small amount, and i don't take the medication everyday. in fact, i usually go a few days and then go about it all naturally by putting the time and effort into achieving an orgasm. haha. i know i might feel pressured in bed, though, to perform more quickly. that, and i have a limited window during the day when i'm able to achieve orgasm which is corresponds to when the levels of medication are at their lowest in my system before having to re-dose.

It's kinda a thing that has become worse over time as I've gotten older. I'm now 31 fixing to be 32 and it seems like that part of my body is just trying to shut down or something. My testosterone last time it was checked was actually on the verge of being high for some reason (as in the past it had normally been low normal, like 200-300's).

I wish dextroamphetamine did that for me lol. I'm sure it's helping somewhat, but I guess I've been taking amphetamines for so long that my body is just used to it. As far as in bed, I've heard the saying it's more about the journey than the destination. Sometimes neither my boyfriend nor I can climax, but we still have fun. (He takes Zoloft and that messes with his ability to achieve orgasm too.)

19 hours ago, basuraeuropea said:

i will look into dopamine agonists once again, but don't you think that they have the potential to cause disruptions in phasic vs tonic firing of the dopaminergic system potentially leading to anhedonia? i've read some online horror stories regarding dopamine-agonist-induced anhedonia and dysphoria. i really don't want to go down that path as i quite enjoy life at the moment as my career is stable, i'm psychiatrically stable, and my interpersonal relationships, save for dating, are fulfilling. i need to go out and meet some boys, though, for sure as going about it alone can be a lonely experience!

It's possible, though I haven't read anything about that anywhere (not that I've looked though). That's really interesting, I've never heard about that. I have heard of DAWS which is an absolute nightmare (I went through it with Abilify). Yes, I hear you on being alone being lonely. I recently met my boyfriend towards the end of March, but before that I hadn't dated anyone in about 7 years.

19 hours ago, basuraeuropea said:

yes, modafinil and armodafinil are slightly dopaminergic, although not terribly so, but they may help nonetheless just by way of increased arousal. i'll talk to my doctor about them during my next appointment. 

I hope you're able to get one of them approved, and that it works for you if you try it!

19 hours ago, basuraeuropea said:

i absolutely cannot get by on a lower dosage of duloxetine. i've tried and my life is miserable. that said, duloxetine isn't causing the problem. re: pregabalin, glutamate, norepinephrine and ejaculatory latency, i think that because excitatory neurotransmission is decreased significantly, i am just too calm to orgasm quickly (or everyday). i mean, this is just a postulation, but oftentimes i do feel fatigued/sleepy due to the combination of medications i'm on, but the dosages are necessary because it's imperative that i am adequately relaxed as one of the main symptoms of both panic disorder and generalized anxiety disorder as they present in me is muscle tension which leads to dry heaving and vomiting, in turn leading to me falling malnourished and dehydrated. basically, the combination that i'm on is the minimum necessary to keep me psychiatrically and physically healthy.

I totally understand about lower doses making life miserable. That's really unfortunate that your panic disorder and GAD is that bad. :( I'm glad you've found somethings that work well for you to help you with that. Side effects can be frustrating though for sure.

20 hours ago, basuraeuropea said:

do you take short drug holidays from viibryd in order to have sex with your boyfriend? what happened to desipramine and zoloft? loss of efficacy?

Well, we haven't had sex yet, we're taking it slowly, but we have messed around a little in the beginning of the relationship. Then he said he wasn't physically attracted to me, so I haven't made any advances to respect his boundaries. He said he does really enjoy spending time with me though and he lets me come over and spend the weekend with him every weekend unless something is going on with one or both of us that we have to tend to.

Desipramine and Zoloft kinda lost its efficacy... It was really unfortunate because it was such a great combination for me. I had been on it for over a year or so, which is actually a long time for me to stay on a medication as they always quit working very quickly for me (probably on account of being bipolar). I could probably start desipramine again and it might help me with my depressive symptoms I'm experiencing currently, mostly anhedonia and poverty of speech (in person). It's really frustrating when I'm with my boyfriend and I just can't talk for some reason. Like I don't know what to talk about, and my memory is horrible so I can't remember to ask him about how something is going on that he's doing or something like that.

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I would be so frustrated if I couldn't ever orgasm. I mean, increasing from 2mg/day of Klonopin to 3mg/day of Klonopin has made it all more difficult, but it's still manageable. I don't know what I would do if I didn't have the ability to release via whatever remedy. I've heard the 'it's about the journey and not the destination' spiel before, but I'm totally not buying that. haha. As an aside, I don't think that at 31/32 that your genitalia is supposed to be shutting down. I mean, I'm 34 and I definitely don't anticipate my penis to stop working any time in the near future, psychotropics be damned. Work with your psychiatrist to find some sort of compromise -- you've listed a bunch of remedies in the posts above, do any of them work for you? 

 

Good for you on finding a boyfriend, though. It can be tough, especially in the suburbs of Orange County, California. That said, LA and SD aren't too far away and they both have large gay meccas. I really should more heavily invest into online dating, though, lest I end up a spinster. On a relationship note, I don't know that I could be with someone who wasn't attracted to me physically. I think physical/sexual attraction is pretty imperative to a successful long-term relationship. I know others are different, though, so I may be overgeneralizing the entire superficial gay community and including myself right along in it. 

 

You should try to restart desipramine and Zoloft to see if they have regained their efficacy if doing so won't destabilize you terribly. Perhaps they have and you'll have one less problem to worry about within the context of a relationship. On another note, I've never heard of poverty of speech outside of the schizophrenic-spectrum disorders. Do you suffer from psychosis associated with your BP II?

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Posted (edited)
4 hours ago, basuraeuropea said:

I would be so frustrated if I couldn't ever orgasm. I mean, increasing from 2mg/day of Klonopin to 3mg/day of Klonopin has made it all more difficult, but it's still manageable. I don't know what I would do if I didn't have the ability to release via whatever remedy. I've heard the 'it's about the journey and not the destination' spiel before, but I'm totally not buying that. haha. As an aside, I don't think that at 31/32 that your genitalia is supposed to be shutting down. I mean, I'm 34 and I definitely don't anticipate my penis to stop working any time in the near future, psychotropics be damned. Work with your psychiatrist to find some sort of compromise -- you've listed a bunch of remedies in the posts above, do any of them work for you? 

I can orgasm a couple of times a week or so, but it's honestly probably a performance anxiety thing in the moment. That's at least how I feel about it anyway. I can save up for a week or so in anticipation of getting off with my boyfriend (in the beginning of our relationship anyway) and still not be able to get off, but when I get home, I can get off just fine. I just can't get off nearly as often as I'd like to I guess.

As for the remedies, I currently take trazodone which should help, but perhaps it's too high a dose and it's working against me. I mainly take it for insomnia. I have some Cialis I use for times when for whatever reason I can't get an erection. I was taking it daily (5 mg) as my NP said it's okay to do that, but eventually it for some reason kept me from getting off and stopped working to help get an erection, so I just take it as needed.

Mirtazapine I never took long enough to assess whether it helps because it caused immense weight gain, and I'm already pretty overweight (5'11" 245 lb). I'm trying to get on and stay on the ketogenic diet, but it's a little difficult when I go out to eat with my boyfriend on the weekends... lol. Buspirone makes me manic as hell, even 5 mg/day. I can't tolerate dopamine agonists because they make me very impuslive/compulsive, especially with spending money. Abilify made me max out my credit cards twice, and I decided it was time to get the hell off of it even though it has heretofore been the best AAP for my mood. I've never tried amantadine; I tried asking for it from my pdoc and she said she would rather stick to benztropine for me (for hyperhidrosis). I'd really like to try amantadine though.

I have taken both modafinil and armodafinil before, and while I didn't recall it affecting my ability to get off one way or the other, armodafinil significantly helped me with my depression and wakefulness problems as well as ADHD. I'd love to get back on it, but I can never get my insurance to cover it for me.

Cyproheptadine I'm afraid will make me gain weight too. I've never tried it before, but it is after all used for an appetite stimulant for a reason, lol.

4 hours ago, basuraeuropea said:

Good for you on finding a boyfriend, though. It can be tough, especially in the suburbs of Orange County, California. That said, LA and SD aren't too far away and they both have large gay meccas. I really should more heavily invest into online dating, though, lest I end up a spinster. On a relationship note, I don't know that I could be with someone who wasn't attracted to me physically. I think physical/sexual attraction is pretty imperative to a successful long-term relationship. I know others are different, though, so I may be overgeneralizing the entire superficial gay community and including myself right along in it. 

Thank you! Yes it can be. A friend of my boyfriend's introduced me to him on an online dating app.

I'm hoping like crazy that from being together long enough that a physical attraction will develop from an emotional attraction. It's always been ideal for me to be good friends first then romantic partners. I love him like crazy, not sure whether he's into me as much as I'm into him, but he does seem to really enjoy spending time with me, which makes me happy. It's also nice to not be alone while going to bed. Just sleeping beside someone I love makes me happy. I really do hope a spark happens on his behalf though.

I believe so too, but we've only been together for 6 months or so. I'm not in a hurry to push into something that we may not be ready for, and I especially don't want to over step boundaries with him.

People in the gay community do tend to want to rush things too quickly, though. It's very uncomfortable for me.

It's pretty fucked up in my part of Alabama. It's like, either they're married to a woman and want to be "discrete" and "NSA," or they are just looking for hookups and nothing else. I got super lucky when I met my BF. This guy messaged me who is a friend of my BF's, and said "hey you should talk to this guy, you two might hit it off," and we really did at first, but the progression of our relationship seems to be slowing down (maybe the "honeymoon" phase is over lol). I'm not really experienced when It comes to dating, so I'm still learning, unfortunately. 😕  I'll never forget though, on our first date, we hugged, and he started to walk away, then came back and hugged me again. It was super sweet. :) 

4 hours ago, basuraeuropea said:

You should try to restart desipramine and Zoloft to see if they have regained their efficacy if doing so won't destabilize you terribly. Perhaps they have and you'll have one less problem to worry about within the context of a relationship. On another note, I've never heard of poverty of speech outside of the schizophrenic-spectrum disorders. Do you suffer from psychosis associated with your BP II?

I'll see, I may just combine the desipramine with the Viibryd. Yes, I do have psychosis from time to time. Abilify really was a wonderful sledgehammer for psychosis, depression, etc., but came with the aforementioned nasty side effect of impulsive spending. Rexulti doesn't work at all for me, it makes me more depressed, and Vraylar in the past kinda did the same thing but not nearly as bad. I didn't want to go from a dopamine partial agonist directly to a dopamine antagonist. I figured Vraylar would be a stepping stone to getting back on something like Latuda again. I had good luck with it in the past.

I don't think I have actual poverty of speech so much as I have severe social anxiety and I'm afraid to talk about anything with anyone, so I shut down and my brain literally can't function on a social level. It happens even with my best friends now. I just never know what to talk about. My pdoc has speculated that she believes I may lie somewhere on the autism spectrum, which may have something to do with it. If I had true poverty of speech in the sense of schizophrenia/schizoaffective disorder, I don't think I'd type much of anything in my posts.

That being said, my pdoc has also said that I may actually be BP I or schizoaffective bipolar type.

Edited by mikl_pls

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if i'm orgasming naturally, i.e., without the use of dexedrine, then i can have an orgasm everyday, albeit with great difficulty which is lessened if i take days off in between orgasms. the orgasms tend to be more intense as well if i take a few days break in between. also, i have a limited time frame during which to work with, as i think i mentioned before, and it typically and predictably corresponds with the time the levels of my medications are at their lowest in my system which can really narrow down the amount of time that i am sexually functional. really, dexedrine is the near-perfect solution and would be if it weren't for the hair loss. i mean, i can use it once a week and still shed noticeably which is disconcerting because, well, i'm vain. haha. 

anyhow, trazodone at 200mg qhs is likely working as an sri and that's going to be counterproductive to normal sexual functioning. additionally, its major metabolite, m-cpp, is not sex-friendly at all and you're likely to experience the effects of said metabolite the higher amount of the drug you take.   that said, i'm amazed that you are still able to orgasm given the amount of medications that you are on. like, bam, you add one more medication to my cocktail (even buspirone!) and i can't cum at all. this is the precise reason i went to ucsd -- medication reduction. and it worked in that i am taking the minimum amount necessary to keep me comfortably stable. i mean, i'm taking high dosages of klonopin and lyrica, with a moderate dosage of cymbalta, but i'm stable, thankfully. 

if even abilify made you compulsive in your spending habits, then i don't think trying amantadine would be the smartest of ideas, particularly when full-on dopamine agonists caused for impulsive/compulsive behavior. 

as for the pde5 inhibitors and anorgasmia/delayed ejaculation, it's a widely recognized problem, particularly for those taking psychotropics/serotonergics and part of the reason i don't use them if at all possible. here's a study abstract to look over -- https://www.ncbi.nlm.nih.gov/pubmed/21929518

what dating app did you use? i'm on okcupid, although it's not working for me very well. hah. i need to invest in creating more online profiles on different sites, though, particularly those that cater to the gay community. i do agree that gays tend to want to rush into sexual activity quickly, although they definitely don't, as a whole, want to rush into relationships quickly. that doesn't quite bother me, although what does is the amount of promiscuity, infidelity, and polyamory that is rampant within the community. it's disheartening to say the least. 

i've been in two long-term relationships and both were wonderful. i'm looking for another that will result in marriage, although i realize that my sexual problems are holding me back which is something that i've wondered how to approach when meeting guys either out or via the internet. i'm not quite sure when to tell them that i have issues surrounding sexual functioning. it's very, very frustrating nonetheless. i absolutely cannot stand how severely impacted i am by anxiety-spectrum disorders. 

i hope that your boyfriend comes around and develops a physical (and emotional) intimacy for you that isn't/aren't currently present! if not, there are plenty of fish in the sea. just make sure not to get yourself stuck in a one-sided relationship as they can be quite toxic to your mental wellbeing. 

it sucks that you aren't able to take a number of medications due to the propensity to gain weight. i wish you the best of luck in sticking to your ketogenic diet!

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