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Sexual dysfunction is a side effect of everything that helps me

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Late 30s male here. Several years ago I was diagnosed with clinical depression and general anxiety. I also have insomnia, which I take a sleep aid for.  I've been on various antidepressants over the years, and SSRIs make me feel absolutely no feelings at all, including intimacy/libido. My doctor then prescribed Remeron, which made me paranoid and gave me sleep problems. So we started trying SNRIs instead, and Effexor helped my moods a lot. It helped motivate me to get in shape and be healthier, which boosted my confidence and energy levels. But when I started it, I wasn't dating at all. When I started dating again, I quickly realized Effexor gave me a ton of random sexual side effects. I'd find someone I was interested in, but I'd have zero libido. Or I'd get into it, but suddenly have E.D. Or we would get started, but I couldn't maintain it. Or I could maintain it, but never climax. It became increasingly frustrating and unsatisfying, so I weaned off Effexor with my doctor's approval. My dating pool had also kind of dried up at the time, so it was a good time to try new meds.

My GP thought for a long time that depression was my primary diagnosis, but a psychiatrist recently helped me determine that all my other diagnoses stem from ADHD: Anxiety, from my ADHD throwing thought-spaghetti at a wall constantly. Depression, from some of those mashed-up ADHD thoughts inevitably being negative and paranoid. Insomnia, due to too many racing thoughts all the time. So I was prescribed Dexedrine, and that helped SO much. I was focused, my brain was quiet, I wasn't tired during the day,  no depression, no anxiety, and I got to sleep much easier. Awesome. Then I just happened to meet someone new. We started seriously dating, and it soon escalated into a relationship. I figured everything was in the clear, until we started becoming intimate. Come to find out that Dex ALSO has sexual side effects, and gave me some of the same issues as Effexor did despite it being a completely different category of drug.

I've started looking into other ADHD meds, other antidepressants, and other categories of meds that might help, but every one I can find (that isn't in a category my brain hates) has "common side effects: sexual dysfunction" or something similar listed in its description. It was fine when I was single, or in less serious dating situations, but I really like this new one and we're talking about our future together, so I want to be able to perform on a regular basis. I'd rather not have to take something like Viagra every time we're intimate, but I'm seeing very few options (and even fewer that are covered under my healthcare plan). What do I do? I'd almost rather be unmedicated altogether just so I could enjoy an intimate relationship for once. 

Edited by MyMedsSuck
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I have this same problem with SSRIs and SNRIs. I hear you. It is frustrating and at times has been upsetting for me and contributed to more depression. 

I don't know much about ADHD medication, but a few months back I convinced my then-psychiatrist to let me try bupropion (wellbutrin). It's an antidepressant that works on norepinephrine and dopamine, not serotonin. It is I think the only antidepressant that helps libido and sexual dysfunction aside from Remeron.. It has been a godsend for me in that area of things. Additionally, I also recently learned that it is sometimes prescribed for ADHD! so this could be a really good option for you. 

Another thing I know is that buspirone (buspar) can be prescribed alongside SSRIs to help sexual dysfunction. I wonder if it also helps that way with ADHD meds? I'm very novice about this stuff and there are much more knowledgeable people here than me. Perhaps @mikl_pls or @browri can offer more. They have been extremely helpful to me :) and also @argh.

Good luck!! I really hope there's something better for you to try. Sexual dysfunction is crushing. 

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Strange, I had the opposite effect when I first started stims (Adderall was my first stim).

Yes, bupropion can target ADHD and sexual dysfunction all in one, I third that.

I second buspirone (BuSpar). It can help with anxiety and I believe has been trialed for ADHD?

I second Provifil/Nuvigil too. They could be an alternative to stims for ADHD. You will need a prior auth if you live in the US, though.

Another alternative is tricyclic antidepressants... they can be used for ADHD, depression, anxiety, and have relatively less sexual side effects than SSRIs/SNRIs. Desipramine, nortriptyline, protriptyline, imipramine all are used in ADHD.

Atomoxetine or (depending on where you live) reboxetine could also be used.

Methylphenidate, a non-amphetamine stimulant, could be another thing to try.

If you take any of the PDE5 inhibitors, try Cialis first (tadalafil). It has a very long half-life, and has a daily dosing regimen at a low dose (2.5-5 mg). Viagra has the potential for some serious side effects.

If all else fails, going back to SNRIs and adding trazodone/nefazodone for sleep/sexual dysfunction could be an option. (Trazodone would be better probably as it's more sedating and has less of a chance of liver failure than nefazodone.) SNRIs can help with ADHD as well, and the trazodone/nefazodone would have 5-HT2A antagonism to assist with sexual dysfunction.

Edited by mikl_pls
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The first thing I always think of for the SD in someone with anxiety is the addition of BuSpar, so another vote for that.! Also agree that Wellbutrin may help, but it might be a little rocky, especially at first, if it messes with your anxiety levels 

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Thanks for the suggestions and feedback. I actually have taken Wellbutrin twice before: Once as my primary depression med about 4-5 years ago, and once with my Effexor to counteract the side effects. Unfortunately, it gave me the same "absolutely nothing" feeling that SSRIs do. I call it "the grey": It's like I'm sitting in a chair inside my own head, watching my own life on autopilot from afar, while my train of thought is basically TV static.

I'd be open to maybe trying it as my primary med again, since I wasn't really in a good place in my life the last time I took it by itself. I'm not really optimistic though, since I've taken it twice now and it didn't give me the positives most people describe. I suppose it could be different when taken independently from Effexor though, and to be fair it was a low dosage the 2nd time.

Fortunately my psychiatrist's office just let me know that an appointment opened up tomorrow afternoon though, so I'll ask her about it then (I'll also ask about buspirone). I just don't want to waste weeks at a time adjusting to something that might make me feel worse when I'm trying to develop a relationship. I'm glad my new girlfriend is patient - she doesn't seem to know much about mental illness, but she's open to learn and she's really supportive, which is great. I just wish the physical part wasn't an obstacle (though fortunately that's not every time).

Will update again after my appointment tomorrow. 

Edited by MyMedsSuck
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@MyMedsSuck How did your appointment go? Sorry I'm a bit late to the game, I would totally second Trintellix as a serotonergic antidepressant that will be less likely to cause sexual dysfunction. I will say though that people need to know the manufacturer's information is contradictory:

Trintellix has been shown to either reduce or in some cases eliminate sexual dysfunction caused by prior antidepressant treatment. Patients well-treated on either citalopram, paroxetine, or sertraline that were experiencing sexual dysfunction were randomized to switch to either escitalopram or Trintellix. Those who switched to Trintellix did have a statistically significant drop in self-reported sexual dysfunction.

It is worth noting that for Trintellix, sexual dysfunction is typically felt at the 15mg and 20mg doses, and it is more of an issue for men than women. I can say from experience that this is pretty accurate, because I don't start to have real problems until Fall and Winter when I increase Trintellix from 10mg to 15mg and then to 20mg. I then decrease it to 10mg and 5mg for Spring and Summer, which is when I have less of an issue.

If you haven't already made any changes, I would say talk to your doctor about Trintellix. Work with them on the dosing, which is usually 10mg to start and then to 20mg at Week 2, but most do better starting on 5mg for Week 1, then going to 10mg at Week 2 and staying there for a few weeks to see what happens. Usually by Week 3 or 4 you have a better idea.

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16 hours ago, MyMedsSuck said:

Got a prescription for Buspirone, and I'll be starting it today. Yay. I guess it'll be a couple weeks before I see results, but I'm currently off of everything else. 

What's the dosage for the buspirone?

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12 hours ago, browri said:

What's the dosage for the buspirone?

Week 1: 10mg at bedtime

Week 2: 10mg in the morning and 10mg at bedtime

Week 3: 10mg in the morning and 20mg at bedtime 

Week 4: 20mg in the morning and 20mg at bedtime

She said that if things feel comfortable where I am, I don't have to increase and can just stay there. 

But lo and behold, when I picked it up, the pharmacist consultation said one of the side effects could be loss of libido. Figures.



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14 hours ago, argh said:

remember, just because it can, doesn't mean it will.

definitely. Furthermore, buspirone is known for actually improving sexual dysfunction caused by antidepressants like SSRIs. More than likely the loss of libido happens at higher doses of buspirone like 60mg/day. At that point, it isn't just a 5HT1A partial agonist. It's also a partial agonist at dopamine receptors, which could possibly cause sexual dysfunction.

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  • 2 weeks later...

Trip report: I started taking 10mg of Buspirone on the night of Monday, December 9th. I've been taking it nightly before bed ever since.

As of Monday, December 16th, I started taking 10mg in the morning too. So it's been over a week of 10mg, and I just started 20mg.

Monday the 23rd I go up to 30mg, and Monday the 30th I go up to 40mg, though my doctor said I don't necessarily have to increase every week if I'm feeling OK where I am. So I might stay at 20mg for 2 weeks just to see how I feel, and either stay at that level or increase from there. 

Notable differences: 

  • My GAD, which it primarily treats, is almost totally gone lately! Life circumstances that naturally trigger anxiety still make me anxious (work stress, holiday travel woes, etc.), but the BuSpar even kind of takes the edge off of that too. But the crippling stay-in-bed-all-day anxiety that happens for no apparent reason is all but gone! 
  • I still had a mini-episode a couple days ago, mildly freaking out about my new relationship and how it's going to crash and burn and fail and why the hell does she even like me oh my god she's just going to leave me for someone else I don't deserve this. That could've been due to increasing my dosage the day before though, and I only felt like that for about half an hour. 
  • I'll group the sexual dysfunction stuff all together (the "TMI" section):
  • I still occasionally have issues climaxing, but it's better than it was; just not quite where I want to be yet. That may actually be performance anxiety though, which my new girlfriend apparently gets too, so it helps to talk about it openly. Sometimes it just takes me a "round 2" after a break, though I can't really say why that is. 
  • I also occasionally have trouble staying erect for longer periods of time, but I've noticed that usually happens at her place, so I figure it's either a psychological thing, or it might just be that it's winter and she has floor to ceiling windows and she never turns the damn heat on.
  • She's away for the holidays visiting family, so unfortunately we won't get to test my increased dosage for a couple weeks. If I keep increasing steadily I'll be at 40mg by the time she's back.
  • No loss of libido. On the other hand, it's been way higher lately! Awesome.
  • Absolutely NO uncooperative E.D. since I started taking it! 
  • The only downside I'm seeing lately is that my ADHD is through the roof, so it's a bit of a tradeoff: I'm a lot more productive, but I'm being productive about several scattered things at once instead of focusing on one thing at a time. At least I'm gradually getting stuff done, but only once I remember to go back to it later and don't just stop in the middle of writing to clean the range over the stove like I did an hour ago and hey look there are squirrels outside. So I'm kind of thinking I should wait a bit to see if I want to increase again, and then maybe try the occasional Dexedrine as-needed when I have a deadline or project.
  • I am tapering off Trazodone as my sleep med. I was at 100mg every night and now I'm at 25mg. I'm sleeping restfully lately, but only getting about 5-6 hours. If I successfully stop Trazodone, and my ADHD levels off so I don't need Dex anymore, BuSpar will be the only med I need to take. I'm really hoping that will be the case.
  • My next doc appointment isn't until February 1st, so I have some time to adjust. Still, I feel a lot better than before. Thanks to everyone who recommended BuSpar! So far, so good. Hopefully I'll keep improving after a few more weeks of adjustment. 




Edited by MyMedsSuck
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