I came across this while doing some searching on the interrelationship
between SSRI’s and Adult ADD.
The infomation is collected by a doctor on staff at U of Chicago.
Most of the approaches have been contributed by doctors who have found
innovative approaches to helping their patients manage the sexual side
effects of SSRI’s. The info pre-dates the release of lexapro; however
it may be work a talk with you physician.
For those planning to discuss this with your doc, I’d suggest that you
print it out and mail them a copy with a cover letter stating that
you’d like to discuss at the next appointment whether any of these
approaches my be appropriate for your case and whether he/she has any
recommendations.
Best to all,
mike
=======================
[dr. bob]
Dr. Bob’s
Psychopharmacology Tips
SSRI sexual dysfunction
Date: Wed, 15 Mar 1995 01:10:41 EST
From: MWKR59A@… (Dr Frederick C Goggans)
Subject: Adding buspirone for SSRI sexual dysfunction
I have had good experience withe use of buspirone to reverse SSRI
effects on libido and orgasm and find this method to be more useful
than other approaches touted in the literature.
Date: Wed, 12 Apr 1995 22:47:16 +0059 (EDT)
From: scole@… (Stanley Cole)
Subject: Adding bupropion for SSRI sexual dysfunction
I haven’t had much luck with buspirone reversing sexual dysfunction (I
am having better luck with bupropion).
Date: Sun, 16 Apr 1995 11:30:20 -0700 (PDT)
From: Ivan Goldberg
Subject: SSRI retarded ejaculation
On Sun, 16 Apr 1995 paznes01@… wrote:
He responded very well to Prozac. Unfortunately he developed
intolerable retarded ejaculation.
Bupropion would be a good choice as it seldom causes sexual
dysfunction. Trazodone can seldom be given in doses high enough to be
effective without being too sedating. If the bupropion does not help,
you might consider restarting the Prozac and co-administering
buspirone 10-20 mg tid. Buspirone has been reported to protect some
men from the sexual side effects of the SSRIs.
If the buspirone fails, some other medications that may help sexual
function are amantadine and cyproheptadine.
Date: Sun, 16 Apr 1995 16:34:08 -0700 (PDT)
From: “Kristin E. Zethren”
Subject: SSRI retarded ejaculation
I have found a number of strategies useful with this type of problem
but no one panacea. Sometimes, adding 75 mg of bupropion can make a
difference. There has been some success for some of my patients with
cyproheptadine 2-4 mg about an hour before sex although most of my
colleagues have not been impressed. There is the danger of the
anti-serotonin effect with this drug but I have never encountered it.
The sedation might also be a problem (since about half the people
using antihistamines become sedated). Of course, sedation would be a
big problem with trazodone, especially for those of us who favor
morning sex.
From: “Richard Rubin, MD”
Date: Mon, 17 Apr 1995 00:28:32 -0500
Subject: SSRI retarded ejaculation
Although I haven’t had a report from any patients yet, I’ve heard that
nefazodone (Serzone) is similar to bupropion in absence of sexual side
effects.
Date: Mon, 17 Apr 1995 07:08:56 -0400 (EDT)
From: Charles B. Nemeroff
Subject: SSRI retarded ejaculation
Either treat the sexual dysfunction secondary to SSRIs with one of the
anecdotal treatments, e.g. buspirone 10-20 mg po tid, amantidine, or
cyproheptidine, or switch to venlafaxine (in my experience less sexual
dysfunction) or bupropion.
Date: Sat, 13 May 1995 08:49:20 -0400 (EDT)
From: Bill Boyer
Subject: Adding methylphenidate for SSRI sexual dysfunction
Dr. John Feighner (creater of the Feighner criteria, which led to the
RDC and then to DSM-III and IV) states that he has successfully
treated SSRI-associated sexual dysfunction in 3 individuals with
methylphenidate (Ritalin), 10-30 mg/day.
This fits conceptually with reports of the efficacy of amantadine,
another dopamine agonist, and with the idea that SSRI-associated
apathy (including lowered libido) may be related to dopamine
down-regulation.
From: Kevin Miller
Date: Fri, 19 May 1995 03:20:36 -0400
Subject: SSRI decreased libido in women
I’ve had fairly good (75%, small n) luck with cyproheptadine, 2-4 mg
several hours before sex or 2-4 mg TID regularly, for sexual
dysfunction/loss of interest with SSRIs. One also can try adding small
doses of bupropion to the SSRI for both depression and loss of sexual
interest.
Date: Sun, 4 Jun 1995 01:43:54 -0500
From: talmadge@… (John M. Talmadge, M.D.)
Subject: SSRI anorgasmia
Some of us have had success with telling patients to skip the dose the
day of expected sexual acitivity, and that works pretty well with
venlafaxine (Effexor) (not a true SSRI, but…) in my experience.
I have also noticed that just switching SSRIs can often alleviate the
problem. I seem to be seeing that on the Prozac-Zoloft-Paxil axis I
can just move a patient from one to another and often clear things up.
I’ll bet that is a buggy solution and that my “n” is not large enough
to justify any conclusions, but as long as it works I guess I’ll keep
going with it.
I have also been disappointed that trying to switch my patients to
Wellbutrin, now touted for its lack of sexual side effects, doesn’t
seem to help many of them.
In the really problematic cases, I urge them to give a TCA a trial,
because despite some of the other side effects those are still very
reliable medications. I just don’t like having that lethal overdose
potential and I prefer the rapid onset of action the SSRIs seem to
demonstrate.
Date: Sun, 4 Jun 1995 10:47:38 -0400
From: Aminadav_Zakai@… (Aminadav Zakai)
Subject: SSRI anorgasmia
My 2 cents’ worth:
* Lower SSRI dose.
* Try SSRI vacation on weekends.
* Add cyproheptadine 4-28 mg 30-60 min prior to sex (if they can
stay awake).
* Add trazodone if problem seems to be erectile failure.
* Add bupropion 75-100 mg in AM (adrenergic effect seems to help).
* Switch out of class to therapeutic dose of bupropion,
nefazodone, etc. My experience is that switching within class rarely
works but is worth try in some cases.
* Re-think if this is medication side effect, consider work with
couple.
Date: Sun, 4 Jun 1995 11:59:23 -0700 (PDT)
From: Ivan Goldberg
Subject: SSRI anorgasmia
There are a few more psychopharmacologic interventions that are often
useful:
* amantadine 100 mg bid or tid
* buspirone 5-10 mg tid or qid (may increase desire too)
* dextroamphetamine 5 mg tid or qid
* methylphenidate 10 mg tid or qid.
Date: Sun, 4 Jun 1995 13:00:55 -0700 (PDT)
From: Thomas Lewis
Subject: Adding yohimbine for SSRI anorgasmia
I’ve also had good luck adding yohimbine, 5.4 mg bid to tid.
Date: Sun, 4 Jun 1995 13:42:34 -0700 (PDT)
From: Ivan Goldberg
Subject: Adding yohimbine for SSRI anorgasmia
Yohimbine is often effective but may precipitate manic episodes in
pholks with bipolar disorder.
From: Fluox@… (Ron Winchel, MD)
Date: Mon, 5 Jun 1995 04:43:29 -0400
Subject: Adding buspirone for SSRI anorgasmia
Try adding buspirone (Buspar). Michael Norden recently reported
benefits. I have been doing the same for about a year with substantial
benefits about 1/2 the time.
I use 5 mg bid upped qweek by 5 bid to 20-30 bid total. Usually it
takes a couple of weeks to get effects. If the patient is on high dose
SSRIs, be careful. One of my patients had a mild serotonin
syndrome-like event on Buspar 60/d and Paxil 60/day.
It is also helpful to be more specific about the sexual side effects.
Decreased libido and ejaculatory latency are different phenomena and
the latter may respond better to Buspar addition. In addition, many
(maybe most) men on SSRIs report decreased masturbation frequency. But
this does not necessarily indicate sexual dysfunction — since on
closer questioning, many of these same men report intact erotic
responsiveness to external sexual stimuli.
From: ORRP@…
Date: Thu, 8 Jun 1995 01:37:25 -0400
Subject: SSRI anorgasmia
One thing to consider is whether you can lower the dose of the SSRI.
That was helpful for three of my female patients. Another female
patient did well with cyproheptadine (Periactin) though it cut down on
spontaneity.
From: M112961F@… (Michael Friedman, M.D.)
Date: Sat, 17 Jun 1995 09:40:45 -0400
Subject: SSRI sexual dysfunction
My experience with SSRIs is that they [can] cause decreased libido as
well as anorgasmia. Personally, I believe that the problems are rather
difficult to treat. I have had little success with adding Periactin,
Buspar or Wellbutrin. I have found that more often than not I am
forced to lower the SSRI or stop it completely when the patient
complains about these side effects.
Date: 18 Jun 95 11:33:33 EDT
From: “Furey A. Lerro” <71544.3434@…
Subject: SSRI decreased libido
I have found that loss of sex drive in depressed patients often occurs
separately from the symptom of diminished libido that is part of
depression. The majority of my patients do not prefer to stop the
medication for fear of return of symptoms. I’ve had some success in
lowering the dosage of the SSRI, but have found various remedies for
the problem, e.g., yohimbine and amantadine, not to be helpful.
Switching to trazodone, bupropion, and most recently nefazodone has
been quite successful.
Date: Thu, 13 Jul 1995 22:09:04 -0700 (PDT)
From: Ivan Goldberg
Subject: SSRI decreased libido in women
On Thu, 13 Jul 1995 Hottod@… wrote:
Can anyone shed light on management of diminished libido in female
patients on SSRIs? Are there any differential strategies across
gender? Lowering dosage and trying cyproheptadine are two that come to
mind. What about buspirone and bupropion in females vs. males?
While cyproheptadine is often useful in reversing the anorgasmia in
both men and women taking SSRIs, it does not usually have any effect
on desire.
Buspirone, bupropion, and amantadine seem to do the best at restoring
desire in both sexes.
Date: Thu, 13 Jul 1995 22:33:08 -0500
From: gsdavids@… (George Davidson)
Subject: SSRIs and decreased libido in women
In extensive practical but not academic experience, lowering the dose
is effective only when you get close to zero, cyproheptadine may work
for anoragasmia (I haven’t had any success with it) but not for
libido, buspirone doesn’t seem to work for anyone I’ve tried it on
(small n, scared off by ineffectiveness or side effects), and you
can’t use bupropion in Canada.
If I have a good response to SSRI, but sexual problems become a
nuisance, I have so far had 100% success switching to nefazadone or
moclobemide.
Date: 15 Jul 95 09:04:01 EDT
From: “Furey A. Lerro” <71544.3434@…
Subject: SSRIs and decreased libido in women
I can echo Dr. George Davidson’s comments regarding buspirone being
unhelpful along with the SSRI. Bupropion has been the best alternative
medication. I’ve also been able to switch a couple of women to
trazodone with very good success. Additionally, returning to the
tricyclics is often worth considering. Dr. Susan McElroy’s article on
treating antidepressant side effects in suppl. 2 of vol. 56 of the
Journal of Clinical Psychiatry this year is excellent and gives many
good references in this area.
From: PMBrig@… (Peter M. Brigham, MD)
Date: Fri, 21 Jul 1995 09:22:23 -0400
Subject: Increased sexual function on buspirone
On Jul 20, 1995, JGMD@… (Jane Garland) wrote:
no one has mentioned the paradoxical occurrence of increased
libido and increased frequency and intensity of orgasms which one of
my patients had on fluoxetine at 20 mg. She was being treated for OCD,
[which] responded well. She also enjoyed the sexual side effects.
I haven’t seen this with SSRIs, but I have a patient on fluoxetine 20
mg for an atypical anxiety disorder who complained bitterly of
anorgasmia, so I added buspirone 10 mg tid and she got her sexual
responsiveness back. She also had some bruxism, which didn’t improve
on the buspirone, so she discontinued the fluoxetine on her own, but
kept the buspirone on board, since it had benefitted her anxiety
level. She told me last week she wanted to continue the buspirone,
since in addition to lowering [her] anxiety it actually heightened her
sexual response — “it makes everything more intense.” She said her
libido was unchanged, but when she did have intercourse it was more
pleasurable.
Date: Sat, 11 Nov 1995 17:10:30 -0500
From: wbrown@… (Walter A. Brown MD)
Subject: SSRIs and decreased libido
I have heard that for folks with sexual dysfunction on paroxetine
or sertraline (not fluoxetine) that using the med four days a week but
not on Friday-Saturday-Sunday will preserve remission of depression
and at the same time allow unimpaired libido on weekends.
–Jaime Smith
According to an article in the Oct 1995 Am J Psychiatry (A Rothschild,
1514) it works in half the patients who try it without exacerbation of
depression.
Date: Tue, 14 Nov 1995 22:41:52 -0800 (PST)
From: “J. Wynn”
Subject: Bupropion for SSRI sexual dysfunction
Interestingly it seems that bupropion was touted early on as a
curative for low libido in and of itself, i.e., before marketing it as
an antidepressant took off it was discussed by sexologists as a
potentially useful item. I have tried it twice with no luck.
From: “Richard Rubin, MD”
Date: Tue, 12 Dec 1995 17:20:14 -6
Subject: Bupropion for paroxetine sexual dysfunction
I’ve tried bupropion 75 mg at 6:00 p.m. in 4 patients who were
complaining of problems with decreased libido as a side effect of
paroxetine. Three of them reported no more side effects when using the
bupropion. They were the women. The one man continued to complain that
he was unable to achieve orgasm.
Date: Thu, 16 Nov 1995 08:00:47 -0800 (PST)
From: Thomas Lewis
Subject: SSRI anorgasmia
For what it’s worth, I have a female patient, 40-ish, on 40 mg of
paroxetine for major depression, who fortuitously discovered that her
dense anorgasmia is relieved for a period of several hours after
aerobic exercise (e.g., running).
Date: Sun, 19 Nov 95 17:49:21 PST
From: “Jim Ellison”
Subject: Bupropion for SSRI sexual dysfunction
Clinicians are adding bupropion to SSRIs [to diminish the loss of
libido they sometimes cause], but I’d be more inclined simply to
switch to bupropion if possible (not always possible!). Walker et al
(J Clin Psychiatry 54: 459-465, 1993) found such a switch helpful for
patients with fluoxetine-induced loss of libido, and Gardner and
Johnston (J Clin Psychopharmacol 5: 24-29, 1985) used such a
substitution to restore libido and erectile function to the majority
of a group of patients on a TCA, tranylcypromine, or trazodone. Adding
the bupropion makes sense in some ways, but one might be concerned
about additive side effects or a synergistically lowered seizure
threshold.
Date: Sun, 19 Nov 1995 18:02:15 -0800 (PST)
From: Ivan Goldberg
Subject: Bupropion for SSRI sexual dysfunction
While I have occasionally had great success adding bupropion to an
SSRI when the sexual side effects were unacceptable, more often than
not, the depression improves a bit but the sexual problems remain
unchanged.
Date: Mon, 20 Nov 1995 20:02:04 -0800 (PST)
From: Peter Forster
Subject: Bupropion for SSRI sexual dysfunction
I have tried adding bupropion to SSRIs with both men and women with
good results in about 80%. Usually I think about switching to
bupropion, but often I don’t because of the very positive response to
the SSRI. In those where adding a second agent doesn’t help, I
sometimes can get a response by decreasing the SSRI (which I always
try without the bupropion augmentation, first), and find that a lower
SSRI dose may be effective with combined therapy. I have also heard of
similar stories from 4 of my colleagues.
Date: Mon, 11 Dec 1995 22:43:14 +0001 (EST)
From: scole@… (Stanley Cole)
Subject: Bupropion for SSRI sexual dysfunction
I’ve used bupropion 75 mg BID (occasionally 75 mg qd will do it,
especially if it is taken in the afternoon) with both fluoxetine and
sertraline. About 80% of people had about an 80% improvement in libido
and delayed orgasm with it. I have tried all the other remedies for
this will rare success (amantadine can help).
Date: Mon, 11 Dec 1995 19:00:41 -0800 (PST)
From: “J. Wynn”
Subject: Bupropion vs. bromocriptine for SSRI impotence
I’ve added bupropion, in doses up to 325 mg/d, to Paxil, Zoloft and
Prozac, with little benefit. I recently added bromocriptine to
venlafaxine for the same problem with prominent apathy, with very nice
results. I’ve also been disappointed with cyproheptadine, buspirone
and yohimbine, though not in a large patient sample.
Bromocriptine is very expensive.
Date: Tue, 13 Feb 1996 22:55:46 -0800
From: jgmd@… (Jane Garland)
Subject: SSRI sexual dysfunction
At recently attended conferences on SSRIs and sexual dysfunction,
the audience was asked to raise their hands depending on the frequency
with which they had seen this problem in private practice. The % ran
between 30 and 50 — much higher than originally reported. This fits
with my experience also. I think that the under-reporting previously
was based on the fact that severely depressed patients aren’t that
concerned initially about sexual dysfunction. It is only later as they
begin to get out of the pit that it becomes an issue. I think
psychiatrists probably also attributed the sexual dysfunction to the
depressed state. The earlier studies were of shorter duration than
what we see when treating patients for years.
–L.James Grold M.D.
I agree, at least 30%, more likely 50%, will have at least some
complaint of delayed or absent orgasm. But many patients will put up
with this, despite mentioning it as a problem, because it is better
than being depressed. Adolescents and spouses get impatient, however.
Of interest is that some of those patients with “reverse” symptoms on
fluoxetine (weight gain, lethargy, somnolence) have “complained” of
increased libido as a problem, suggesting something about that
norfluoxetine metabolite implicated in reverse symptoms.
My patients have had the same sexual symptoms on nefazodone as on
SSRIs, which was disappointing after initial marketing hype on this.
Date: Fri, 3 May 1996 01:17:10 -0300
From: Ivan Luiz de Vasconcellos Figueira
Subject: Increased sexual function on fluoxetine
I have a woman in her late 20s on fluoxetine 20 mg/day for 2 weeks
for depression (of a mild to moderate severity). She felt it as odd
that her sexual arousal was improved more than she would have thought
from her small improvement in mood.
–Jonathan Pulman
I think it’s more than just improvement in depression — increase
in libido with fluoxetine is seen as well in some patients with eating
disorder (not that they don’t get depressed, too). J Clin Psychopharm
reported a couple of patients on fenfluramine for bulimia with libido
increased to the point of obsessive pursuit of sexual experience,
which was very unpleasant for them — not just improvement of mood.
I’ve seen (and read about) sexual obsessions with Prozac treatment,
too — though I believe that to be very rare, much more so than the
opposite effect.
–Jim Ellison
Some authors (1, 2) reported beneficial sexual effects associated with
fluoxetine. Garcia-Campayo et al (3) described a case of orgasm as a
side-effect of fluoxetine. However, I’ve never seen such a case.
Patients with social phobia or panic disorder on fluoxetine who have
had a normal sexual life before the drug frequently complain about
sexual problems induced by fluoxetine. In my experience sexual
side-effects are the principals obstacles in the long term treatment
of anxiety disorder patients using SSRIs.
1. Power-Smith P. Beneficial sexual side-effects from fluoxetine. Br J
Psychiatry, Feb 1994, 164 (2): 249-50. Comment: Br J Psychiatry, Jun
1994, 164 (6): 854.
2. Smith DM, Levitte SS. Association of fluoxetine and return of
sexual potency in three elderly men. J Clin Psychiatry (United
States), Aug 1993, 54 (8): 317-9.
3. Garcia-Campayo J, Sanz-Carrillo C, Lobo A. Orgasmic sexual
experiences as a side effect of fluoxetine: a case report. Acta
Psychiatr Scand, Jan 1995, 91 (1): 69-70.
Date: Mon, 20 May 1996 16:19:50 -0400 (EDT)
From: Randi Rubovits-Seitz
Subject: Switching to nefazodone
A couple of people I switched to nefazodone, one each from Prozac and
Paxil, to which they’d had otherwise excellent responses, reported
some improvement in sexual function on nefazodone but were so much
less happy with it as an antidepressant that they requested
reinstitution of the SSRI.
Date: Mon, 20 May 1996 14:30:11 -0700
From: jgmd@… (Jane Garland)
Subject: SSRI anorgasmia
Lots of my patients read the articles about nefazodone in our local
press about a year ago because of local release and research. I
switched over quite a number of patients over. To date, no or marginal
improvement in anorgasmia and relapse of depression have been the
result. I have been much more impressed with bupropion for reversal of
anorgasmia. I have had a few patients with an antidepressant response
(somewhat, not too impressive) to nefazodone (mostly anxious ones who
did well on trazodone but got too sedated in the past), but not those
I switched for anorgasmia. I am not opposed to trying a few more,
however, in case one of them reverses, as this side effect is
disabling, but nefazodone has been quite disappointing overall.
Perhaps a clearer profile of potential responders will emerge.
From: bojrab@… (Christopher D. Bojrab, M.D.)
Date: Thu, 27 Jun 1996 22:38:33 -0400
Subject: SSRI anorgasmia
Before trying any of these approaches, I believe that one should make
sure that the depression has resolved to the point where the patient
could realistically expect the return of his or her normal libido.
P.S. My personal “small n” favorite is bupropion 75-100 mg QPM, which
I have had the most reliable luck with, especially in women.
From: LJGROLD@… (L.James Grold M.D.)
Date: Thu, 11 Jul 1996 11:30:15 -0400
Subject: SSRI sexual dysfunction
My experience with yohimbine is that it rarely has worked, however, a
patient of mine found yohimbine chewing gum at a health food store. He
chewed 10-15 pieces and had according to him an incredible sexual time
with his girlfriend.
Date: Thu, 11 Jul 1996 10:46:37 -0700 (PDT)
From: Denis Franklin
Subject: SSRI sexual dysfunction
Success [of yohimbine] in SSRI induced hypo-orgasmia has been reported
to me by a couple of patients.
I recommended use of 0.5 to 1 tab (5.4 mg each) an hour or so ahead of
the event. Yohimbine does also produce insomnia, so one has to arrange
the timing and titrate the dose to accommodate the circumstances. The
insomnia can actually be an additional benefit to the romantic,
bonding aspects of the relationship, and the man’s status in the eyes
of the woman, because he can’t roll over and go to sleep immediately
after orgasm.
From: CWangTSA@…
Date: Fri, 8 Nov 1996 23:27:36 -0500
Subject: Ginkgo biloba for SSRI sexual dysfunction
I read about a pilot study by psychiatrist Alan Jay Cohen at the
University of California at San Francisco. It suggests that ginkgo
biloba, an ancient Chinese herbal medicine, may be an antidote to
diminished libido or delayed orgasm. Cohen presecribed a
patent-protected formulation of ginkgo-tree leaf extracts, two 60 mg
capsules qid, to 37 men and women, all of whom experienced diminished
libido and delayed orgasm as a result of Prozac, Zoloft, and Paxil.
(The subjects had tried switching to other antidepressants, taking
sexually activating prescription drugs before bedtime, or avoiding
medication on weekends, all to no avail.) After taking the ginkgo
biloba 86 percent reported substantial improvement in their sexual
function, with virtually no side effects. Cohen says that ginkgo
biloba seems to restore blood flow to the genitalia, which is often
blocked by serotonin-enhancing drugs.
Date: Fri, 8 Nov 1996 20:55:18 -0800 (PST)
From: Camilla Cracchiolo
Subject: Ginkgo biloba for SSRI sexual dysfunction
Very interesting, especially in light of ginkgo’s vasodilating effects.
Two fast comments:
1. Since Traditional Chinese Medicine uses the seed and not the
leaf, the traditional indications for gingko don’t neccessarily apply
to this work.
2. I don’t see any mention of a placebo control group.
Date: Sat, 9 Nov 1996 04:42:43 -0800
From: “Jim Ellison”
Subject: Ginkgo biloba for SSRI sexual dysfunction
I spoke with Dr. Cohen in the course of preparing a talk on this topic
and after reading his New Research Abstract (NR 715) in the 1996 APA
syllabus. He is a UCSF psychiatrist and has had excellent results with
ginkgo — but his studies are not controlled and must be seen in that
light. The mechanism claimed for ginkgo is enhanced vascular flow, but
that too should be considered tentative.
Date: Sat, 30 Nov 1996 14:10:34 -0800 (PST)
From: Camilla Cracchiolo
Subject: Ginkgo for SSRI sexual dysfunction
I mentioned using ginkgo to treat SSRI related sexual dysfunction to
my personal physician, who responded that she had been prescribing
ginkgo to treat male erectile difficulties for the past 3 years and
found that it works fairly well. She originally enountered the idea in
the Journal of Urology. Unfortunately, she didn’t have the reference
at hand.
From: rdb@… (Richard David Brand, MD)
Subject: Bupropion for SSRI sexual dysfunction
Date: Sun, 13 Apr 1997 00:17:40 -0400
Bupropion 75 mg QAM has worked for about half the SSRI related sexual
dysfunction patients I’ve treated (n about 12-20).
Date: Wed, 14 May 1997 00:02:00 -0400
From: Ivan Goldberg
Subject: Relative SSRI sexual dysfunction
How does fluvoxamine compare to the other SSRIs with respect
to sexual dysfunction?
I have not seen any meaningful differences between the SSRIs with
regard to sexual dysfunction. But we use very little fluvoxamine.
–Larry Ereshefsky
Many psychopharmacologists who prescribe a lot of SSRIs have noted
that the incidence of sexual side effects with fluvoxamine is higher
than that of the other SSRIs. I am unaware of any good data on the topic.
From: jefferson_jeff_w@…
Date: Wed, 14 May 97 15:15:33 CST
Subject: Relative SSRI sexual dysfunction
The lore that fluvoxamine has a lower incidence comes from Nemeroff et
al. Depression 3: 163-169, l995. In a double-blind comparison,
“Significantly more patients reported sexual dysfunction in the
sertraline (28%) than in the fluvoxamine (10%) group.” It was not
clear if sexual function was evaluated by specific questioning. The
party line from Solvay to me in a letter dated 2/7/97 was, “Reaching
definitive comparative conclusions regarding SSRIs and incident rates
of side effects is difficult… Overall, SSRIs cause significantly
less sexual dysfunction than tricyclic antidepressants.”
Date: Thu, 29 May 1997 09:17:11 -0400
From: Jim Ellison MD
Subject: Nefazodone for SSRI sexual dysfunction
A recent letter to the editor cited use of nefazodone with sertraline.
The purpose was to block 5HT2 postsynaptic receptors and reduce sexual
dysfunction:
Reynolds RD. Sertraline-induced anorgasmia treated with intermittent
nefazodone [letter]. Journal of Clinical Psychiatry. 58 (2): 89, 1997 Feb.
Date: Thu, 10 Jul 1997 10:10:38 -0700 (PDT)
From: “J. Wynn”
Subject: SSRI sexual dysfunction
Reference for SSRI-induced sexual side effects being even more common
than most of us realize:
Modell JG, Katholi CR, Modell JD, DePalma RL. Comparative sexual side
effects of bupropion, fluoxetine, paroxetine, and sertraline. Clinical
Pharmacology & Therapeutics. 61 (4): 476-87, 1997 Apr.
Of patients given an SSRI, 73% reported at least one type of sexual
dysfunction and 27% reported no problems.
Date: Wed, 23 Jul 1997 22:17:35 -0400
From: Ivan Goldberg
Subject: Ginkgo for SSRI sexual dysfunction
Ginkgo has been mentioned on this list a number of times as a possible
treatment for patients with antidepressant-induced sexual dysfunction.
The July issue of Clinical Psychiatry News (p. 5) contains a report on
a presentation by Alan J. Cohen, MD, at the recent San Diego annual
meeting of the APA. Dr. Cohen reported that 60-120 mg twice a day of
ginkgo led to relief of antidepressant-induced sexual side effects in
30 of 33 women and 23 of 30 men. Side effects of ginkgo were reported
to have been minimal.
Erectile failure, anorgasmia, and decreased libido were the symptoms
reported to have responded. Ginkgo was tried for 6 weeks before being
considered to have failed. (6 weeks is possibly long enough for some
patients to have developed tolerance to the sexual side effects of
their antidepressants.)
Dr. Cohen utilized ginkgo in an uncontrolled manner. A
placebo-controlled, double-blind study is now being organized.
From: Cmindell@…
Date: Thu, 24 Jul 1997 17:40:47 -0400 (EDT)
Subject: Ginkgo for SSRI sexual dysfunction
I’ve tried ginkgo with one man, in his late 50s, after some months on
sertraline with decreased sexual interest, some difficulty in getting
an erection, and prolonged ejaculation. He was taking one aspirin a
day, and after I checked with an internist who knew about ginkgo, who
didn’t think the potential interference with platelet aggregation
would be much of an issue, he started at 60 mg qd. At 60 mg bid the
above side effects diminished significantly. (Bupropion hadnn’t
helped, nor had stopping the medication for up to 2 days prior to
sex.) He stayed on the ginkgo for about 8 weeks, until we tapered him
off the sertraline. He had no side effects from the ginkgo.
From: TomRusk@…
Date: Fri, 25 Jul 1997 08:41:43 -0400 (EDT)
Subject: SSRI sexual dysfunction
I haven’t seen people develop tolerance to the sexual side-effects of
SSRIs and venlafaxine.
Date: Fri, 25 Jul 1997 16:22:46 -0400
From: Ivan Goldberg
Subject: SSRI sexual dysfunction
I have seen a few people in whom tolerance to the sexual side-effects
of SSRIs seemed to develop… or maybe their compliance decreased and
they failed to report that.
Date: Fri, 25 Jul 1997 23:37:04 -0400
From: William Braden
Subject: SSRI sexual dysfunction
Yes, some patients do lose the sexual side-effects (after 2 to 6 months).
Date: Sat, 26 Jul 1997 06:57:45
From: “Richard David Brand, MD”
Subject: SSRI sexual dysfunction
Several patients of mine have regained sexual normal sexual activity
after 3-6 months on venlafaxine.
Subject: Ginkgo for SSRI sexual dysfunction
Date: Mon, 1 Dec 97 19:50:51 -0000
From: Geoff Hyde
Ginkgo Biloba for Drug-induced Sexual Dysfunction
Alan J. Cohen, M.D., Department of Psychiatry, University of CA at
SF; Barbara D. Bartlik, M.D.
In an open trial, ginkgo biloba, an herb derived from the bark of
the Chinese ginkgo tree, noted for its cerebral enhancing effects, was
found to be 84% effective in treating antidepressant-induced sexual
dysfunction due predominantly to selective serotonin reuptake
inhibitors (SSRIs) (N = 63). Women (N = 33) were more responsive to
the sexually enhancing effects of ginkgo biloba than men (N = 30),
with relative success rates of 91% versus 76%. Ginkgo biloba generally
had a positive effect upon all four phases of the sexual response
cycle: desire, excitement (erection and lubrication), orgasm, and
resolution (afterglow). This study originated from the observation
that geriatric patients on ginkgo biloba for memory enhancement noted
improved erections. Patients exhibited sexual dysfunction secondary to
a variety of antidepressant medications including SSRIs, SNRIs, MAOIs,
and tricyclics. Dosages of ginkgo biloba extract ranged from 60 mg qd
to l80 mg bid (average 200 mg/d). The common side effects were
gastrointestinal disturbances, headache, and general CNS activation.
1. Cohen A. Treatment of antidepressant-induced sexual
dysfunction: a new scientific study shows benefits of gingko biloba.
Healthwatch. 5 (1), 1996 Jan.
2. Kleijnen J, Knipschild P. Ginkgo biloba. Lancet. 340 (8828):
1136-9, 1992 Nov 7. Comment: 1992 Dec 12; 340 (8833): 1474.
From: docohen@… (alan cohen)
Date: Tue, 2 Dec 1997 23:09:01 -0800
Subject: Ginkgo for SSRI sexual dysfunction
Please see my Brief Report on Long Term Safety and Efficacy of Ginkgo
Biloba Extract in the Treatment of Antidepressant-Induced Sexual
Dysfunction.
Date: Tue, 20 Jan 1998 23:28:41 -0500 (EST)
From: Charles S Berlin
Subject: Granisetron for SSRI sexual dysfunction
Although only a single open use case report, there was a fascinating
letter in the November Journal of Clinical Psychiatry. Drs. Nelson,
Keck, and McElroy note the theoretically inviting view that
granisetron, a 5HT3 antagonist (and sexual stimulant in rats), might
counteract SSRI induced sexual side effects (which they believe stem
from SSRI activity at 5HT2 and 5HT3 receptors).
They thus had one of their patients take this medication 1 hour before
sex: “On three out of three trials Ms. A noticed a complete recovery
of sexual interest and ability to achieve orgasm.”
This is tantalizing enough to warrant further exploration.
Unfortunately, there is at least one drawback: this medication
(available as Kytril, labelled for chemotherapy-related nausea
control) costs an eye-popping $50/pill! (My consulting pharmacist
quipped, “It would have to be a heck of an encounter to justify that!”
when she looked up the price.) I’m sure insurance companies would balk
at this very quickly…
Nelson EB, Keck PE Jr, McElroy SL. Resolution of fluoxetine-induced
sexual dysfunction with the 5-HT3 antagonist granisetron. Journal of
Clinical Psychiatry. 58 (11): 496-7, 1997 Nov.
Date: Wed, 28 Jan 1998 23:15:21 -0600
From: michelle & evan peterson
Subject: Yohimbine for SSRI sexual dysfunction
Charles S Berlin wrote:
While yohimbine is often mentioned as potentially helpful for SSRI
sexual side effects, my own clinical experience with this, and reading
the anecdotal reports of others, is that the results in actual use
overall seem to be somewhat disappointing.
Yohimbine evidently increases peripheral blood flow, and its
reputation for improving male sexual performance came from
observations of vasocongestion of genitals in animals that ate it.
From: tgarton@… (Theresa Garton,MD)
Date: Sat, 28 Feb 1998 11:04:17 -0800
Subject: SSRI sexual dysfunction
I add bupropion, at a low dose of 75 mg daily, for symptoms of
decreased interest in sex or delayed orgasm in patients who are also
using SSRIs. I have good luck with this specific use. I will admit
though, that this is not infrequently the first step in switching from
an SSRI to single drug therapy with buproprion.
For inability to acheive erection, I would also consider other
etiologies. A thorough history, exam, etc., would probably be in order
for that symptom unless the patient was clearly attributing his lack
of erections to a nonexistant interest in sexual activity.
From: M. Kirsten Miller, M.D., M.P.H.
Date: Sun, 5 Apr 1998 23:20:01 EDT
Subject: Mirtazapine for SSRI sexual dysfunction
I’ve used Remeron (mirtazapine) fairly often for SSRI induced sexual
dysfunction — with or without Wellbutrin.
Date: Mon, 20 Apr 1998 21:18:12 -0400
From: “Marianna C. Glenday”
Subject: Urologic workup before initiating treatment
With impotence presumed to because by SSRIs there are a number of
reasons to do a urologic workup before initiating treatment.
There may be another primary or co-morbid cause of the impotence that
would have been subclinical until the addition of the SSRI, and some
of these causes can be major health problems such as undiagnosed
diabetes, vascular disease and even alcoholism. The depression may
also be the result of such a comorbid illness and all three of the
problmes found to be from a common pathology.
From: Ron Podell
Date: Mon, 4 May 1998 04:04:37 EDT
Subject: SSRI sexual dysfunction
Granisetron is anecdotally reported to help orgastic dysfunction –
inhibited or delayed ejaculation in men and orgastic dysfunction in women.
Erectile dysfunction in SSRI users is an interesting problem. Does the
man have any history of erectile dysfunction prior to the SSRI? If so,
then a work up with nocturnal penile tumescence testing (for example,
with the Rigiscan) is something that could be done to see if there are
any organic factors present. If there are, Viagra is a very legitimate
choice. If not, the erectile dysfunction is probably secondary to
decreased desire or orgastic dysfunction. If the patient has orgastic
dysfunction then ginkgo biloba and granisetron may be a good combination.
Viagra does enhance response to sexual stimulation in normals, but who
cares unless you are getting older and want 95% rigidity instead of
80%? Rigidity matters, but only if it’s less than 60-65% or you are
dating much younger women and worry about it.
From: “Fier, Eric”
Subject: SSRI sexual dysfunction
Date: Mon, 18 May 1998 15:48:08 -0400
How much buproprion for a man on Prozac to assist with sexual
impairment?
75-150 mg of the regular or the SR preparation, usually dosed daily;
in some cases, used PRN 1 hour before sex:
Ashton AK, Rosen RC. Bupropion as an antidote for serotonin reuptake
inhibitor-induced sexual dysfunction. Journal of Clinical Psychiatry.
59 (3): 112-5, 1998 Mar.
You may also consider adding nefazadone 50-100 qHS or mirtazapine
7.5-15 qHS.
Has Viagra been tried for this?
Initial studies of sildenafil citrate looked at
erectile dysfunction secondary to assorted etiologies; success rate of
70-80% reportedly included patients with antidepressant-induced
impotence. No specifics yet on this cohort. Dose 50 mg initially; may
try 75 or 100 mg if no improvement.
Date: Tue, 19 May 1998 23:51:01 -0400
From: “Howard Rudominer, M.D.”
Subject: SSRI sexual dysfunction
I have had to use as much as 300 mg of buproprion SR to see results on
occasion. I would stay away from the regular preparation because of
the increased risk of seizures. I see no reason to use it over the SR
form unless the patient had an idiosyncratic reaction to it.
The problem with mirtazapine is that it may work to reverse the sexual
dysfunction, but not without the cost of marked weight gain.
Nefazadone does not have as favorable a side effect profile as
buproprion SR.
I have had some success with ginkgo biloba 120 mg bid.
Date: Thu, 21 May 1998 22:37:09 -0400
From: Ivan Goldberg
Subject: Sildenafil for SSRI sexual dysfunction
One of my female patients with Prozac-induced anorgasmia tried 100 mg
of her husband’s Viagra and reported that it made it much easier for
her to reach orgasm.
Date: Thu, 21 May 1998 20:15:31 -0700 (PDT)
From: Ronald Shlensky <3004rs@…
Subject: Sildenafil for SSRI sexual dysfunction
What has made Viagra so attractive is not that it is the only
remedy for erectile dysfunction, as potency problems are called
medically. There are half a dozen other effective treatments. But
unlike the others, Viagra is a pill, making it a far simpler and more
discreet remedy than its rivals, which include drugs injected or
inserted into the penis and devices implanted and inflated.
But in the wave of enthusiasm surrounding this drug over the last
two months, many physicians and their patients have ignored its
limitations and side effects — those already known and those that may
become apparent after millions of men have used it.
“Whenever a new drug is introduced, pharmaceutical companies
always tout it as extraordinarily effective and without side effects,”
said Dr. Robert Kolodny, medical director of the Behavioral Medicine
Institute in New Canaan, Conn., and a former associate of the
pioneering sex researchers, Dr. William Masters and Virginia Johnson.
“In every case, a year or two later when the drug becomes widely
used, new side effects emerge that were not previously seen,” Dr.
Kolodny said. “This is uncharted territory. There may be interactions
between Viagra and other drugs men are taking. Men may use it at
higher doses than it was designed to be used. And it will undoubtedly
be used by a wide range of people, not all of whom are suitable or
adequately screened medically beforehand.”
Dr. Kolodny noted that some women are already taking Viagra, even
though no data have shown its effectiveness or hazards for women.
Likewise with adolescents, who may take it because of a medical
problem that causes impotence or simply as a recreational drug in
hopes of enhancing their virility.
Because most men with potency problems are in the later decades of
life, some Viagra users no doubt will be in very poor health,
suffering from diabetes, heart disease, arthritis and other ailments.
Will their hearts stand the physical demands of sexual intercourse?
How will Viagra interact with other medicines they may be taking?
Men who are rendered impotent by drugs for high blood pressure or
depression are likely to constitute a large share of Viagra users, but
until large numbers use the potency enhancer, its possible adverse
interactions with their medicines will not be fully known.
What is known so far about Viagra, also known as sildenafil, is
that it cannot safely be taken by anyone using nitrate medications
and, according to a report last week in The New England Journal of
Medicine, about a third of men experience one or more minor side
effects, including headaches, flushing, indigestion, stuffy nose and
temporary changes in visual perception of color or brightness. But in
tests of Viagra in hundreds of men, few dropped out because of such
effects.
“Whether the promise of sildenafil will be realized after many
more men have been treated and the drug has been taken repeatedly for
prolonged periods remains to be seen,” Dr. Robert D. Utiger cautioned
in an editorial in the same issue of the journal.
–NY Times
From: Ron Podell
Date: Fri, 22 May 1998 00:49:50 EDT
Subject: Sildenafil for SSRI sexual dysfunction
Viagra helps with the excitement phase of the sexual response. It does
nothing for desire — except what it might contribute psychologically
to a person who now believes he can have sexual relations. The
orgastic problem with SSRIs is a threshold problem. The hill one has
to climb to reach orgasm is higher. The increased excitement phase
response due to Viagra has helped some of my patients climb the hill
all the way to the top and over. The only question is whether that
will continue. But it does not directly affect desire or orgastic phases.
From: Henry F. Crabbe
Date: Tue, 26 May 1998 03:46:07 EDT
Subject: Sildenafil for SSRI sexual dysfunction
My experience is similiar. Viagra 50 mg reversed anorgasmia in a
female patient treated with Prozac.
Date: Tue, 26 May 1998 14:11:48 -0700 (PDT)
From: Denis Franklin
Subject: Sildenafil for SSRI sexual dysfunction
I, too, had a female patient who overcame anorgasmia by taking her
husband’s sildenafil… and giving it to her boyfriend. 
Date: Sun, 07 Jun 1998 07:12:35 -0400
From: Ivan Goldberg
Subject: Sildenafil for SSRI sexual dysfunction
While I believe that it is too soon to prescribe sildenafil (Viagra)
for antidepressant-induced sexual difficulties, about a dozen of my
male and female patients have obtained it by various means and have
tried it out. The success rate seems to be about 75% in both men and
women, and the side effects seem to be minimal, so far.
This topic is indexed under the following subjects:
Antidepressants, selective serotonin reuptake inhibitors
Sexual problems
Buspirone
Antidepressants, new (bupropion, mirtazapine, nefazodone,
venlafaxine)
Antidepressants, other and in general
Dopaminergic agents
Serotonin antagonists
Stimulants
Antidepressants, tricyclic
Yohimbine
Antidepressants, monoamine oxidase inhibitors
Sildenafil
Herbs
Serotonin antagonists
Match: all terms any term [ Psychopharmacology Tips | Interpsych |
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[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@…
URL: http://www.dr-bob.org/tips/split/SSRI-sexual-dysfunction.html
Original tips copyright 1994-98 original authors.
Web page copyright 1995-98 Robert Hsiung.