SSRI and a bit of Info:

[Guest guest]

Hi All

Ihave had ssri sexual dysfunction for 30 years--never recovered.

I have researched for many years-

In most articles in medical Journals today the concensus always points to-

Lexapro--the worst offender--for eveyone

Typical side effects

The usual for SSRIs: headache, nausea, dry mouth, sweating, sleepiness or

insomnia (with insomnia more likely), diarrhea or constipation, and assorted sex

problems. Weight gain is a lot less likely than with other SSRIs and all of the

typical side effects tend to be milder. The most likely sexual side effect is

anorgasmia, i.e. you can't come, no matter how much romance and/or porn is

involved. In the prudish language of PI sheets and clinical trials, anorgasmia

affects only women. With men the problem is listed as an " ejaculation disorder. "

Venlafaxine-

Typical Side Effects

The usual: headache, nausea, dry mouth, sweating, sleepiness or insomnia, and

diarrhea or constipation, weight gain, loss of libido and a host of other sexual

dysfunctions. Most everything but the weight gain and sexual dysfunctions

usually goes away within a couple of weeks. Although some women will notice that

the sexual side effects will diminish above 200–225mg a day when the

norepinephrine kicks in. Maybe.

Paxil-

Typical side effects

The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or

insomnia, constipation (pretty bad for some people, feature and not bug for

anyone with IBS), weight gain, and loss of libido. Everyone I've read on the

subject of how long side effects last (Dr. Stahl's Essential

Psychopharmacology: The Prescriber's Guide, Dr. Diamond's Instant

Psychopharmacology, Dr. Drummond's The Complete Guide to Psychiatric Drugs ,

Preston et al.'s Consumer's Guide To Psychiatric Drugs'`) agrees that everything

but the weight gain and loss of libido usually goes away within a couple of

weeks. Paxil is notorious for having the worst impact on your libido of all

SSRIs.

While much has been written on alternative therapies to counteract the

effects--there is no conclusive evidence-for anything-however-some people do

respond to different thereapies-again we can theorise on why-also- in my

dealings with many people over the years-those who say they have found some

improvement etc.--are usually people who have not suffered from complete genital

anasthenia for a long period of time.

One alternative Macca Root--seems to help some people.

Everyone is different--and everyone experiences different levels of

dysfunction-no matter what the med.

I feel for anyone who has any type of sexual dysfunction from taking these

drugs-no matter how long they have been suffering--and I hope all will one day

recover from this side effect that ruins the lives of so many of us.

Never give up--and keep an open mind-

regards.

stan.

Here is an article which some may not have seen before- with regards to Audry

Bahrick- a pioneer in SSRI Sexual dysfunction.

clinical Psychology and Psychiatry: A Closer Look:

Psychiatric medications, science, marketing, psychiatry in general, and

occasionally clinical psychology. Questioning the role of key opinion leaders

and the use of " science " to promote commercial ends rather than the needs of

people with mental health concerns.

Sexual Side Effects of SSRIs: Even More Troubling

I just bumped into a very interesting gem of an article by Dr. Audrey Bahrick, a

psychologist at the University of Iowa University Counseling Service, which

deals with SSRI-induced sexual side effects.While we are all aware that sexual

side effects are common with SSRIs, the general assumption that these side

effects are transient and that they vanish within a few weeks or when medication

is terminated.Indeed, that the SSRIs cause a decrease in males' perception of

sexual pleasure has led some to believe that SSRIs should be used to treat

premature ejaculation.

As Dr. Bahrick aptly points out, there is no evidence that SSRI side effects

disappear.Indeed, sexual side effects can be long-lasting.

She starts out by noting " Depending on definitions of sexual dysfunction and

methodology, post-market prevalence studies have found rates between 36% and

98%. The 5 to 15% rates of SSRI and SNRI-induced sexual side effects listed in

the current drug-insert literature are based on information obtained in the

initial trials via spontaneous reports of individuals who had been on the

medications for a short time. The differences in reported rates between the

pre-market trials and post-market prevalence studies are an artifact of

methodology; we now know that when individuals are directly asked about their

experience of sexual side effects via either a structured clinical interview or

a self-report inventory, we obtain vastly different rate information than if we

rely on individuals to spontaneously volunteer personally sensitive information

about changes in sexual functioning. "

It was easy to NOT find sexual side effects by making sure to not look for

them!Likewise, she notes that although researchers have now noted that sexual

side effects occur, they have avoided asking if they persist upon treatment

discontinuation. To top if off, researchers have designed measures of sexual

side effects that may miss some of the most common and impairing sexual side

effects. Note what Bahrick has to say about these effects, which include

" …erections that may be easily achieved and maintained yet are numb or nearly

numb; orgasms that are preceded by little sense of building arousal and are

experienced as pleasureless or nearly so; and genitals that respond to touch by

erection or lubrication but without attendant subjective feelings of arousal.

Aspects of normal sexual functioning seem to be mimicked without the attendant

capacity to experience pleasure. While SSRI/SNRI-related decreased genital

sensation or genital anesthesia, and decreased orgasmic intensity or ejaculatory

anhedonia are reported to be uncommon, it is more accurate to say that they are

uncommonly assessed. Our literature appears to be building upon the assumption

that the symptoms are rare by failing to systematically include such symptoms in

our instruments, and by failing to transparently report them when they are

included. "

She points out that the most common measure of sexual side effects does not

include an item on genital anesthesia.Additionally, " The instrument does include

an item related to reduced pleasure of orgasm and its severity.However the item

is not separately scored, but rather folded in with two other items related to

frequency and timing of orgasm. "

Zajecka and colleagues examined these symptoms in a 1997 publication, yet the

data were apparently not reported fully.According to Bahrick, there is only one

study (Montejo et al., 1999) that has examined the emergence of sexual side

effects after cessation of SSRI medication.In this study, patients who had

experienced significant reductions in depressive symptoms in response to an SSRI

were switched to amineptine (which impacts the dopaminergic system and

noradrenergic systems to a much greater extent than it impacts serotonin) or to

Paxil.A third group received amineptine only (they were not switched from an

SSRI).Amineptine-only treatment resulted in 4% incidence of sexual dysfunction,

whereas the switched-to-Paxil group had an 89% incidence of sexual dysfunction,

and the switched-to-amineptine group decreased from a 100% to a 55% incidence of

sexual side effects.Mind you, these treatments lasted for six months, so those

who switched to amineptine, a drug that rarely induces sexual side effects,

still had a high rate of sexual side effects six months after SSRI treatment

discontinuation.

In Bahrick's article, an internet community known as SSRIsex is described, in

which discussion of post-SSRI discontinuation sexual side effects is

prominent.Indeed, the group is reported to have coined the term Post SSRI Sexual

Dysfunction (PSSD).In addition, two case reports (here and here) have been

published in 2006 regarding PSSD.

In sum, there is emerging evidence from case reports, an internet discussion

group, and at least one empirical study that SSRI-induced sexual dysfunction may

last longer than previously thought and is causative of genital anesthesia,

ejaculatory anhedonia, and decreased orgasmic intensity.

Here's hoping that more thorough investigation of this topic will be done.I have

a feeling the investigation will occur at about the same time a new

antidepressant emerges that does not cause sexual side effects.Wellbutrin has

gone generic, so there is no incentive for its manufacturer (Glaxo-Wellcome) to

demonstrate the prevalence of long-term SSRI side effects or of the other

treatment-emergent side effects mentioned above.

In fact, I'll lay down an idea here.A drug company could make a me-too ripoff of

bupropion (Wellbutrin) and then conduct these very studies on the sexual side

effects of SSRIs.Wellbutrin tried to market their drug in such a fashion.Indeed,

I'll not soon forget the Wellbutrin commercial with the man getting on the horse

while talking about a lack of sexual side effects.Freud must have been rolling

over in his grave!Maybe Wellbutrin's campaign did not go far enough – they

should have sponsored more research on the topic.Or maybe reboxetine can be

pulled off the shelf (Are you listening, Pfizer?) and run through trials for FDA

approval, though one should read the following case study regarding reboxetine

due to its bizarre nature. In any case, if we assume that further research would

find long-term sexual side effects related to SSRI's, there is actually money to

be made by making an antidepressant that does not cause sexual side effects, so

step to it! Or, God forbid, we can start referring depressed patients for

psychotherapy due to its propensity to not cause sexual side effects and its

better long-term performance?Nah, that's crazy talk!

Read the full text of Dr. Audrey Bahrick's excellent article here.Alas, this

link will cease functioning at some point soon because Div. 55 of the APA

apparently does not provide a permanent link to back issues of their

publication.Email me if the link is broken and you'd like a copy.