POZ Community Forums
Main Forums => Living With HIV => Topic started by: lydgate on July 14, 2006, 11:35:55 am
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Just read an earlier thread, started by Hermie, about how many people take anti-depressants. I'm guessing that the majority of those on ADs have experienced some form of sexual dysfunction, either transient or chronic. Either loss of libido, erectile failure (in men), delayed orgasm or even anorgasmia. (I think tar heel mentioned that taking Prozac makes it more difficult to coax "Junior" to cum.) I'm wondering what people have done specifically to combat this common and exasperating side effect (or bunch of side effects) -- switched drugs, augmented with another drug, gone off meds, just put up with it.... What's worked and what hasn't?
Jay
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This is an interesting topic! I've been taking Prozac for 1.5 months now for anxiety and panic attacks. I'd never had these before... it seems the HIV+ diagnosis affected me more than I thought. I felt the benefits of the Prozac within a week. I also started to feel the sexual side effects. It's not that I don't enjoy sex now; it's as good as ever. It's not that I can't get erect; that works too. It takes so damned long to finally finish! When I do, it's really good. It almost seems like the Prozac makes me feel so good in general that sex doesn't add as much pleasure as it did in the past. I was telling a friend about it. I told her that it's like driving a car to a specific destination. Instead of the interstate, as in the past, I now take the scenic route and enjoy that as much as the destination... if I even have enough time to get there! It's weird to me, 'cause sex has always been very high on my list of important things. Now, I just feel so good all the time that it's well worth these side effects.
I guess the severity of the side effects depends on the dosage, too. I take 20 mg per day. If the side effects were a lot worse, I might feel differently about the Prozac. I also take Adderall for ADD. It seems to speed my metabolism up (it is an amphetamine, after all) and increases the intensity of some drugs. With my experiences, I'd highly recommend Prozac and Adderall! ;)
David
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I'm currently on Wellbutrin XL, which supposedly has 'no sexual side effects', but I'm not entirely sure that is correct.
In the past, Zoloft DEFINITELY had an effect (negative), Prozac and Effexor also, not sure about Remeron, I was so knocked out on that drug I can't remember if I had any sex drive or not....
My solution: Levitra, or if drastic measures needed, caverject
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I've been on both Celexa and Wellbutrin for years, both before and after my diagnosis. I've also had many different dosages, currently on 10 mg of celexa and 300 mg of Wellbutrin XL/daily. When I first started taking Celexa years ago, I had the "takes a long time to reach orgasm" side affect. I've had no sexual side affects for years.
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I was on Celexa in the past, and had the "hard to achieve orgasm" side effect. It was sort of frustrating. It would either take a l-o-n-g time to happen, or would just not happen at all. I am now on Zoloft, and my libido is less, but I am not sure if that is from the Zoloft, or that I have just not felt real well this past year.
Alan- I was on Remeron also. I slept for 6 weeks straight, almost all day, and all night. It was horrible.
Christine
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Christine and Alan -- I took one dose of Remeron, slept for 28 hours straight, pretty much, and felt groggy for two days after. Seriously. NOT the drug of choice for people who are sensitive to anti-histamines.
Alan -- Are you on Wellbutrin XL as monotherapy (and what dose) or are you combining/augmenting with something else? And the Levitra and Caverject -- these can help with erectile problems of course, but do they also help with the delayed orgasm/no orgasm problem?
Steve -- Did you stop having the sexual side effects by adding Wellbutrin? Or lowering the Celexa dose? Or did they just go away with time?
David -- That's super that you're enjoying the scenic route! And you're on a pretty standard dose of Prozac (the side effects of Prozac and its SSRI siblings are definitely dose-related).
Jay
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I was briefly on Wellbutrin (Zyban) three years ago and experienced no sexual side effects. I was wondering if anyone has experience with Cymbalta (http://www.cymbalta.com/index.jsp)?
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Hello ,
I have never been on Anti-depressants. I was given a one month trial of amitriptyline, that I will start on Monday. I have gone through several periods of erectile dysfunction,/ and low drive, throughout the past three years. Currently My sex drive isn't that bad, but it is certainly not as frequent as it used to be. Plus Im 54.
But, I will be curious as to what side effects this amitriptyline may produce. I am hoping it will help with the neuropathy.
Ray
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Jordan -- Choosing the right anti-depressant, the one you have a great "fit" with, the one that works without seriously disruptive side effects -- well, that's always a bit of a mug's game. Trial and error plays a big part in psychiatry. Are you experiencing symptoms of clinical depression? If so, seeing your PCP and then a psychiatrist is pretty important. Cymbalta (duloxetine) is similar to Effexor (venlafaxine). They're both SNRIs (more on the chemistry of all this if anyone is interested) and have similar side effect profiles. The thing with ADs, though, is that one drug at a certain dose might work very well for X but not at all for Y; similarly with side effects. Some people report that Cymbalta is better for sexual dysfunction than Effexor and the SSRIs; some people say it's the same, even that it makes you dead below the waist. In other words, your mileage may vary greatly from the next guy's. Eli's massive "Where does depression hurt?" campaign is being run because the company hopes to capture a greater share of the AD market, since Prozac is no longer patent protected.
One psychiatrist, though, did say to me that he'd had a very poor experience with Cymbalta in terms of efficacy (compared to the SSRIs and with Effexor or Wellbutrin), that he'd pretty much thrown away the remaining Cymbalta samples that Eli Lilly had given him. But of course, that's just one p-doc's experience/opinion, hardly scientific fact. Psychiatrists in general will be more comfortable in prescribing an SSRI (Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro) or Effexor or Wellbutrin or maybe even Remeron -- most have been around longer and extensively studied.
Ray -- Has your doctor prescribed amitriptyline for peripheral neuropathy or for depressive symptoms or both (and at what dose)? If solely for depression it's a somewhat odd first choice, so I'm guessing it's for the PN or both PN and mild depression. In terms of efficacy, as good as any of the newer drugs that started coming out in the mid-80s, in fact the TCAs might even have a slight edge here. But there bothersome side effects and greater overdose potential, so tricyclics are generally not used as first-line treatment. As for low sex drive -- so what if you're 54! Get your testosterone levels checked, especially if you're feeling tired, and augment if necessary; the virus and the meds can do funny things with your body's production of testosterone.
Jay
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Jay,
It's primarily for the neuropathy. I had some discussion with this the other day at his office. These pills were samples that he gave to me in his office.
I had to get a magnifying glass. The pill has MP 25 on one side, (nothing on the other)
AND this is great... there are some pills in this batch also have GG 44 on them (one side only)
Great !! now I am wondering whether I have differant types of pills here, or if they are the same !!!
Dammit !!
JUST WANT TO ADD, THE PILLS LOOK IDENTICLE
Ray
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Jay,,
Just to add, I just looked the pills up. Even though they are differant markings, they are both 25 MG.
The Same....
Ray
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I take 20mg Citalopram , when i first started taking it i had real problems but that has lessened quite considerably in the last few months
Garry
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I had that kinda trouble while on Paxil. Then I changed to Remeron, fine and dandy since 8)
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After the hurricane my doctor offered to put me on one of the more popular anti-depressants(Zoloft) ...I chose not to start the regiment. Instead I have Ativan on hand...for those times when I feel I need to chill out. Sexual side effects...hmm! I'm still waiting for the sex part :P
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Hi All
I was on Prozac (20mg) but while I kind of enjoyed the hyped up state of my mind it did affect me. On the Moh scale of hardness I went from Diamond to Gypsum. The real pisser was that I had flown all the way to the Czech Republic from London soon after starting. It is meant to take three weeks to kick in but I seemed to notice the 'buzz' almost immediately. It did not help my fledgling relationship but a bit of imagination can go a long way.
One night I took it in combo with my meds including Sustiva at the time, smoked a joint and then knocked back some Czech 60% Absinthe. Crazy I know. I was going thru a Hunter S Thompson phase. I got very paranoid and watched the Luc Besson film about Joan of Arc at the same time. I was having delusions of granduer convinced that I was a latterday incarnation. I then watched a James Wood's film about a mass murderer who was convicted of one murder but was talked into writing a full confession to another 22 murders by a trusting a religious guard. He got the chair as a result, apparently a true story. I took this second movie as a warning that were I to write my sexual history I would suffer the same fate, even though I was untested back during this Casanova period. This was due to my brain addled state of course. I woke the next day and read some of my scribblings. I felt fine and my recorded thoughts made fun reading.
Sorry to go off the subject slightly.
It does make me wonder about prescribing a drug that can reduce libido to varying degrees to people with an STI. Kind of like giving Bromide to soldiers in their tea during WWI.
I ascribe to the idea of 'Hugs not Drugs' and am still paying off my credit card after the Prozac also triggered a spending spree. A noted side effect is that it makes you very adamant. One cannot understand when people do not agree with you.
I stopped Prozac after switching to Viramune as I thought the Sustiva was making me depressed. I have good days and bad days but 'Junior' is back to normal. I meet another lady months after stopping Prozac. We were on holiday for ten days and had intimate relations everyday. It can depend on the person and shared chemistry.
Cheers Aldous
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I take WellbutrinXL and have no sexual side effects whatsoever. Not that I ever get a chance to take advantage of that.. but my hand has never been disappointed. ::)
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Jay,
I'm on Wellbutrin XL 300, once a day. I was also taking Lexapro, but felt that it was not doing much.....tried adding an 'oldie' Prozac, but it only seemed to give me frequent headaches. So yes, just the Wellbutrin alone is all I am currently taking.
Seems like several of us had the same experience with Remeron.....I lost about 3 days of my life, it was just like being put to sleep in the hospital....how could anyone take that and FUNCTION?
I'm afraid the Levitra and the caverject don't offer any 'assistance', as far as difficulty reaching an orgasm. This can be very exasperating, can't it?
Good luck,
Alan
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Alan,
So the delayed-orgasm problem (maybe "taking the scenic route" should become the official euphemism for this) on the Wellbutrin alone? I'm assuming you started with the 150XL; any problems then? And when was the last Prozac you took? That has a very long half-life and can take a month to be fully flushed out of your body.
I'm thinking of trading in Effexor forWellbutrin, or using both at low doses; we'll see.
As for the Remeron thing: theoretically, the higher the dose, the less sedating it is, because at higher doses it affects the norepinephrine, activating, receptors as well. So 45 and 60 are, paradoxically, less sleep-inducing than 15 or 30. But I know I'll never take it again; mirtazapine (Remeron) is a strong antagonist of the h1 histamine receptor, basically allowing more histamine to remain in your body. Even one-third of a teaspoon of Benadryl knocks me out cold; as I said, very sensitive to anti-histamines, so no more Remeron for me.
Jay
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Jay,
I've been on Wellbutrin for so many years, I honestly can't remember when I started it (NOTE TO NEWBIES: KEEP A JOURNAL!), but yes I did start at the lower dose.
I've been 'chemically altered' for so many years, I am not sure how much of the orgasm problem is due to the antidepressant drugs, how much is due to AIDS, how much is due to me being almost 50.....I say it all the time, I've so far removed from "Normal" that I can't even remember what Normal feels like.
Oh, and I'm not sure if it was the Prozac causing my headaches, or Truvada which I started in May....I sure do seem to have a lot of them lately. Anyone else having Truvada headaches?
Alan