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SSRI long term damage/risk thread

ssri serotonin antidepressant anxiety depression attention adhd libido long term

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#1 brainslugged

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Posted 22 May 2013 - 04:30 PM


Considering that I will be at a psychiatrist in a few hours, complaining about social anxiety and attention problems, there is a moderate chance that I will be given an SSRI.

So, this thread is for assessing the risk of taking an SSRI, mostly in terms of long term risk (post cessation).

There are often claims of long term effects of SSRIs unsupported by research.

The goal of this thread is to assess the risks based on scientific evidence and scientific reasoning as well as talk about preventative measures.

Short term effects (ie: those while on the SSRI that diminish after quitting) are not as important, as you can obviously stop the medicine if you find them to be unbearable.

My main areas of interest are SSRIs with respect to (long term)
  • motivation
  • emotion/affect blunting
  • libido
  • concentration/focus
  • memory
  • pleasure
  • "Brain Zaps"
  • effects in the ADHD population
  • effects in the Personality Disordered population (specifically avoidant and schizoid)

If you have another concern, please bring it up.

Anecdotes are welcome but will not be considered evidence.

#2 brainslugged

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Posted 22 May 2013 - 10:50 PM

Yep, appointment was less than 5 minutes. Didn't even get to explain anything, really. I am in a bad mood, waiting a month and paying for the psych and then this.

To celebrate, here are a few studies about long term negative effects that can be found on the wikipedia page of the drug he gave me, paxil (Paroxetine)

http://www.ncbi.nlm....pubmed/16456219

Chronic paroxetine treatment may lead to 5-HT2-receptor down regulation, with desensitization of 5-HT1A and 5-HT2 receptors, which may contribute to tardive rebound symptoms upon abrupt withdrawal

-Tardive anxiety and panic attacks...

http://www.ncbi.nlm....pubmed/18173768

SSRIs can cause long-term effects on all aspects of the sexual response cycle that may persist after they are discontinued. Mechanistic hypotheses including persistent endocrine and epigenetic gene expression alterations were briefly discussed.

-Confirming long term sexual dysfunction after quitting.

http://www.ncbi.nlm....pubmed/11565624

Paroxetine specifically impaired delayed recall in a word learning test at a dose of 20 and 40 mg... The additional anticholinergic effects of paroxetine could account for its induction of long-term memory impairment.

Okay, so this is presumably not long term, but anticholinergic effects??? Good news is that Zoloft actually seems to be good for working memory.

http://www.ncbi.nlm..../pubmed/8654061

Three cases of akathisia were reported in 67 patients treated with paroxetine

-Long term effects are unknown from what I gather. Would be nice to see if akathisia goes away upon discontinuation.

http://www.ncbi.nlm....arch&querykey=1

We report a case of a 26-year-old male who experienced genital anaesthesia during sertraline treatment and continued to be symptomatic despite medication discontinuation 6 years previously

-Although it is admittedly rare, 6 years!?!?!?

I will try to find some better ones that aren't on wikipedia, but I am trying to figure out what to do right now. Leaning away from taking the paxil (or getting it filled for that matter). I don't know, got my hopes up too much, I guess.
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#3 Rior

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Posted 23 May 2013 - 02:01 AM

Having taken SSRIs before, they can absolutely leave some lasting mal-effects. My cognition feels lesser than it was before I was taking mine (Zoloft) even 6 months after cessation, and I have some post-ssri libido issues.

There are people on here that have taken SSRIs and it has been a godsend--however, in my honest opinion, unless you are literally -unfunctional- it's not worth taking an SSRI. Even if you have debilitating social anxiety, there are better routes to take that won't leave with lasting problems.
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#4 brainslugged

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Posted 23 May 2013 - 04:36 AM

Having taken SSRIs before, they can absolutely leave some lasting mal-effects. My cognition feels lesser than it was before I was taking mine (Zoloft) even 6 months after cessation, and I have some post-ssri libido issues.

There are people on here that have taken SSRIs and it has been a godsend--however, in my honest opinion, unless you are literally -unfunctional- it's not worth taking an SSRI. Even if you have debilitating social anxiety, there are better routes to take that won't leave with lasting problems.

Thanks for the personal account. How long did you take it for? I am wondering if taking it for a month or two just to say I tried it would hurt.

I am probably not going to take it. The social anxiety is... livable.

On the other hand... how am I going to lie and say that I tried it? I am horrible at lying like that. The goal is to eventually get full evaluation and stimulants diagnosed for attention problems... but I am not going to lie to get there. Or, more like, I can't lie to get there.

What are the chances that adverse effects persist, especially after a few months? That is what I want to know.

#5 Rior

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Posted 23 May 2013 - 07:20 AM

If you want a diagnosis for attentional problems, seek out an attentional therapist of some sort. Basically, find someone who's willing to run the diagnostic tests that show you have attentional issues. You don't need your psychiatrist's diagnosis for that (I was diagnosed with ADHD-PI by someone entirely different than my psych). I took Zoloft for about 7 months, and it helped with some issues I had, but I also feel as if I could have conquered them without the use of Zoloft. I feel like I'm in a much better place now without it. I still had anxiety while on the Zoloft, just lesser. Taking bacopa monnieri right now is helping me substantially more than the Zoloft did.

In terms of persisting adverse effects, it's going to change person to person. One person could take an SSRI continuously for 8 months and get no residual effects, and another could take it for 2 months and have horrible residual effects. All in all, though, SSRIs feel kind of like a thing of the past. We may not have yet surpassed them with better pharmaceuticals, but I certainly feel like we're getting close. I've got a very jaded view towards SSRIs

#6 brainslugged

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Posted 23 May 2013 - 07:42 AM

If you want a diagnosis for attentional problems, seek out an attentional therapist of some sort. Basically, find someone who's willing to run the diagnostic tests that show you have attentional issues. You don't need your psychiatrist's diagnosis for that (I was diagnosed with ADHD-PI by someone entirely different than my psych). I took Zoloft for about 7 months, and it helped with some issues I had, but I also feel as if I could have conquered them without the use of Zoloft. I feel like I'm in a much better place now without it. I still had anxiety while on the Zoloft, just lesser. Taking bacopa monnieri right now is helping me substantially more than the Zoloft did.

In terms of persisting adverse effects, it's going to change person to person. One person could take an SSRI continuously for 8 months and get no residual effects, and another could take it for 2 months and have horrible residual effects. All in all, though, SSRIs feel kind of like a thing of the past. We may not have yet surpassed them with better pharmaceuticals, but I certainly feel like we're getting close. I've got a very jaded view towards SSRIs


I see. Well, I have decided, I think, against the paxil. Considering that I have reacted poorly to serotonin-increasing supplements in the past and the fact that there is a moderate risk factor with SSRIs, I don't think I wish to take them. I am extremely adverse to the idea of emotional dampening of any sort, and my goal thus far has been to conquer my issues with my emotions unhindered, so to speak. Things like theanine to calm me occasionally, I accept, but I don't think I want desensitization of receptors that control arousal or anything of that sort. I feel as though I have made some progress like this, and I will continue with this mindset until the problem is either solved or impossible.

Bacopa unfortunately had no noticeable effect on me when I took it for a few months.

I was unaware of that about the ADHD diagnostic test. Either way, I am probably going to have to get the anxiety in control a bit more before I attempt that. As it is, talking about problems of any sort to an authority figure tends to make me extremely anxious. However, since this is obviously behavioral (I don't get anxiety at all in certain social situations), I believe it can be solved with self-CBT. Overall, I think this is a better approach than throwing SSRIs at it and desensitizing myself in order to be able to handle it.

Not to sound hypomanic here (although I haven't slept in a day, so it there may be a big mood increase right now, lol), but I believe that by countering the difficulties in the troubled state while my emotions are "overly sensitized", I can rid myself of the negatives and be left with the positive, that I do tend to have large amounts of emotional capability to feel good in social situations or to empathize when I am not troubled by self-esteem or anxiety (although I could be getting carried away or being narcissistic here).

Anyway, thank you for helping my in my own little personal crisis :) They happen quite often, ha ha, and they are always resolved much better when I have help.

NOW, back to SSRI studies. I will scour around some more tomorrow. I hate derail my own thread, lol.

#7 blood

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Posted 24 May 2013 - 05:18 AM

Very long term use of SSRIs may increase risk of osteoporosis & bone fractures.

article: http://www.wellnessr...ajor_bone_loss/

SSRIs may have many neuroprotective effects. See the Wikipedia entry on SSRIs - particularly the "mechanism of action" section.

#8 chung_pao

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Posted 24 May 2013 - 07:04 AM

Anecdotal report of fluoxetine:
It didn't help me at all. It did not brighten up my mood. It elevated my serotonin. Nothing else.
I became an unmotivated, over-eating zombie of a man. Devoid of testosterone or any desires (other than food and sleep).

For me, ampakines and focusing on my hormonal levels have been more effective. This makes me incredibly motivated and much happier.
IMO, happiness is not a state of sedated calm or contentedness that SSRI's bring about. It's a state of excitement and purpose.
The mechanism of action of SSRI's antagonise this state, and bring about a parasympathetic rest-and-relax physiological state.
I took SSRI's for 6 months and had family members do the same. I know people on SSRIs who have continued to take the medication and withered in character and personality as a result.
I can not recommend it. Instead, I think you should address the actual issue (environment, stimuli...) while focusing on performance enhancement, as most diseases are a state of suppressed ability of the body to perform.
I'm just ranting from personal experience, trying to offer something useful.

Edited by chung_pao, 24 May 2013 - 07:06 AM.

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#9 blood

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Posted 24 May 2013 - 09:15 AM

I take velafaxine.

It is helpful to me. If I had to describe its effects or benefits in a nutshell, I'd say it gives me a more resilience for dealing with unavoidable sources of stress (e.g., people, work).

I'll need to come off it at some point - the bone weakening effects of very long term SSRI use are sobering.

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#10 HeyItsMeLC

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Posted 25 May 2013 - 01:15 AM

Save yourself! Run!

SSRIs are poison. They can be a Godsend, and for me they surely gave me my life back at the time, but I was in such a deep dark hole there was no other way out at the time.

On the other hand I am fairly confident it permanently destroyed my libido. (PAXIL). Oh also, as an added bonus I gained 60+ pounds

Please look into natural alternatives. Depression and Anxiety can be successfully managed without drugs.

Edited by HeyItsMeLC, 25 May 2013 - 01:18 AM.

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#11 blood

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Posted 25 May 2013 - 01:47 AM

On the other hand I am fairly confident it permanently destroyed my libido. (PAXIL). Oh also, as an added bonus I gained 60+ pounds


I guess I got lucky with my response to venlafaxine... my libido ramped up (almost to uncomfortable levels initially, at times), and I had a noticeable loss of appetite, which eventually had a very pleasing slimming effect on my waist. It's a bit of a crap shoot with SSRIs I suppose. I tried a few til I found one I was happy with.

Edited by blood, 25 May 2013 - 02:33 AM.


#12 HeyItsMeLC

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Posted 25 May 2013 - 02:07 AM

On the other hand I am fairly confident it permanently destroyed my libido. (PAXIL). Oh also, as an added bonus I gained 60+ pounds


I guess I got lucky with my response to venlafaxine... my libido ramped up (almost to uncomfortable levels), and I had a noticeable loss of appetite, which eventually had a very slimming on my waist. It's a bit of a crap shoot with SSRIs I suppose. I tried a few til I found one I was happy with.



Reports
On December 20, 2006, the database of Netherlands Pharmacovigilance Centre
Lareb contained three reports concerning sexual disinhibition associated with the
use of venlafaxine.
Patient A is a male aged 26 who was using venlafaxine 37.5 mg twice daily.
Indication for use was not reported. After seven weeks he experienced increased
libido and sexual disinhibition. It was assumed that the effects would disappear
with time, but symptoms persisted and the venlafaxine dosage was reduced. At the
time of reporting the patient had not recovered. No concomitant medication was
reported.
Patient B is a male aged 34 who was using venlafaxine 75 mg once daily.
Indication for use was not reported. After 2-3 days of treatment he reported a libido
increase, which he considered to be very disturbing. Venlafaxine was withdrawn,
patient outcome is unknown. No concomitant medication was reported.
Patient C is a female aged 45. She has a medical history of depression. She used
venlafaxine for depression in increasing doses, first 75 mg twice daily and
thereafter 75 mg three times daily. Ten days after the dose increase she
experienced a libido increase which she describes as disturbing. Dose was
reduced to 37.5 mg once daily. Patient outcome is unknown. No concomitant
medication was reported.


Mechanism
Norepinephrine facilitates libido and erections [2]. It has been reported that
ephedrine, an α-adrenergic and β-adrenergic agonist significantly can facilitate the
initial stages of psychological sexual arousal in women [5]. Venlafaxine enhances
norepinephrine transmission and could therefore lead to libido increase in patients
treated with this drug.
The re-uptake of dopamine is inhibited while using venlafaxine [1]. It has recently
been shown that drugs that increase dopaminergic transmission, i.e. drugs that are
used in the treatment of Parkinson’s disease, can cause sexual disinhibition [6].

Conversely I have read many forum users complaining about loss of libido on Effexor. Remember though its a SNRI, so there is a mechanism there for increased libido with the Norepinephrine...

#13 nowayout

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Posted 25 May 2013 - 03:17 PM

There is some research indicating that SSRIs can inhibit the HPT axis (i.e., they inhibit testosterone production). You can google or pubmed it. Maybe that is respoinsible in part for the sexual side effects in men but most likely just in part.

I have seen anecdotal reports of increased sexual functrioning when combining an SSRI/SNRI with mirtazapine. The latter inhibits some of the serotonin receptors that are thought to reduce sexual functioning when using SSRI/SNRIs alone.

Edited by nowayout, 25 May 2013 - 03:23 PM.


#14 nowayout

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Posted 25 May 2013 - 03:26 PM

Something else that has to be taken into account is the deleterious effect on lipid profiles of some antidepressants. I have seen research to this effect on sertraline but it is most likely true for all of the SSRI/SNRIs, as well as some of the tricyclic and atypical antidepressants.

I think the take-away is that these are some serious drugs and should not be prescribed as life style drugs.

Edited by nowayout, 25 May 2013 - 03:27 PM.


#15 HeyItsMeLC

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Posted 25 May 2013 - 10:47 PM

nowayout: good point, have also seen anecdotal evidence of pro sexual effects with Remeron.

I also agree these are serious drugs and should only be used a last resort.

#16 Sunwind

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Posted 26 May 2013 - 12:13 AM

I was on Citalopram for 2 years (SSRI) and I could stop abruptly and start re-taking it with no problem whatsoever. the only side-effects while taking it were low libido and anorgasmia, but those went away whenever I stopped.

I tried Mirtazapene, it made me feel like I was drunk+sick and I couldn't last longer than 3 days on it.

Finally tried Venlafaxine, started at 75mg, felt sick at first but perservered, eventually symptoms went away after a few weeks, the last week I had very bad fatigue too. I got bumped up to 150mg, had minor headaches during the transition, didn't last long, then eventually up to 225mg, no problems. The side effects I get are just low libido and anorgasmia. I stopped taking them a month ago because I wanted to do some MDMA, I felt fine after stopping and I felt like my emotions came back (must have been blunting them) so I didn't take them again. My depression came back in full force and I started taking the full 225mg again after 1 month of being off them. I felt like death for 2 days, but smoking weed after taking it made it quite bearable. Again, the side effects I experienced while taking it went away when I stopped, nothing has been permanent.

Just wanted to show another side to this.

#17 nupi

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Posted 26 May 2013 - 10:59 AM

A 6 month course of Venlafaxine ten years ago left me with delayed ejaculation (some would argue that is a benefit) but other than that, side-effects did not seem to persist upon discontinuation. Despite Venlafaxines particularly bad rap when it comes to discontinuation, I had no issues whatsoever getting off it.

Right now, on Fluxoetine, the only major side effect is low motivation (and low libido but that never bothered me - in fact I somehow can't wrap my head around why people are disturbed by it) but I am not so sure I want to give up the upsides because of that.

#18 Sunwind

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Posted 26 May 2013 - 11:02 AM

A 6 month course of Venlafaxine ten years ago left me with delayed ejaculation (some would argue that is a benefit) but other than that, side-effects did not seem to persist upon discontinuation. Despite Venlafaxines particularly bad rap when it comes to discontinuation, I had no issues whatsoever getting off it.

Right now, on Fluxoetine, the only major side effect is low motivation (and low libido but that never bothered me - in fact I somehow can't wrap my head around why people are disturbed by it) but I am not so sure I want to give up the upsides because of that.


Is there a reason why people / us have no problem withdrawing from certain things? Is that indicative of any certain mental problems do you know?

#19 nupi

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Posted 26 May 2013 - 01:32 PM

Good question - despite having used probably in excess of a 100 Lorazepam pills (mixed with some Diazepam), I had no issues getting of the benzos, either. I also never got addicted to cigarettes despite being a social smoker. The only thing were I actually see as risk is beer/wine but even there, if I don't have time to drink, I won't miss it. It's more of way to kill time, I guess (also, while I do get drunk, I sadly derive very little (social) disinhibition from booze, mainly it causes me to drink some more on the same evening..).

I also do have a very high tolerance for caffeine (3-4 espresso by 9am is totally normal) and while I will be grumpy if I do not get my coffee, it does not seem to cause any real withdrawal. 23andme lists me as a fast metabolizer of caffeine, maybe it's related to that?

Edited by nupi, 26 May 2013 - 01:36 PM.


#20 Sunwind

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Posted 26 May 2013 - 01:36 PM

Good question - despite having used probably in excess of a 100 Lorazepam pills (mixed with some Diazepam), I had no issues getting of the benzos, either. I also never got addicted to cigarettes despite being a social smoker. The only thing were I actually see as risk is beer/wine but even there, if I don't have time to drink, I won't miss it. It's more of way to kill time, I guess (also, while I do get drunk, I sadly derive very little (social) disinhibition from booze, mainly it causes me to drink some more on the same evening..).


I have came off benzos twice now also, it took two weeks at the most and while I felt shitty it was easily doable and didn't take very long

#21 nowayout

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Posted 26 May 2013 - 05:08 PM

Right now, on Fluxoetine, the only major side effect is low motivation (and low libido but that never bothered me - in fact I somehow can't wrap my head around why people are disturbed by it) but I am not so sure I want to give up the upsides because of that.


That's the fluoxetine talking. Your mind has been snatched by a foreign entity my friend. :)

Motivation, including but not confined to motivation to be socially adventurous, is closely related to libido, in my experience.

Edited by nowayout, 26 May 2013 - 05:09 PM.


#22 nupi

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Posted 26 May 2013 - 08:04 PM

It's actually not the Fluoxetine (or any AD, really). I have long since wondered why the lack of libido would bother people - I can see why ED coupled with normal libido would be bothersome but lack of libido itself is not bothersome the least. You doj't miss what you miss,if you want.

motivation to be socially adventurous, is closely related to libido, in my experience.


I never really had the desire to be socially adventurous (or adventurous at all, when I think about it), so that may explain it. If anything, I am scared of it.

Edited by nupi, 26 May 2013 - 08:05 PM.


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#23 nowayout

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Posted 26 May 2013 - 08:32 PM

It's actually not the Fluoxetine (or any AD, really). I have long since wondered why the lack of libido would bother people - I can see why ED coupled with normal libido would be bothersome but lack of libido itself is not bothersome the least. You doj't miss what you miss,if you want.

motivation to be socially adventurous, is closely related to libido, in my experience.


I never really had the desire to be socially adventurous (or adventurous at all, when I think about it), so that may explain it. If anything, I am scared of it.


I can somewhat relate to this. In the past couple of months, something has turned off my libido completely; it's just been nonexistent. I suspect eszopiclone (Lunesta) I take for sleep. What's interesting is that I can't get worked up about it.

As a result (I think), I haven't had the desire to do anything but staying home reading, and that's how I've spent all my free time. No social impulse at all. Going out to bars or clubs has always been a negative experience for me, but at least previously I would force myself to go in the hope of maybe one day meeting someone attractive, but that motivation is gone; I wouldn't even be able to get aroused enough to get it up with a supermodel. I can't even be bothered to call anybody back to keep up the little social life I had. I know intellectually I should be bothered with this and that I may have regrets later that I have been wasting my life, but I can't seem to get emotionally bothered by it. Normally I would be bothered by it, so I'm pretty sure it's the pill talking. When night comes and I get to the point where I have to choose between being able to sleep or having a life, I just take the damn pill.

I know it is not an SSRI but my point here is that I think sexual motivation and social motivation are two sides of the same coin.

Edited by nowayout, 26 May 2013 - 08:49 PM.


#24 protoject

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Posted 26 May 2013 - 10:11 PM

I just created a new thread about this, maybe I shouldnt have.. i didnt see this one first. Anyway. Just wondering did anyone experience long term or permanent issues from dosing with low doses of escitalopram? 2.5 mg doses or less. Thanks.

#25 nupi

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Posted 27 May 2013 - 05:23 AM

I can somewhat relate to this. In the past couple of months, something has turned off my libido completely; it's just been nonexistent. I suspect eszopiclone (Lunesta) I take for sleep. What's interesting is that I can't get worked up about it.

As a result (I think), I haven't had the desire to do anything but staying home reading, and that's how I've spent all my free time. No social impulse at all. Going out to bars or clubs has always been a negative experience for me, but at least previously I would force myself to go in the hope of maybe one day meeting someone attractive, but that motivation is gone; I wouldn't even be able to get aroused enough to get it up with a supermodel. I can't even be bothered to call anybody back to keep up the little social life I had. I know intellectually I should be bothered with this and that I may have regrets later that I have been wasting my life, but I can't seem to get emotionally bothered by it. Normally I would be bothered by it, so I'm pretty sure it's the pill talking. When night comes and I get to the point where I have to choose between being able to sleep or having a life, I just take the damn pill.

I know it is not an SSRI but my point here is that I think sexual motivation and social motivation are two sides of the same coin.

It could also be a form of atypical depression... Did you try switching Eszopiclone for another sleeping medication?

In my case, the reading is partially replaced by watching movies but the point stands (I was never much of a fiction reader and usually can't be bothered to get started with books although if I do, I generally do finish them). But the "I know intellectually I should be bothered with this" or wasting my life part sounds pretty familiar. Unfortunately, choosing between being depressed and anxious (and not really doing anything productive with live, either with all motivation coming from anxiety) and being in a sort of SSRI lull that at least takes care of the anxiety to some degree, the SSRI clearly does win out. It of course does not help that I have pinched nerve in my neck that prevents me from doing sports since 2 months and typing quite painful (physiotherapy is slowly making it better but it will be a while still)...

#26 brainslugged

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Posted 27 May 2013 - 11:10 PM

Reading all these experiences has been interesting.

I wonder if SSRIs primarily work through mood-blunting to decrease anxiety. Of course, that would translate to lower ratings on social anxiety, but also lower quality of life for those of us with social anxiety but lacking generalized anxiety.

I have seen anecdotal reports of increased sexual functrioning when combining an SSRI/SNRI with mirtazapine. The latter inhibits some of the serotonin receptors that are thought to reduce sexual functioning when using SSRI/SNRIs alone.

...

I think the take-away is that these are some serious drugs and should not be prescribed as life style drugs.

Mirtazapine is interesting to me. Unfortunately, it pretty strongly antagonizes DRD4, which is heavily implicated in attention.


I am wondering if there is anything that SSRIs can do that other things can't do better, in fact. They seem to help with a lot of problems "safely", but it doesn't seem like they help directly, really.

For depression, they help, but it may just be because of increased BDNF, in which case, there is a LOT of medicine that could be more helpful/direct.

For generalized anxiety, they seem to work primarily by blunting, which may or may not be the best solution. MAOIs may be better tolerated with a proper diet.

For social anxiety, MAOIs have better clinical response and lack long term negative effects, even having positive 2ndary effects while on them a lot of the time. Unfortunately, they are pushed to the back of the line because of the deitary restrictions. Amphetamine would also be a potential treatment, but would need to be further studied in combination with something like memantine. Inositol may be great for someone with social anxiety but no ADHD. I feel as though it strongly helped my social anxiety, but the ADHD problems that came with it were just too much. Maybe for an otherwise normal person, it would have been very effective. I am thus wondering if amphetamine/ritalin, memantine(both for stim tolerance and to reduce the Ca+ activity by inositol), high dose piracetam(countering excess choline side-effects by inositol and for memory), and inositol would be the perfect cure. The effects seem like they could either counter each others negatives and create the perfect mental state or could just end up canceling each other out and leaving no positive effect. Conisdering my own reaction to inositol and the general reaction to MAOIs, I wonder if social anxiety has universally low monoamine activity.

In cases of OCD or obsessive anxiety, inositol would be a better 1st line treatment, I think. It is safer and should have fewer side effects to people who are not ADHD.

The only thing were I actually see as risk is beer/wine but even there, if I don't have time to drink, I won't miss it. It's more of way to kill time, I guess (also, while I do get drunk, I sadly derive very little (social) disinhibition from booze, mainly it causes me to drink some more on the same evening..).


I can't say that I have tried many euphoric drugs, but I tend to be slightly more resistant to compulsive redosing of euphoric substances than most people, and even seem to be less pleasure-reinforcing in general. However, taking piracetam(750mg), phenibut(~500mg), and a few glasses of wine really killed my social inhibitions, fully. To be honest, it strangely felt a bit like an improved version of ritalin. That combination was the best I have had so far, increased concentration and social ability. Don't know how I feel about that. Several people in my family on my mothers side have been alcoholics (the same part of my family that tends to have social anxiety/avoidance traits), so it is something I have to be careful about.

A single beer does nothing much at all, though, and I don't have access to alcohol often. It may have acutally just been the combination of the three.

I can somewhat relate to this. In the past couple of months, something has turned off my libido completely; it's just been nonexistent. I suspect eszopiclone (Lunesta) I take for sleep. What's interesting is that I can't get worked up about it.

As a result (I think), I haven't had the desire to do anything but staying home reading, and that's how I've spent all my free time. No social impulse at all. Going out to bars or clubs has always been a negative experience for me, but at least previously I would force myself to go in the hope of maybe one day meeting someone attractive, but that motivation is gone; I wouldn't even be able to get aroused enough to get it up with a supermodel. I can't even be bothered to call anybody back to keep up the little social life I had. I know intellectually I should be bothered with this and that I may have regrets later that I have been wasting my life, but I can't seem to get emotionally bothered by it. Normally I would be bothered by it, so I'm pretty sure it's the pill talking. When night comes and I get to the point where I have to choose between being able to sleep or having a life, I just take the damn pill.

I know it is not an SSRI but my point here is that I think sexual motivation and social motivation are two sides of the same coin.

That is kinda strange. Normally benzos have a positive, dopaminergic after-effect when used for sleep, right? Maybe something about eszopiclone is different. Or, like nupi said, maybe it is depression, which I think can be caused by GABA-acting substances.

Have you tried other benzos or z-drugs? Maybe there would be something that didn't cause this. Etizolam, in particular, has a low half-life and low incidence of tolerance and side-effects, so it might be helpful for sleeping.

I agree with the sexual motivation and social motivation being interlinked, and it does make a lot of sense. In more schizoid phases, when I have almost no social motivation, I also tend to have no sexual motivation. However, porn and similar things remain as pleasurable. If the social aspect is removed, the actual sex and porn still entertains/arouses me. I just lose interest in people and thus in any thought of having sex with them. Don't mean to get too side-tracked, but do you notice the same thing? Do you find yourself averse to the idea of sex itself or just to the interactions of people and social aspect of it?

It could also be a form of atypical depression... Did you try switching Eszopiclone for another sleeping medication?

In my case, the reading is partially replaced by watching movies but the point stands (I was never much of a fiction reader and usually can't be bothered to get started with books although if I do, I generally do finish them). But the "I know intellectually I should be bothered with this" or wasting my life part sounds pretty familiar. Unfortunately, choosing between being depressed and anxious (and not really doing anything productive with live, either with all motivation coming from anxiety) and being in a sort of SSRI lull that at least takes care of the anxiety to some degree, the SSRI clearly does win out. It of course does not help that I have pinched nerve in my neck that prevents me from doing sports since 2 months and typing quite painful (physiotherapy is slowly making it better but it will be a while still)...


Have you considered the possibility that you may have a mild form of ADHD? It is possible for this sort of thing to occur because of depression, but the fact that it gets WORSE with SSRIs means you should maybe at least look into it.


I just created a new thread about this, maybe I shouldnt have.. i didnt see this one first. Anyway. Just wondering did anyone experience long term or permanent issues from dosing with low doses of escitalopram? 2.5 mg doses or less. Thanks.

I don't know about escitalopram, but my step-dad has taken zoloft(Sertraline) at about 12.5mg/day for most of my life for OCD/Generalized anxiety, and he hasn't had any problems with congnition as far as I can tell. Of course, I can't speak for sexual side effects, but it is highly unlikely considering any side-effects of anything makes him immediately quit the medicine. Similar to your 2.5 of escitalopram, it is 1/4 of the commonly effective dose.

However, he doesn't like the way it makes him feel, and he complains about it, and goes off of it for a year or so every few years because of that. Currently, he is taking inositol with some success. Protoject, if you have not tried inositol, I would recommend it before SSRIs, especially if you don't have any summer classes/major responsibilities. I had a bad experience with it, but I plan to retry it when I get attention problems under control. For now, however, it messes with my attention too much for me to be functional on it. Maybe you will have better luck with it.
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#27 Sunwind

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Posted 27 May 2013 - 11:14 PM

Libido is definitely linked with motivation/"risky" behaviour. Have you heard of No Fap? This video explains quite clearly how libido is linked with motivation and how it can cause social anxiety etc.

I agree with the sexual motivation and social motivation being interlinked, and it does make a lot of sense. In more schizoid phases, when I have almost no social motivation, I also tend to have no sexual motivation. However, porn and similar things remain as pleasurable. If the social aspect is removed, the actual sex and porn still entertains/arouses me. I just lose interest in people and thus in any thought of having sex with them. Don't mean to get too side-tracked, but do you notice the same thing? Do you find yourself averse to the idea of sex itself or just to the interactions of people and social aspect of it?


I'm exactly the same way. I find when I am not on an antidepressant and I abstain from fapping, my libido/motivation goes through the roof and almost forces me to interact with people to satisfy my base desire to get my dick wet.

Edited by Sunwind, 27 May 2013 - 11:17 PM.


#28 nowayout

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Posted 27 May 2013 - 11:32 PM

That is kinda strange. Normally benzos have a positive, dopaminergic after-effect when used for sleep, right? Maybe something about eszopiclone is different. Or, like nupi said, maybe it is depression, which I think can be caused by GABA-acting substances.

Have you tried other benzos or z-drugs? Maybe there would be something that didn't cause this. Etizolam, in particular, has a low half-life and low incidence of tolerance and side-effects, so it might be helpful for sleeping.


It's the eszopiclone, I think. Normal benzos have a pro-sexual after-effect for me.

I agree with the sexual motivation and social motivation being interlinked, and it does make a lot of sense. In more schizoid phases, when I have almost no social motivation, I also tend to have no sexual motivation. However, porn and similar things remain as pleasurable. If the social aspect is removed, the actual sex and porn still entertains/arouses me. I just lose interest in people and thus in any thought of having sex with them. Don't mean to get too side-tracked, but do you notice the same thing? Do you find yourself averse to the idea of sex itself or just to the interactions of people and social aspect of it?


Let me put it this way. I am always averse to the social aspect of meeting people, but I can sometimes overcome this when I have sexual motivation. When I don't have sexual motivation, I have no motivation for porn, and I have no motivation to meet new people (even just for friendship), and I even have very little motivation to hang out with friends.

Edited by nowayout, 27 May 2013 - 11:33 PM.

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#29 nupi

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Posted 28 May 2013 - 07:06 AM

I'm exactly the same way. I find when I am not on an antidepressant and I abstain from fapping, my libido/motivation goes through the roof and almost forces me to interact with people to satisfy my base desire to get my dick wet.


Doesn't really happen to me. I coincidentally also don't put sex in the lowest level of the Maslow pyramid - far from it. In fact, self-actualization rates much higher for me - I go nuts if I can't do something I find interesting but lack of sex has a comparatively very benign impact.

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#30 brainslugged

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Posted 28 May 2013 - 09:11 AM

http://www.ncbi.nlm....pubmed/12135539

Compared to controls, patients reported significantly (p<0.05) less ability to cry, irritation, care about others' feelings, sadness, erotic dreaming, creativity, surprise, anger, expression of their feelings, worry over things or situations, sexual pleasure, and interest in sex.


http://journals.lww...._Review.10.aspx

An amotivational, or apathy, syndrome has been reported in a number of patients receiving SSRI treatment over the last decade. This adverse effect has been noted to be dose-dependent and reversible,

-It is claimed to be reversible, however, which is encouraging.

Libido is definitely linked with motivation/"risky" behaviour. Have you heard of No Fap? This video explains quite clearly how libido is linked with motivation and how it can cause social anxiety etc.

I agree with the sexual motivation and social motivation being interlinked, and it does make a lot of sense. In more schizoid phases, when I have almost no social motivation, I also tend to have no sexual motivation. However, porn and similar things remain as pleasurable. If the social aspect is removed, the actual sex and porn still entertains/arouses me. I just lose interest in people and thus in any thought of having sex with them. Don't mean to get too side-tracked, but do you notice the same thing? Do you find yourself averse to the idea of sex itself or just to the interactions of people and social aspect of it?


I'm exactly the same way. I find when I am not on an antidepressant and I abstain from fapping, my libido/motivation goes through the roof and almost forces me to interact with people to satisfy my base desire to get my dick wet.


Honestly, I tried nofap a few times, and never really liked it. It does change libido, normally positively, but I can't say that I particularly enjoyed the change. I would prefer not to constantly have sex-undertones to my thoughts, and I think that is very well subdued by daily/every other day masturbation. Not to mention, I enjoy porn and the activities that go along with it. As far as sex goes, masturbation is sufficient.

It's the eszopiclone, I think. Normal benzos have a pro-sexual after-effect for me.

Let me put it this way. I am always averse to the social aspect of meeting people, but I can sometimes overcome this when I have sexual motivation. When I don't have sexual motivation, I have no motivation for porn, and I have no motivation to meet new people (even just for friendship), and I even have very little motivation to hang out with friends.

Hmm... can't you switch to benzos? At least, etizolam can even be bought without prescription. I don't know, but good luck.

Doesn't really happen to me. I coincidentally also don't put sex in the lowest level of the Maslow pyramid - far from it. In fact, self-actualization rates much higher for me - I go nuts if I can't do something I find interesting but lack of sex has a comparatively very benign impact.


Agreed, mostly. I would place sex at a pretty high place on my pyramid. What would be lower, however, is the need for relationships/contact. I would far rather have a good relationship without sex than good sex without a relationship.

To relate this to the topic of the thread, my entire reason for wanting to be more social is because contact with people is extremely pleasurable to me, and I want it badly. The few times that I have had contact in a relational sense, briefly(and very mildly) involved with a girl in highschool, it was only things like hugs, hair-playing, and stuff like that, but it was a hugely great feeling, better than opioids as I compare the memories. I can endure loneliness. I am not going to be driven crazy because of it, but I am afraid that, by taking an SSRI, the blunting would prevent that sort of feeling, and, to be honest, I don't care for socialization if that were to occur. What is the point in reducing how much I care about it in order to get it (in a sub-desirable form)?

This is why I don't understand SSRIs for social anxiety. Aside from my specific problems, if we assumed that someone was totally resistant to the side effects and had super-concentration, and the only purpose was for the reduction of social anxiety via the dampening mechanism, it still seems like a HUGE compromise. I mean, yeah, the emotions can be overwhelming, especially when negative, but why not increase ability to deal with them instead of repressing them or try to only decrease the negatives? Is it to be more functional is a job/school or something? Does anyone have a counter to this? I can see how things like panic/severe depression could be justified this way when they make it impossible to enjoy anything anyway, so less of good and bad emotions is okay as long as it is less of the bad which were dominating your life in the first place, but in social anxiety, taking away part of the want to be social so that you can be more social seems counter-productive. Maybe I am stuck in the nootropic mentality that medicines should ONLY do good with extremely little harm.

Am I wrong about how this works? I would be interested in hearing how SSRI has helped your anxiety/social anxiety without a general dampening of emotions. Depression not so much included here, as depression itself can be mood suppressing, and probably increases in BDNF that cause an exit of depression are what cause the net increase in emotionality, but, hey, if you want to tell your story, I am not going to stop you :D.





Also tagged with one or more of these keywords: ssri, serotonin, antidepressant, anxiety, depression, attention, adhd, libido, long term

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