6 replies to this topic

[JamesJones92]

Hi how's it going,

 

I have bad OCD, and tried staying away from SSRIs for a while but they're the only thing that really take the edge off for me. They work well I can't deny it. I'll probably have to be on Brintellix indefinitely.

 

I'm having some strong sexual side effects though. Decreased libido, reduced feeling down there, and delayed orgasm. It's the most annoying thing because otherwise the SSRI is working pretty well. Can someone who's knowledgeable on psychopharmacology please help me understand with receptors have to do with this, and therefore I can counter the sides with another medicine.

 

Here's what I think I understand:

 

Brintellix has the mechanism of action of Buspar "built in". 5-ht1a partial agonist. So adding Buspar to counter the sexual side effects theoretically wouldn't do anything.

 

Wellbutrin is the other most common prescribed drug to counter sexual sides, but can cause agitation and activating anxious feelings in those prone to bad anxiety (me).

 

I've been reading a lot and have read that a 5-HT2c antagonist would increase dopamine in the PFC, leading to a decrease in sexual side effects. Some examples would be Agomelatine, Nefazodone, Mirtazapine. What I don't understand is that Prozac is a 5-HT2c anatagonist and I've been on it before and had much worse sexual side effects than on the Brintellix

 

Lastly, I read that stimulation of 5-HT2a causes sexual side effects. But a 5-HT2a antagonist is an antipsychotic, and I'm pretty sure risperidone isn't really precribed to counter SSRI sexual side effects.

 

I'm really not an expert AT ALL on psychopharmacology. I'm a businessman with OCD who's trying to get his shit together. I'd really appreciate if someone knowledgeable can help break it down for me based on their knowledge of Brintellix and what medicine I should try to counter the sexual side effects.

[Kinesis]

Tough one, JJ. Buspirone is sometimes used to help offset the sexual side effects of SSRIs, but as you point out vortioxetine is not a classic SSRI. But you may be oversimplifying buspirone's mechanism. According to the Wikipedia entry for buspirone,

"Buspirone also binds at dopamine type 2 (DA2) receptors, blocking presynaptic dopamine receptors. Buspirone increases firing in the locus ceruleus, an area of brain where norepinephrine cell bodies are found in high concentration. The net result of buspirone actions is that serotonergic activity is suppressed while noradrenergic and dopaminergic cell firing is enhanced."

The upshot of this is that buspirone might still help. If not, maybe another dopaminergic could be considered. Barring that, another primary therapy might be tried.

Commonly bupropion is regarded as being relatively free from sexual side effects, but maybe at the expense of others as you suggest ... I have found it to be stimulating too. The mainstream options narrow pretty quickly beyond that, but mirtazapine might be one. There are also the tricyclics like amitriptyline and tianeptine, usually regarded as less prone to sexual side effects than SSRIs,

Edited by Kinesis, 12 April 2016 - 03:16 AM.

[sant2060]

Did you try Wellbutrin? I'm highly anxious too, however can tolerate 150mg XL without problems.

Trazodone also helps me a lot.

Yohimbine too. I can PM you which herbal suplement I use...I'm VERY sensitive to it, so just one capsule does the trick (but also has some sides, most notably chills plus running nose).

 

With help of those I managed to mostly counter SSRI and post-SSRI sexual disfunction that bothered me for years.

[JamesJones92]

Thanks guys I appreciate the help. I haven't tried Buspar or Wellbutrin yet. Buspar because I thought Brintellix was essentially an SSRI with Buspar's mechanism of action combined. And Wellbutrin because I'm sensitive to stimulating medications. But I'll definitely look into them.

 

And yes if you could PM me the herb that you use that would be great. Thanks so much.

[jaiho]

Prozac doesn't bind strongly to 5HT2C, and it also depends on your neurochemistry on how well it binds.

For me, Prozac has less sexual sides than any other SSRI.

 

You might need a stronger 5ht2c antagonist in combo with an SSRI to remove sexual sides, such as Nortriptyline.

 

For OCD, Luvox is the best SSRI, then you can add Nortriptyline to counter many of the SSRIs side effects.

Edited by jaiho, 17 April 2016 - 03:58 PM.

[jadamgo]

Yohimbine is unquestionably effective, but it's quite stimulating. You'd be better off with bupropion because it's actually been shown to reduce anxiety in the long term, perhaps by calming hypersensitivity in the NE system. The effect seems to last even after you quit taking the drug -- though I doubt the sexual benefits would also last. 

 

The downside to bupropion is surviving the first month or two of increased agitation. If I were in your situation, I'd keep some chamomile tea or valerian around to keep my nerves calm until those chemicals finish re-balancing. Theanine might work too, depending on how well you respond to it. 

 

BTW, all of what I just said can also apply to nortriptyline, as mentioned above -- except notrtiptyline leans more heavily on NE than on DA, so it might be less effective in reversing the sexual side effects of your SSRI. 

 

Another option would be using psychological methods to try and calm the anxiety. A month you started bupropion wouldn't be a great month to undertake exposure therapy, so a more relaxation-focused approach would be good. Yes, that's only a band-aid, I know -- but a short-term problem calls for short-term, fast-acting relief.

[Junk Master]

Or raise testosterone through either natural (H.I.T training, herbs), or exogenous means (HRT).  Add daily tadalafil, good for blood pressure and symptoms of enlarged prostate, as well as a nootropic, and your delayed orgasm becomes less of a problem and more of a benefit with your heightened libido.  Plus, testosterone is anxiolytic, analgesic, and cognitive enhancing.

 

http://www.ncbi.nlm....pubmed/15598144