Anecdata: an ex experienced this on SSRIs. Was brutal on her and tough for me. A friend had the same issue.
Antidepressants are an awfully tough thing to get right. Whenever my friends talk to me about them I recommend therapy and all the other things before starting ssris or the other families of brain drugs.
Ugh. Yes. Not meaning to be crude here and I’m incredibly sympathetic to the men I date, but as a woman in her late 30s it’s hard to find a man my age who doesn’t have problems getting / keeping it up. Most of them link back to antidepressant use.
What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
Trouble in that department is also heavily impacted by men just generally being more sedentary, having poorer diets, and due to those reasons and more, having lower testosterone. Also, consuming pornography in much greater amounts than previously available to people is known to cause serious problems here.
Yes, changing diets, better sleep and giving up porn works wonder in my case. I'm in my mid 30s and never had any sexual dysfunction, but relatively small changes cause major changes in my perceived feelings of "potency", if you will.
Fatty meats, cholesterol heavy foods (butter, eggs), vitamin D have the biggest effect on me, still less than just simply giving up porn.
> What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
GPs have very limited amounts of time for individual patients. Therapists, counsellors and psychiatrists are expensive and have mixed results, and require a significant time investment from the patient and the professional. It may be a long time before any kind of talk therapy has results. For many people who go into a doctor's office complaining of depression symptoms, it will go away within a reasonable timeframe. In many countries, there are waiting lists for any kind of further treatment.
The whole situation adds up to handing out SSRIs as a first line treatment when anyone comes to a GP reporting depressive symptoms; it's cheap, it buys time, it gives the patient a feeling that they're doing something to work on their issue, and gives them time to sign up for further support and get through their waiting list. As far as the GP knows, in most cases, side effects are rare. For many people coming in with mild depressive symptoms, there is some temporary life factor that will go away within the first course of treatment, and with it the symptoms, and that is a "success" for the SSRI stats.
Of course, anyone who's been on SSRIs of various types for any longer length of time knows that's bullshit, and they're quite serious substances with prolonged side effects and withdrawals. I really hope the situation changes.
Dating apps are awful, but were a lot better once I challenged my standards (and lowered them a bit; I’m not the young hottie I used to be and that was a hard realization).
Feeling inadequate is integral to the cherchez-la-femme experience. But it's probably better to be humiliated in night clubs (where eg. women sometimes will pretend not to even see you) than in apps; ego defense mechanisms have less of a chance there. Also: actually kissing tells you a lot that detailed self-reported profiles will never do -- the "chemistry" thing is real, sometimes two people find someone cute and stylish but the kissing doesn't work.
> What about modern society drives the need for such widespread use of antidepressants?
There's little space for compassion and sociability. Most people in the West spend 8 hours a day working through an endlessly growing backlog of demands, all the while justifying each hour to clients and managers, then go home to drink and watch TV or scroll through news feeds. Our brains are not suited to constantly worrying over the demands of others while being so disengaged from social face to face contact.
"There's little space for compassion and sociability"
I would argue there is more space now than there used to be.
I mean, women were basically property at one point, with changing degrees of freedom. You might not get out of the house much, depending.
Folks working as servants around 1900 basically had to do what their employers said, even if that meant you simply weren't allowed to have a romantic partner.
We kept slaves, and unfortunately, some folks still do.
We are probably lucky to spend only 8 hours a day on things, and I'm really happy that housework doesn't take up a lot of time now. Doing housework or working long hours doesn't grant you much space for compassion nor sociability.
The television and feeds are hobbies and entertainment. The folks in the past did similar stuff, and they had their own outcries - books, bicycles, women's ankles, and so on.
Drinking has been with us for literally Millenia. The amount of drunkards has varied alongside whatever it is we feel is "too much" - in other words, drinking daily wouldn't be strange if that is in the culture, but it is possible that same culture would frown on daily drunkenness.
> I mean, women were basically property at one point, with changing degrees of freedom. You might not get out of the house much, depending.
Can we please stop just repeating cliches that are not even obviously true? While certain countries certainly had these notions, this is not a universal.
And even in cultures with strong 'female ownership', the picture you're painting is incredibly wrong. While women may be considered 'basically' property, they would constantly be socializing with one another. They would be out of their house often with other women and their children. The appearance of 'ownership' would only be from the vantage point of men.
For example, looking at Middle Eastern society, it's completely false to say women don't get out of the house. Women have entire portions of the house to themselves, where they and their female friends can get together, talk, interact, and gossip without any interference from men, including their own husband.
Today we are way more atomized. Many people work, watch TV, and sleep. That's sad. We used to spend most of our day with friends and family. Even the slaves would.
What about modern society drives the need for such widespread use of antidepressants?
Honestly, the "about" is that we've developed medicines that aren't nearly as horrible as the medicines of yesteryear. Prozac wasn't marketed until the 80's, and a lot of other things have been marketed since then. Marketing is key too - it is really hard to take this stuff if you don't know something is available. And misery has been with us for quite some time.
Is that something we should be willing to give up?
Well, no. Giving up antidepressants means that people suffer more. We could work on reducing the general population's suffering and anxiety. We aren't 100% sure on how to do this, it seems, but we know things like easily affordable health care and a safety net helps out lots.
It hasn’t always been this way, has it?
Actually, yes. And no. I'm not convinced that housewives that used to take vallium in the 70's were taking it because they were happy, for example. We didn't always think to write about this stuff - doubly so when going on about it could get you in a non-modern mental hospital. The 'no' is simply because we can do something about it now. I like to think we are more compassionate overall now, but I have no real reason to think this.
I don't see how that is relevant here. I'm guessing relieving financial stress is really effective in some too.
So what?
It doesn't help all patients, which means that we just can't cure everyone with exercise. Hence, we'd be worse off without them as some folks would suffer more.
It's relevant because there are a variety of therapies available. No single treatment will work for all patients. Medication is sometimes appropriate but it isn't always the best option.
> What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
It's completely possible that there's something messed up in modern society that causes depression, or in medicine that diagnoses depression and/or prescribes antidepressants, but the null hypothesis would be that before modern times, people were... just depressed. And then more recently that they'd try treating it with cocaine/meth/etc. Or that they'd fail to treat it, and some percentage of those people would commit suicide, and the remainder would never admit that there was anything wrong, both of which mean the outcome you observe wouldn't happen.
Again, this isn't to say there isn't a more interesting answer, just that you have to at least consider the possibility that it's not something about modern society.
We know that exercise is an effective antidepressant for some people. In pre-modern times people were generally more physically active so I suspect that prevented a lot of depression symptoms.
Depression is relative. Today on social media, people come away with the false conclusion that they are meant to feel euphoric most of the time.
I don't believe in 'feeling happy', yet every magazine promises me i'll be happy if I just do X. Instagram says if I just follow <blah>, my life will become infinitely better. It's all a joke. I never feel happy, but I am not depressed. And more importantly, I have no interest in constant happiness... how boring. Most days I just feel meh. Sometimes I feel hungry.
I tied the knot in my early 30s, but friends who chose to remain free agents (even having had opportunities to marry someone great) report that the market thins out more and more as time goes by. And these are men, with easier access to a younger pool.
I wouldn’t say women have it much different — I end up dating a lot of significantly younger men. It is harder to have much in common outside of physical attraction with someone too far from your age group though.
My wife is actually five years older than me. But we met on a night club and made out before talking too much and it stuck. I think we developed a crush on each other in the ensuing daytime dates, came to admire each other and recognize common values. But we had kissed first and tested the chemistry.
People overthink dating and mating. We'd all probably be reasonably happy on arranged marriages. With apologies for the non-inclusive language of an old song, "woman needs man and man must have his mate, on that you can rely as time goes by".
5 years isn’t that much difference and you still share some cultural overlap. I’ve dated people who are closer to 15 years younger and it was hard to have more than a physical relationship because our personalities were formed in such different contexts.
It's not about society, it's about having the option now.
I have severe anxiety and I always just accepted it. After taking 75mg/day of Effexor, I don't have that anxiety anymore and I can function like a normal human. I'm in my mid-30s and I can have sex 3-4x/day easily and it still functions like when I was 15.
I wouldn't blame it all on anti-depressants, since sexual issues for 35+ year old men are common even without them. Blaming anti-depressants is convenient though since no one wants to blame it on genetics/health.
I am a straight man, so have no experience with other men obviously, but this is fascinating. How can it be that so many of us are on antidepressants? Something is surely wrong as you've said right?
There may also be selection effects as men in their late 30s may not have 'paired up' so to speak due to depression. But still, I'm curious if anyone has stats on how many people are on these drugs.
About 15-20%. But that’s just the antidepressants; sexual dysfunction can also be caused by blood pressure medication, epilepsy meds, etc. Anecdotally I would say regular sexual dysfunction among men over 35 is probably closer to 50%.
I don’t know how this compares to past eras though.
This was one of the factors that made me think twice about going back on anti-depressants, until I made peace with the fact that my ability to orgasm wasn't going to pull me out of the hole I was in. It's a shitty choice but the desire to not be suicidal forces your hand.
It's literally like flipping a switch. One day, the plumbing works. The next day, it doesn't. Many times I'd just give up, out of boredom.
The side-effects are clearly stated but to use myself as an example, I vastly underestimated just how strong they would be.
That said, if you're dealing with the big black dog as it were, don't use it as a reason to avoid anti-depressants if you really need them. Keep your doctor up to date about the side-effects so they can adjust your prescription. And don't be shy just because you're talking about your private parts.
Have you considered augmenting with something like Wellbutrin? Some people find it helps with the side effects. I've tried it myself and while I found it was too anxiety-inducing (I felt too keyed up) there's truth to that at least.
No, not personally. I eventually was able to come off the medication. Took a couple of weeks to get back to some semblance of normal but I'm sure there's permanent damage still.
That said, it's not easy to walk away from suicidal depression (and attempts to commit suicide) without a decent helping of trauma, and potentially even PTSD. So, of course, there isn't really a 'normal' to go back to once you've got the awareness of that and how far down the rabbit hole you fell. Normal becomes something else.
Wellbutrin has no sexual side effects (the opposite, in fact) and is very effective for depression (but not anxiety). You might want to give it a try if you are still struggling. Of course, it comes with its own tapestry of possible issues.
You ever look into ketamine for treating depression?
Self medicated this past weekend and had some major breakthroughs with my long time depression/suicidal intrusive thoughts. Nice thing is you don’t have to stay on it unlike other antidepressants—I would never do a medication that you have to constantly take.
Ketamine can be pretty rough on the bladder and kidneys. Please read up on the risks. It is definitely dangerous to take recreational doses several times per week - it seems that low/moderate doses every week or two avoids most of the problems while still providing therapeutic effects, but definitely keep an eye on the health of those systems, ideally with letting your doctor know so they can help.
Many of users on /r/researchchemicals using either ket or novel analogs at recreational doses regularly for both fun and depression relief end up with bladder issues after over-consuming for a period - so while it's a promising depression treatment, I'd recommend caution around dosage and frequency and titrating to find your minimum effective dose.
I just lost a friend to Ketamine, and there is another thread on the front page about someone famous who destroyed their life with it.
Ketamine seems like a miracle but a ton of people cant control their usage of it at all. Even if you think you know how addiction works, Ketamine sneaks up on you in a way cocaine, heroin, and oxytocin do not.
Of course, I am very responsible with my illicit drug use. Probably did < 50mg across several night and am not planning on doing it again for 6+ months. Good advice though for everyone!
I appreciate the concern but, honestly, it's exhausting to keep fielding 'have you tried...', 'have you looked into...', 'have you explored...' questions.
I get that it comes from a good place, but I'm sharing my experience, not asking for advice.
The best help you and others can offer is to just listen, instead of offering another solution.
There are two replies to me in the 'have you tried' vein. I'm not aiming it at you specifically, just trying to stop a pattern.
I get what you’re saying. The only reason I suggested looking into it is because they are seeing hugely promising results (70%+ reported improving symptoms) but you only have to do a few sessions. It’s not another pill you have to take each morning.
For what it's worth, from at least one person's perspective it's exhausting to just read these replies, as if you or other OPs are eternally naive neophytes with no experience or understanding, or that providing a personal anecdote is automatically, implicitly, and irrevocably requesting advice. This tends to be the case with a lot of medical discussions online, but especially with mental health.
(It would be somewhat better if these questions were asking for advice themselves—"Have you tried $medication? It's been recommended to me and I'm interested in others' experiences"—but it's almost always "Surely you haven't tried ($medication || $lifestyle_change || $religion || just_grow_up()) because I have and it's a panacea.")
Thanks. I just want to share and be heard, and maybe someone can relate.
Good intentions all around, but people need to understand that you're not always someone to be helped or saved. It can feel quite disempowering at times.
I don’t usually post here, especially on such personal topics, but feel I should. I’ve been on SSRIs and SNRIs for some time now (Pristiq, and now Zolof), and can definitely attest to the some of the changes described in the article. I clearly remember reading the documentation in full that came with both drugs before starting each, and the mentioned side effects were only mentioned in passing, along with possibly every other side effect imaginable, so it was very easy to dismiss - especially when you are in a place you know you need help out of. There was also no real warning of long term side effects from both doctors that have prescribed me.
I guess I don’t have any real point, other than if you are considering anti-depressants do more research than I did before taking what you’ve been prescribed - and if in doubt get answers from your doctor, and failing that find a better doctor (if you can).
In my case (Pristiq), it was a net positive. My libido decreased (but never desapeared) and I've never had erectile disfuncion so far. Totally worth it for me, with my specific metabolism.
Sertraline (Zoloft) often causes more sexual side effects in males than it does in females. I have seen this used at the max dose to control hypersexual behaviour in a patient with dementia.
First of all, I need to say I always pay attention to all side effects indicated. I really treat with caution every prescription I get. As for Sertraline, I noticed that the generic one I got from https://www.canadapharmacy.com/ has less sides than the branded one. Don't know why there is the difference, but it still calms me down a bit.
I spent about 18 months on sertraline. Even on the 'therapeutic' dose that I started off with, it basically nuked my ability to perform. Could still get an erection easily enough, the frustration was being unable to do anything with it.
It wasn't that much better with fluoxetine, but with that I found that I could at least wait a few days to sort of build up the energy.
As with another poster here, I'm happy being open about this stuff too. The first hurdle is opening up about mental health, I think that already puts you on a good track to take the shame away from the sexual aspect.
When I was in my mid-20s my doctor wanted me to take blood pressure medication because when I went to her office in the morning I had blood pressure of 150/110. I told her I wanted to see what I could do on my own first.
I cut out salt and caffeine, increased potassium and exercised every day. I went back in two months and my blood pressure was 120/80. She took it four times because she didn't believe it. I think the primary thing was the caffeine - it just gives me a temporary but strong spike in blood pressure.
Years later, a doctor prescribed me Lexapro. I actually picked up the prescription. But I never took it. I started exercising every day, started mindful meditation, removed sugar from my diet, read the book Learned Optimism and did the CBT-like work in there. Ended up never taking the SSRI but haven't had anxiety in 7 years. (btw Learned Optimism was recommended to me on HN).
Some people definitely need medication - I worked with a guy in his early 20s that had cholesterol of 400+. I saw him eat oatmeal every day for breakfast and lunch and then saw his cholesterol go up to 420. I'm sure there are people that need SSRIs. But it does seem like doctors at least prescribed it to me when I didn't need it.
Probably eating the oatmeal that made his cholesterol get higher.
There are now tons of research coming out about how cereals (wheat and corn specially) are basically the culprit of a lot of diseases that in the past were blamed on "fat", and also that this past blame was partially due to corruption (for example coca-cola literally gave six digits money to Harvard scientists so they would lie and say sugar was safe and the culprit for people problems was meat).
- The biggest influence on blood cholesterol level is the mix of fats and carbohydrates in your diet—not the amount of cholesterol you eat from food.
- Although it remains important to limit the amount of cholesterol you eat, especially if you have diabetes, for most people dietary cholesterol is not as problematic as once believed.
This seems to be a thing for pretty much every food/nutritional category. I've decided for myself to just "ignore" the science since the definition of "healthy" seems to change so often. Instead I try to use common sense for picking my meals.
Food science is highly politicised because of the massive amounts of lobbying involved. If you have the time and expertise, you should look at the actual paper, correlate it with things like sample size, age of participants, funders biases and then come up with your own conclusions. Also, research on oneself is great, vary something, measure whether it makes a positive difference, if yes, do more of it, if not, try something else. Lots of 'scientific' nutrition advice is outright wrong and harmful.
any nutrition advice that makes sweeping statements about entire macronutrients (protein/fat/carbohydrates) should be ignored and is mostly used to sell fad diets. "Carbohydrates" could be HFCS or leafy greens. "Fats" could be shortening or avocado. The nutrition of the individual food is much more important than the macronutrients.
There's a U-shaped curve for all cause mortality with cholesterol levels, just like anything else. Cholesterol is not bad, it's literally the building block of steroid hormones, vitamin D, etc.
Similarly, there's a good argument to be made that most people actually eat too little salt. If you compare most sodium guidelines to data of sodium intake versus all cause mortality, you're more at risk of death following the guidelines.
Lifestyle changes are the best treatment there is. Shame they can't make a pill out of it. Statistically most people fail to maintain lifestyle changes over the long term. Especially dietary changes.
Pharmacological treatments allow doctors to help those people.
I have never had a doctor recommend lifestyle treatments to me. They don't make any money on those. I have osteoarthritis in my hip and multiple doctors recommended an immediate hip replacement. I did a ton of research and ended up on the anti-inflammatory index diet in combination with changing exercises from running and golf that put high impacts on my hip to cycling which does not. All of my pain was gone in three months and has stayed gone for the last two years.
As a herbal observation, it seems like such a scam that medical pamphlets will list possible side-effects, but not frequencies.
Knowing that one person in one thousand saw some issue is very different from 20% of people. Especially as almost every medication I've ever seen advertised has a list two pages long of possible side effects.
How is a person supposed to make an informed judgment?
I don't know if it's the law here in France or just nice manufacturers, but I've seen side effects broken down by occurence rate ( 1 in 100,000: X, Y, Z; 1 in 1,000,000: A, B, C, etc.) multiple times.
A different anecdotal experience from my own use (10mg Lexapro) - I've always had a problem with premature ejaculation. Was trying all kinds of tricks like doing math problems in my head during sex or trying different breathing techniques - all of that was useless, once I started taking Lexapro it's like it flipped some switch in my head and I can basically go as long as I like now, and finish almost on command. Absolute game changer, it's a fantastic improvement to my quality of life. I also take 5mg of Cialis daily, which definitely helps with erections.
Ummm I’m pretty sure the cialis is keeping the blood engorged where it needs to be. Why not try an experiment, lose the cialis and see if you can “keep it up” so to speak. (This is not medical advice, I’m speaking hypothetically fyi)
This is interesting. I'm a founder of an app[1] that deals with this ballpark of issue, by providing (among other things) couples with sensate focus therapy, which is a form of sex therapy that has an extremely strong evidence base, and is a pretty standard go-to for libido issues.
We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques are proven.
I took SSRIs for a year in my late twenties. They had no effect on my depression, but resulted in permanent sexual dysfunction. My own fault for not properly researching the potential long-term side effects, I suppose, but it certainly wasn't raised as an issue by the prescribing doctor either. I hope someday there will be cure of some kind.
Have you tested your hormone profile (blood test)? Testosterone, Free T, Estradiol, Prolactin, Progesterone, SHBG - you could check if all of those are in range because that might be the root cause of your issue. There were studies done where use of SSRIs was causing elevated levels of serum prolactin.
Interesting, thanks. I did do a basic consumer blood test which reported my testosterone as "normal" (whatever that means), but I should probably do a more in-depth one and check these things.
Endocrinologists are terrible at knowing what hormone ranges are good for your age and sex. As a man with thyroid problems, I am thoroughly disabused of the idea that most endocrinologists have any clue what they're talking about. Certainly, for a middle aged women, must can put it together, but barring that, you're better off on facebook groups.
A close friend took an SSRI, citalopram, for a year in his early twenties and he got that too. It wasn't permanent, though ("full") recovery took almost a decade! Keeping in mind varying-milage and a sample size of one, he's vaguely suggested that his recovery was speeded by working out muscles in his hips. Perhaps a combination of our Western sedentary lifestyle, our proclivity to sit in computer chairs all day, and the effect of the SSRI? Far be it from me to dispense medical advice, but working to open one's hips and doing some squats probably can't hurt, even if it doesn't actively help.
When did the sexual dysfunction begin? During treatment, immediately after or was there a delay between the time you stopped taking the medication and when it began?
I feel you. I was on escitalopram in my twenties too for a depressive episode. It wrecked my libido and 10 years down the line there is hardly any sign of improvement in sight.
I have a very understanding spouse, luckily, but I'm honestly devastated in not being able to accommodate this dimension of our relationship anymore.
Recently, my GP offered to prescribe me antidepressants again for an episode of burnout, but I'm absolutely not keen to go down that road again. I get that it's cheaper and more available than therapy, but I've been burned before.
I’ve had significant problems with my anti-psychotic before my psychiatrist and I found a proper mix. Given I frequently deal with hypersexuality, there was no way I’d stay on medication long term if that wasn’t fixed.
For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.
My personal anecdote: I'm on Venlafaxine which is an SNRI (also cited in the article), and I definitely suffer some of those side-effects. It sucks. At times it makes me want to shy away from sex completely. Other times I think I'm doing OK, only to find out I can't finish, or I finish weakly with no adrenalin rush.
So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really.
Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;)
As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.
Not the poster, but exercise and diet really helps with my side effects. Sometimes I think about tapering off or trying some other drug, but then I get scared. I don't want to go back into the tunnel of depression.
Cannabinoids are a promising future treatment for depression; however, right now they are unproven.
There is already stigma associated with being on antidepressants. The consequences of discontinuing SSRIs or SNRIs can range from catastrophic to deadly. Please keep in mind that posts promoting alternative treatments can add to that stigma.
Hey I'm also on venlafaxine! It's worked very well for me as well, though I don't think I can really speak to the topic of the OP since I started taking it when I was relatively young. I haven't noticed.. much? I guess?
Are you overweight & do you exercise ? What are your test & free-test levels ? Did you try any other meds ? Maybe you don't hit the side effects bingo on other similar meds.
I am in a similar situation to mattowen_uk. Venlafaxine has been the best for me and I was eventually able to work through the side effects. Communication with your partner is key and if I find I can't reach orgasm, I can pay more attention to her. In some ways, it has been a very good thing, allowing me to be open and honest in the bedroom and out.
I too am older, so I totally understand how sexual side effects could be brutal for someone younger and in the active dating scene. If this is you, please know you are not alone. Depression is a literal killer. With a bit of work tuning the amount and type of medication, things will get better.
I had the same problem with Venlafaxine (Effexor XR). My psychiatrist had me switch to Duloxetine (Cymbalta) and my problems went away (but it worked as well as Venlafaxine for GAD and depression). FWIW I'm in my mid-40's but I had this problem about 10 years ago (when I switched).
I'm taking Venlafaxine also for GAD and depression. I think I will talk to my doctor & psychiatrist about Duloxetine at my next check-in. Thanks for the heads-up!
There are two medications on the market that have FDA approval for the claim that they have lower incidences of sexual side effects than other similar medications.
One is vortioxetine and the other is vilazodone. In addition to acting as SSRIs, they have high affinities for 5HT1A autoreceptors, activation of which disinhibits the release of neurotransmitters. SSRI sexual side effects are hypothesized to be the result of 5HT2C activation, which inhibits the release of neurotransmitters. The idea is that 5HT1A activation might help with the effects of 5HT2C activation.
There's also bupropion, an NDRI, and mirtazapine, which blocks 5HT2C. Buspirone acts as a 5HT1A activator, as well. They might help with those side effects.
I can tell you from first hand experience that Venlafaxine does not inhibit the effects of LSD in all people. It might in some, but certainly not in all. I have one data point.
Also, it does limit, if not entirely mask, the effects of some common recreational dopamine reuptake inhibitors.
Vortioxetine (Trintellix) is expensive as fuck, most insurance plans have it under multiple restrictions (step therapy (ST), prior auth (PA), others). They have a manufacturer discount card to take off $100 max but if your prescription benefits don't kick in until after you're deductible you will max out every year pretty quickly. I just paid $900 for a 3 month supply.
But... Anecdotally, it does have less sexual side effects than escitalopram (Lexapro), and helps about the same amount with anxiety as escitalopram (Lexapro), though maybe a little bit less effective at that.
Have you been on venlafaxine before? If so, how would you compare it to escitalopram, not in terms of sexual side effects but in terms of efficacy with anxiety.
Wow! This was very educational to me. I'm also on venlafaxine, and have been off and on for more than 15 years. About 5 years ago I went on it more consistently, and at a higher dose.
I'm 38 years old. I... uh.... "concluded", based on my observations of myself that "I guess it's true, male sex drive must peak in the early 30s! Ah well, I had a good run, no regrets!"
Now I don't know what to think! Maybe it's the meds? Or age? Or both? Thanks for this! (meant in earnest, not sarcasm)
I'm also on venlafaxine, and have been for years. I've recently (4 months) started MMJ for my chronic pain, and it seems to offset the sexual side effects of the Effexor: (1) I have a libido again (2) I always finish now (3) and it feels pretty damn good.
The 3rd needs explanation for those who haven't experienced it; one nasty side effect is when you orgasm you ejaculate and feel NOTHING. It messes with the male psyche in a big way in my experience.
PSSD seems to be in part mediated by desensitization of 5HTP1A receptors. Psychedelics are known to modulate 5HTP1A and increase plasticity of serotonin neurons. This would logically be another research avenue for psychedelics.
I could not find anything substantial on this specific avenue in a brief literature search, but the mechanism is there, and anecdotally people have reported success.
We need to de-schedule these drugs. At the absolute minimum, we need to get rid of the vile Schd 1 "no medical uses" to allow their research to be more politically/financially palatable.
One thing I find super interesting is how that side effect is pretty inconsistent even in the same person. I’m currently on Wellbutrin/Zyban/Bupropion as a smoking cessation aid and am not having that side effect this time. But last time I was on it for the same reason… oooooohhhhh boy, yeah, it’s a good thing that I had a partner who was good with that!
It’s possible some of the variation is from the specific manufacturer or manufacturing process. In the case of Wellbutrin XL, generic brands have even been recalled due to not being bioequivalent (https://www.medicinenet.com/script/main/art.asp?articlekey=1...)
I have been told by a doctor that effects appear inconsistent across brands or places of manufacture, even with non-recalled generics. You should always consult with your own medical professionals about your medication, but you can often ask for a different generic at the pharmacy.
That’s because Wellbrutin is an NDRI (norepinephrine–dopamine reuptake inhibitor). It’s a stimulant.
It’s actually a third-line medication for ADHD and is sometimes used with other medications to counteract the sexual side-effects of other medications.
I wonder when we're going to find out better ways to alter the body without causing deleterious entropy. Surely pills and shots are not a solution for everything and are only present because of their easy testability. We need better methods and aggressive creative problem solving and the funding to incentive it.
Yes. I have been taking sertraline for over a decade and it has literally saved my life. I was able to become the person I always wanted to be without social anxiety overtaking my life at every corner.
Please don't take any advice from anyone on HN, including me. This community often attracts armchair anecdoctors. Go and speak to a doctor.
Many many summers and a thousand years ago, I went to a pdoc to complain of anxiety issues. I left (after a good hour+ of talking) with a bipolar 2 diagnosis. The diagnosis was correct: at low doses, lamotrigine/Lamictal behaves like an antidepressant (and you have to taper in slowly to prevent bad reactions) and I flipped the fuck out in euphoric mania. I shortly after went on lithium and never regretted it. I started having dreams that seemed to resolve my deeper "psychoanalytical" issues. It really fixed me up.
This has been like 15 years ago. The more I learn, the more it seems I was the textbook case doctors never expect to meet. People are not generally aware that dysphoric mania is a thing. A good diagnosis can change your life.
They can't sleep, can't focus.
Like they are rolling on their bed all the time but no real sleep.
Then on the next day when they have the interview their cognition is exhausted and tired.
Solution: CBD helped them sleep better like in 40 min.
Situation 2. Meeting or having a situation that they will be anxious. (meeting, new job,etc).
CBD before makes the "negative voices" stop.
I talking CBD only.
You will not feel high or anything.
Indeed you will forgot that you use it but then you will not be anxious.
Meaning -> it does not give a "kick" that you feel. suddenly you are relaxed and "forgot" about being anxious.
I was a person that thought the medicinal effects were "exagerated" so the ""hipppies"" could use it. But then once I saw it working I changed my prejudice.
My experience with CBD is that it will knock you out and give you a deep sleep on day 1, but the more you use it the harder it is to sleep without it. Almost like the payday loans of falling asleep.
Anecdotally, yeah. It's worth it. To be frank (I'll comment more on this elsewhere) I think the risk of permanent sexual dysfunction or any other permanent effect is dramatically overblown by articles like this one. The short-term and while-you're-taking-it side effects are real, but for me and many others well worth it.
Everyone in my family has some sort of anxiety issue. Citalopram (with the help of therapy and lifestyle changes) helped me overcome severe anxiety, helped my brother stop throwing up whenever he got in a too-high-pressure situation, and gave my sister the willpower to move out of my parents' house and get a job.
They're good drugs with frustrating downsides. That's life. I'd still recommend them.
I also agree. First of all, consult a specialist. Additionally, I need to say I always pay attention to all side effects indicated. I really treat with caution every prescription I get. As for Sertraline, I noticed that the generic one I got from https://www.canadapharmacy.com/ has less sides than the branded one. Don't know why there is the difference, but it still calms me down a bit.
Yes. I've been on/off (mostly on) them for around 20 years. It started when I was young and a girl broke my heart. I just couldn't get out of my "funk". I started taking Zoloft and it gave me a life again. I probably have social anxiety and I am def. more comfortable in public and around people I don't know when I'm on an SSRI. I am not as negative and cynical and have hope for the future. I don't want to take them, wish I didn't have too but even with consistent exercise, therapy etc. it just wasn't enough without the medical help.
SSRIs need to be obsolesced already. Screw the sexual dysfunction, how about increaased risk of suicidal ideation? How about them taking two entire weeks to work?
The thing is the rest of the world doesn't seem to feel the burning desire to get as many people on them as possible and even have alternatives which aren't as limited. Reversible MAOI drugs like moclobemide have been around since the 90s and while they have a higher interaction profile (Can't mix it with anything serotonergic basically, so no amphetamines or cocaine or other antidepressants, which is fine), the reduced side effect profile is considered a bonus and the biggest reason for lack of adoption of this along with other treatments (It's astonishing how long we have known about the ketamine thing without using it) happens to just come down to marketing and doctors scared off by the early MAOIs where you need to strongly consider diet. The new stuff even reportedly improves sexual function. And you can't get it in the USA.
SSRIs took me from being unable to function and leave my home due to social anxiety to knocking out the bulk of my symptoms and having a solid 15 years of being socially and professional productive. I'd prefer we keep them.
Heroin, interestingly enough. IIRC they screened pain medicine recipients for depressive symptoms and in this way determined opiates relieve major depression more efficaciously than SSRIs.
Yes, and a close relative (oxycodone) is something I’ve had experience with and can confirm it’s quite good at curing the depression. The problem is the permanent brain damage and/or death it will cause when taken long-term. Link < https://www.drugabuse.gov/publications/research-reports/hero...>
I don't see opiates as a tenable longterm solution but I mentioned heroin because it's only long term side effect as far as I know is constipation, which can be managed. Same with morphine.
My point in bringing this up is why accept SSRIs if they have more side effects and are less efficacious than heroin?
Did you read your 2nd link? All of the typically bad sides in the second grouping are related to poor hygiene and needle sharing. The first grouping is more benign than most antidepressant sides.
Yes, I did. Nowhere does it say that. If you want to get a point of reference for what heroin might look like if it wasn't a street drug, oxycodone is quite similar yet distributed without the additives found on the street since it is manufactured by big pharma. Still, it is associated with respiratory depression.
I know it doesn't say that but it should be obvious most of them are due to poor IV administration. You don't need to administer heroin or morphine via IV.
True, people occasionally OD on prescription medication, but it's usually as a rebound after having the prescription withdrawn and then finding more drugs.
That can happen with prescription drugs too though. People lose access to their insurance and then end up going off the drug too fast.
The bottom line is, don't you think if they could sell more of this drug, they would? Opiates are a pretty terrible choice for an antidepressant for multiple reasons.
> Opiates are a pretty terrible choice for an antidepressant for multiple reasons.
You've failed to present this. That opiates are bad is just dogma left around from the first religious-linked anti-drug pushes. I think they are inappropriate, but in the same way SSRIs are inappropriate, and have explained my position.
E.g. a UK study found that if you just give people all the heroin they want they quit after 2 years. There are no other complications than constipation.
> There are no other complications than constipation.
You keep saying this, ignoring the fact that I showed (with a citation) that it is addictive, which is a complication. This is a pointless discussion, since the dogma is that you are pro-opiate past the point of reason. I seriously doubt you’ve even tried this drug.
I am in the US and I have never heard of the treatments you mentioned. I guess this is your point! This makes me very sad. I am glad a SSRI worked for me, but I know that a percentage of people will also be at great risk for self-harm.
I am not a doctor and do not know the difference between brain zaps and EHS (or whether there is one), but this article[1] summarizes it well.
For me, it is a loud sound but sort of within the head, accompanied by the sensation you get when you receive an electrical shock, which of course startles you awake. This unfortunately occurs just at the boundary between consciousness and sleep, which after it happens a few times in a row can put you off the idea of even trying to sleep. Occasionally I did awaken thinking there had been a literal explosion in the building.
I haven't taken SSRIs for 3 years and still get them, albeit less than when I was weaning off of them.
MAOIs have potentially serious dietary interactions and side effects. They can cause serotonin sickness just by taking it with OTC tryptophan supplements.
SSRIs are not perfect but have a safer track record of being a first-attack against depression and anxiety, before having to resort to bigger guns like MAOIs.
This is actually the biggest thing keeping this line of treatment from being the preference, but when it comes to reversible vs irreversible MAOIs the dietary interactions are actually not a concern![1] It was actually my first comment when I was told about this, but as it turns out you're more looking at potential drug interactions with the reversible MAOIs. The dietary interactions definitely stand with the irreversible MAOIs in the first generation antidepressants, which I think are generally reserved these days for really serious depression cases that don't respond to other treatment, or parkinsons like symptoms, or people going on jungle treks to drink shaman brews. I think the benefit of treatment kicking in immediately is really key as well, 2 weeks is a long time to wait for a drug to work when you're potentially on the brink of suicide.
SNRIs have resolved my suicidal ideation. I credit Effexor with saving my life. The increased risk of suicidal ideation in young anxiety patients is probably offset by the reduction in self-harm amongst the major depression people.
From another post about COVID treatment. Welcome to world wide sterilization.
“If WHO recommends this, you will see it widely taken up,” said study co-author Dr. Edward Mills of McMaster University in Hamilton, Ontario, adding that many poor nations have the drug readily available. “We hope it will lead to a lot of lives saved.”
The pill, called fluvoxamine, would cost $4 for a course of COVID-19 treatment. By comparison, antibody IV treatments cost about $2,000 and Merck’s experimental antiviral pill for COVID-19 is about $700 per course. Some experts predict various treatments eventually will be used in combination to fight the coronavirus.
I am from a generation that when SSRI became available, it was a marvelous drug.
Prescribed to teenagers freely and plentiful.
Now on my peers of friends, we have many people who don't have any libido.
The hardest-hit group was Women as they go to therapy more[1].
It is so huge we have Forums like "dead bedroom."
Once a friend that took SSRI told me how she felt about sex:
"I am looking forward to when my husband reaches his 40s, so he does not bother me about sex anymore."
"Brushing my teeth is more useful and fun than sex."
I am not talking about sex partners that are not "competent" or good.
It is like you never felt hungry or willing to eat. But then you *have* to eat, and when you are tasting the food, it is like cardboard * every time*
The concerning part is that our PharmaCo does this every ten years. (Thalidomide, SSRIs, etc.)
So can we believe the mRNA vacuum is really safe?
The thing with the mRNA vaccine is that you have to compare it with the risks of getting infected. Long COViD has pretty annoying long term effects including sexual ones.
Takes me a little longer on Zoloft. My psychiatrist and I agreed this is more of a good thing than a bad thing. The crippling anxiety I had without it was much worse for my libido.
That being said, I wish we understood these drugs better, because I know the side effects and efficacy vary in the extreme. I know for some people it's like trying to put out a fire with gasoline.
Continued anecdata: when I forget to get my refill, the withdrawal is terrible. Dizziness, malaise, and "brain zaps". One of these days I'm going to have to wean off of it carefully before I try psychedelics.
I'm not a doctor, but I'd caution against trying psychedelics at all if you had crippling anxiety before.
I didn't realize just how bad my anxiety could get until after I did Psilocybin. It wasn't the root cause of my anxiety, of course, but it sure as hell exacerbated it to the point of being pretty debilitating.
I'm now on 25mg of Sertraline, which has all but wiped out my anxiety.
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Antidepressants are an awfully tough thing to get right. Whenever my friends talk to me about them I recommend therapy and all the other things before starting ssris or the other families of brain drugs.
What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
Fatty meats, cholesterol heavy foods (butter, eggs), vitamin D have the biggest effect on me, still less than just simply giving up porn.
[citation needed]
GPs have very limited amounts of time for individual patients. Therapists, counsellors and psychiatrists are expensive and have mixed results, and require a significant time investment from the patient and the professional. It may be a long time before any kind of talk therapy has results. For many people who go into a doctor's office complaining of depression symptoms, it will go away within a reasonable timeframe. In many countries, there are waiting lists for any kind of further treatment.
The whole situation adds up to handing out SSRIs as a first line treatment when anyone comes to a GP reporting depressive symptoms; it's cheap, it buys time, it gives the patient a feeling that they're doing something to work on their issue, and gives them time to sign up for further support and get through their waiting list. As far as the GP knows, in most cases, side effects are rare. For many people coming in with mild depressive symptoms, there is some temporary life factor that will go away within the first course of treatment, and with it the symptoms, and that is a "success" for the SSRI stats.
Of course, anyone who's been on SSRIs of various types for any longer length of time knows that's bullshit, and they're quite serious substances with prolonged side effects and withdrawals. I really hope the situation changes.
As a man in his 30s growing up I witnessed a shift in attitudes from "just man up" to "seek help", so there's that.
If anything I would suggest humanity to give up dating apps. They're essentially making people feel inadequate and pay for the dubious privilege.
There's little space for compassion and sociability. Most people in the West spend 8 hours a day working through an endlessly growing backlog of demands, all the while justifying each hour to clients and managers, then go home to drink and watch TV or scroll through news feeds. Our brains are not suited to constantly worrying over the demands of others while being so disengaged from social face to face contact.
I would argue there is more space now than there used to be.
I mean, women were basically property at one point, with changing degrees of freedom. You might not get out of the house much, depending.
Folks working as servants around 1900 basically had to do what their employers said, even if that meant you simply weren't allowed to have a romantic partner.
We kept slaves, and unfortunately, some folks still do.
We are probably lucky to spend only 8 hours a day on things, and I'm really happy that housework doesn't take up a lot of time now. Doing housework or working long hours doesn't grant you much space for compassion nor sociability.
The television and feeds are hobbies and entertainment. The folks in the past did similar stuff, and they had their own outcries - books, bicycles, women's ankles, and so on.
Drinking has been with us for literally Millenia. The amount of drunkards has varied alongside whatever it is we feel is "too much" - in other words, drinking daily wouldn't be strange if that is in the culture, but it is possible that same culture would frown on daily drunkenness.
Can we please stop just repeating cliches that are not even obviously true? While certain countries certainly had these notions, this is not a universal.
And even in cultures with strong 'female ownership', the picture you're painting is incredibly wrong. While women may be considered 'basically' property, they would constantly be socializing with one another. They would be out of their house often with other women and their children. The appearance of 'ownership' would only be from the vantage point of men.
For example, looking at Middle Eastern society, it's completely false to say women don't get out of the house. Women have entire portions of the house to themselves, where they and their female friends can get together, talk, interact, and gossip without any interference from men, including their own husband.
Today we are way more atomized. Many people work, watch TV, and sleep. That's sad. We used to spend most of our day with friends and family. Even the slaves would.
Honestly, the "about" is that we've developed medicines that aren't nearly as horrible as the medicines of yesteryear. Prozac wasn't marketed until the 80's, and a lot of other things have been marketed since then. Marketing is key too - it is really hard to take this stuff if you don't know something is available. And misery has been with us for quite some time.
Is that something we should be willing to give up? Well, no. Giving up antidepressants means that people suffer more. We could work on reducing the general population's suffering and anxiety. We aren't 100% sure on how to do this, it seems, but we know things like easily affordable health care and a safety net helps out lots.
It hasn’t always been this way, has it? Actually, yes. And no. I'm not convinced that housewives that used to take vallium in the 70's were taking it because they were happy, for example. We didn't always think to write about this stuff - doubly so when going on about it could get you in a non-modern mental hospital. The 'no' is simply because we can do something about it now. I like to think we are more compassionate overall now, but I have no real reason to think this.
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-...
So what?
It doesn't help all patients, which means that we just can't cure everyone with exercise. Hence, we'd be worse off without them as some folks would suffer more.
It's completely possible that there's something messed up in modern society that causes depression, or in medicine that diagnoses depression and/or prescribes antidepressants, but the null hypothesis would be that before modern times, people were... just depressed. And then more recently that they'd try treating it with cocaine/meth/etc. Or that they'd fail to treat it, and some percentage of those people would commit suicide, and the remainder would never admit that there was anything wrong, both of which mean the outcome you observe wouldn't happen.
Again, this isn't to say there isn't a more interesting answer, just that you have to at least consider the possibility that it's not something about modern society.
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-...
I don't believe in 'feeling happy', yet every magazine promises me i'll be happy if I just do X. Instagram says if I just follow <blah>, my life will become infinitely better. It's all a joke. I never feel happy, but I am not depressed. And more importantly, I have no interest in constant happiness... how boring. Most days I just feel meh. Sometimes I feel hungry.
People overthink dating and mating. We'd all probably be reasonably happy on arranged marriages. With apologies for the non-inclusive language of an old song, "woman needs man and man must have his mate, on that you can rely as time goes by".
I have severe anxiety and I always just accepted it. After taking 75mg/day of Effexor, I don't have that anxiety anymore and I can function like a normal human. I'm in my mid-30s and I can have sex 3-4x/day easily and it still functions like when I was 15.
I wouldn't blame it all on anti-depressants, since sexual issues for 35+ year old men are common even without them. Blaming anti-depressants is convenient though since no one wants to blame it on genetics/health.
There may also be selection effects as men in their late 30s may not have 'paired up' so to speak due to depression. But still, I'm curious if anyone has stats on how many people are on these drugs.
I don’t know how this compares to past eras though.
It's literally like flipping a switch. One day, the plumbing works. The next day, it doesn't. Many times I'd just give up, out of boredom.
The side-effects are clearly stated but to use myself as an example, I vastly underestimated just how strong they would be.
That said, if you're dealing with the big black dog as it were, don't use it as a reason to avoid anti-depressants if you really need them. Keep your doctor up to date about the side-effects so they can adjust your prescription. And don't be shy just because you're talking about your private parts.
And make sure you have a therapist too.
That said, it's not easy to walk away from suicidal depression (and attempts to commit suicide) without a decent helping of trauma, and potentially even PTSD. So, of course, there isn't really a 'normal' to go back to once you've got the awareness of that and how far down the rabbit hole you fell. Normal becomes something else.
Either way, hope you are doing OK/OK enough.
Self medicated this past weekend and had some major breakthroughs with my long time depression/suicidal intrusive thoughts. Nice thing is you don’t have to stay on it unlike other antidepressants—I would never do a medication that you have to constantly take.
Tell that to your heart doctor when you're 70.
Many of users on /r/researchchemicals using either ket or novel analogs at recreational doses regularly for both fun and depression relief end up with bladder issues after over-consuming for a period - so while it's a promising depression treatment, I'd recommend caution around dosage and frequency and titrating to find your minimum effective dose.
https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
Ketamine seems like a miracle but a ton of people cant control their usage of it at all. Even if you think you know how addiction works, Ketamine sneaks up on you in a way cocaine, heroin, and oxytocin do not.
Please be careful.
I get that it comes from a good place, but I'm sharing my experience, not asking for advice.
The best help you and others can offer is to just listen, instead of offering another solution.
There are two replies to me in the 'have you tried' vein. I'm not aiming it at you specifically, just trying to stop a pattern.
(It would be somewhat better if these questions were asking for advice themselves—"Have you tried $medication? It's been recommended to me and I'm interested in others' experiences"—but it's almost always "Surely you haven't tried ($medication || $lifestyle_change || $religion || just_grow_up()) because I have and it's a panacea.")
Good intentions all around, but people need to understand that you're not always someone to be helped or saved. It can feel quite disempowering at times.
Not a doctor, by the way.
It wasn't that much better with fluoxetine, but with that I found that I could at least wait a few days to sort of build up the energy.
As with another poster here, I'm happy being open about this stuff too. The first hurdle is opening up about mental health, I think that already puts you on a good track to take the shame away from the sexual aspect.
I cut out salt and caffeine, increased potassium and exercised every day. I went back in two months and my blood pressure was 120/80. She took it four times because she didn't believe it. I think the primary thing was the caffeine - it just gives me a temporary but strong spike in blood pressure.
Years later, a doctor prescribed me Lexapro. I actually picked up the prescription. But I never took it. I started exercising every day, started mindful meditation, removed sugar from my diet, read the book Learned Optimism and did the CBT-like work in there. Ended up never taking the SSRI but haven't had anxiety in 7 years. (btw Learned Optimism was recommended to me on HN).
Some people definitely need medication - I worked with a guy in his early 20s that had cholesterol of 400+. I saw him eat oatmeal every day for breakfast and lunch and then saw his cholesterol go up to 420. I'm sure there are people that need SSRIs. But it does seem like doctors at least prescribed it to me when I didn't need it.
There are now tons of research coming out about how cereals (wheat and corn specially) are basically the culprit of a lot of diseases that in the past were blamed on "fat", and also that this past blame was partially due to corruption (for example coca-cola literally gave six digits money to Harvard scientists so they would lie and say sugar was safe and the culprit for people problems was meat).
I... don't think so
https://www.health.harvard.edu/heart-health/research-were-wa...
https://www.sciencedaily.com/releases/2016/10/161007085247.h...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885279/
https://www.sciencedaily.com/releases/2008/01/080108102225.h...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394769/
> There are now tons of research coming out about how cereals (wheat and corn specially) are basically the culprit of a lot of diseases
Care to share more on what you are referring to?
https://www.hsph.harvard.edu/nutritionsource/what-should-you...
Similarly, there's a good argument to be made that most people actually eat too little salt. If you compare most sodium guidelines to data of sodium intake versus all cause mortality, you're more at risk of death following the guidelines.
Pharmacological treatments allow doctors to help those people.
Recently learned about it, and based on my own measurements, seems I have it to some extent.
Every time i measure it at home its 110s/70.
Knowing that one person in one thousand saw some issue is very different from 20% of people. Especially as almost every medication I've ever seen advertised has a list two pages long of possible side effects.
How is a person supposed to make an informed judgment?
Google "Product name prescribing information"
What does this mean?
We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques are proven.
[1] https://www.blueheart.io
^ has information on why 'normal' isn't a good range for everyone.
> The Art of Manliness participates in affiliate marketing programs
Seems like a terrible resource. Much better would be blood work at your PCP (and a possible referral to an endocrinologist).
I have a very understanding spouse, luckily, but I'm honestly devastated in not being able to accommodate this dimension of our relationship anymore.
Recently, my GP offered to prescribe me antidepressants again for an episode of burnout, but I'm absolutely not keen to go down that road again. I get that it's cheaper and more available than therapy, but I've been burned before.
For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.
So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really.
Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;)
As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.
This is not medical advice, only anecdotal interest, but, have known many to leave SSRI for well-timed CBD oil.
Wonder if issues requiring an SNRI are "similar" enough?
Wishing you well!
There is already stigma associated with being on antidepressants. The consequences of discontinuing SSRIs or SNRIs can range from catastrophic to deadly. Please keep in mind that posts promoting alternative treatments can add to that stigma.
I too am older, so I totally understand how sexual side effects could be brutal for someone younger and in the active dating scene. If this is you, please know you are not alone. Depression is a literal killer. With a bit of work tuning the amount and type of medication, things will get better.
One is vortioxetine and the other is vilazodone. In addition to acting as SSRIs, they have high affinities for 5HT1A autoreceptors, activation of which disinhibits the release of neurotransmitters. SSRI sexual side effects are hypothesized to be the result of 5HT2C activation, which inhibits the release of neurotransmitters. The idea is that 5HT1A activation might help with the effects of 5HT2C activation.
There's also bupropion, an NDRI, and mirtazapine, which blocks 5HT2C. Buspirone acts as a 5HT1A activator, as well. They might help with those side effects.
I'm not sure what the mechanism behind venlafaxine's blunting effect on LSD is.
Also, it does limit, if not entirely mask, the effects of some common recreational dopamine reuptake inhibitors.
But... Anecdotally, it does have less sexual side effects than escitalopram (Lexapro), and helps about the same amount with anxiety as escitalopram (Lexapro), though maybe a little bit less effective at that.
I'm 38 years old. I... uh.... "concluded", based on my observations of myself that "I guess it's true, male sex drive must peak in the early 30s! Ah well, I had a good run, no regrets!"
Now I don't know what to think! Maybe it's the meds? Or age? Or both? Thanks for this! (meant in earnest, not sarcasm)
The 3rd needs explanation for those who haven't experienced it; one nasty side effect is when you orgasm you ejaculate and feel NOTHING. It messes with the male psyche in a big way in my experience.
I don't think we understand nearly enough about these systems, though I'd argue that anti-depressants are still a big net positive.
I could not find anything substantial on this specific avenue in a brief literature search, but the mechanism is there, and anecdotally people have reported success.
We need to de-schedule these drugs. At the absolute minimum, we need to get rid of the vile Schd 1 "no medical uses" to allow their research to be more politically/financially palatable.
I have been told by a doctor that effects appear inconsistent across brands or places of manufacture, even with non-recalled generics. You should always consult with your own medical professionals about your medication, but you can often ask for a different generic at the pharmacy.
It’s actually a third-line medication for ADHD and is sometimes used with other medications to counteract the sexual side-effects of other medications.
Please don't take any advice from anyone on HN, including me. This community often attracts armchair anecdoctors. Go and speak to a doctor.
Good luck.
This has been like 15 years ago. The more I learn, the more it seems I was the textbook case doctors never expect to meet. People are not generally aware that dysphoric mania is a thing. A good diagnosis can change your life.
But please consider alternatives as CBD or a healthier routine.
Situation 1. Interview next day.
They can't sleep, can't focus. Like they are rolling on their bed all the time but no real sleep.
Then on the next day when they have the interview their cognition is exhausted and tired. Solution: CBD helped them sleep better like in 40 min.
Situation 2. Meeting or having a situation that they will be anxious. (meeting, new job,etc).
CBD before makes the "negative voices" stop.
I talking CBD only.
You will not feel high or anything.
Indeed you will forgot that you use it but then you will not be anxious. Meaning -> it does not give a "kick" that you feel. suddenly you are relaxed and "forgot" about being anxious.
I was a person that thought the medicinal effects were "exagerated" so the ""hipppies"" could use it. But then once I saw it working I changed my prejudice.
Everyone in my family has some sort of anxiety issue. Citalopram (with the help of therapy and lifestyle changes) helped me overcome severe anxiety, helped my brother stop throwing up whenever he got in a too-high-pressure situation, and gave my sister the willpower to move out of my parents' house and get a job.
They're good drugs with frustrating downsides. That's life. I'd still recommend them.
The thing is the rest of the world doesn't seem to feel the burning desire to get as many people on them as possible and even have alternatives which aren't as limited. Reversible MAOI drugs like moclobemide have been around since the 90s and while they have a higher interaction profile (Can't mix it with anything serotonergic basically, so no amphetamines or cocaine or other antidepressants, which is fine), the reduced side effect profile is considered a bonus and the biggest reason for lack of adoption of this along with other treatments (It's astonishing how long we have known about the ketamine thing without using it) happens to just come down to marketing and doctors scared off by the early MAOIs where you need to strongly consider diet. The new stuff even reportedly improves sexual function. And you can't get it in the USA.
My point in bringing this up is why accept SSRIs if they have more side effects and are less efficacious than heroin?
> SSRIs aren't addictive [1]
There are also a large number of side effects and risks associated with heroin; it's not just constipation as you say. [2]
[1] https://www.mayoclinic.org/diseases-conditions/depression/in....
[2] https://www.drugabuse.gov/publications/drugfacts/heroin
True, people occasionally OD on prescription medication, but it's usually as a rebound after having the prescription withdrawn and then finding more drugs.
The bottom line is, don't you think if they could sell more of this drug, they would? Opiates are a pretty terrible choice for an antidepressant for multiple reasons.
You've failed to present this. That opiates are bad is just dogma left around from the first religious-linked anti-drug pushes. I think they are inappropriate, but in the same way SSRIs are inappropriate, and have explained my position.
E.g. a UK study found that if you just give people all the heroin they want they quit after 2 years. There are no other complications than constipation.
You keep saying this, ignoring the fact that I showed (with a citation) that it is addictive, which is a complication. This is a pointless discussion, since the dogma is that you are pro-opiate past the point of reason. I seriously doubt you’ve even tried this drug.
Could you expand on this? Is this the "exploding head syndrome" where you have an incredibly "loud" hallucinatory experience just as you fall asleep?
For me, it is a loud sound but sort of within the head, accompanied by the sensation you get when you receive an electrical shock, which of course startles you awake. This unfortunately occurs just at the boundary between consciousness and sleep, which after it happens a few times in a row can put you off the idea of even trying to sleep. Occasionally I did awaken thinking there had been a literal explosion in the building.
I haven't taken SSRIs for 3 years and still get them, albeit less than when I was weaning off of them.
[1] https://www.medicalnewstoday.com/articles/brain-zaps#how-the...
SSRIs are not perfect but have a safer track record of being a first-attack against depression and anxiety, before having to resort to bigger guns like MAOIs.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188542/
You have to take pills more often (3x a day vs 1 a day) and only one potential benefit over SSRI which is less likelihood of sexual dysfunction.
https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
“If WHO recommends this, you will see it widely taken up,” said study co-author Dr. Edward Mills of McMaster University in Hamilton, Ontario, adding that many poor nations have the drug readily available. “We hope it will lead to a lot of lives saved.”
The pill, called fluvoxamine, would cost $4 for a course of COVID-19 treatment. By comparison, antibody IV treatments cost about $2,000 and Merck’s experimental antiviral pill for COVID-19 is about $700 per course. Some experts predict various treatments eventually will be used in combination to fight the coronavirus.
I am from a generation that when SSRI became available, it was a marvelous drug.
Prescribed to teenagers freely and plentiful.
Now on my peers of friends, we have many people who don't have any libido.
The hardest-hit group was Women as they go to therapy more[1].
It is so huge we have Forums like "dead bedroom."
Once a friend that took SSRI told me how she felt about sex:
"I am looking forward to when my husband reaches his 40s, so he does not bother me about sex anymore."
"Brushing my teeth is more useful and fun than sex."
I am not talking about sex partners that are not "competent" or good. It is like you never felt hungry or willing to eat. But then you *have* to eat, and when you are tasting the food, it is like cardboard * every time*
The concerning part is that our PharmaCo does this every ten years. (Thalidomide, SSRIs, etc.) So can we believe the mRNA vacuum is really safe?
[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27
My wife took birth control for a day or two in her twenties before we married, had the symptom, and threw the pills away.
It's very sad. Women's sex drives are as strong as men's, and much stronger when ovulating.
That being said, I wish we understood these drugs better, because I know the side effects and efficacy vary in the extreme. I know for some people it's like trying to put out a fire with gasoline.
Continued anecdata: when I forget to get my refill, the withdrawal is terrible. Dizziness, malaise, and "brain zaps". One of these days I'm going to have to wean off of it carefully before I try psychedelics.
I didn't realize just how bad my anxiety could get until after I did Psilocybin. It wasn't the root cause of my anxiety, of course, but it sure as hell exacerbated it to the point of being pretty debilitating.
I'm now on 25mg of Sertraline, which has all but wiped out my anxiety.