Aswad
Posts: 9374
Joined: 4/4/2007 Status: offline
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quote:
ORIGINAL: Petronius Without knowing the specific medications causing the problem it is difficult to present any meaningful suggestions. Definitely. quote:
However, there are some classes of medications that produce the problem. More classes than you'd think. SSRIs, TCAs, mood stabilizers, antipsychotics, etc. quote:
The "dopamine reuptake inhibitors" or DARIs are another class of antidepressants and include bupropion (Wellbutrin) and phenmetrazine (Preludin). And amineptine (Survector), which is the most selective DARI. Usual dose is 3 tabs a day, I think, while the highest recorded long-term dose was several packages per day, with no ill effects, unless you consider getting high (from several hundred tabs a day) a bad thing. Women are the most likely to abuse DARIs, apparently. quote:
The DARIs have a much lesser effect on sexual matters and Welbutrin is even marketed with the slogan "... has a low incidence of sexual side effects." DARIs are pretty universally sex-positive. Bupropion (Wellbutrin) is not a DARI, but rather a Norepinephrine-Dopamine Reuptake Inhibitor, which is an entirely different beast. For sex-neutral, the RIMAs are a better choice. The Emsam patch is sex-positive. quote:
Moreover, since dopamine is a neurotransmitter linked to pleasure and desire, some people taking DARIs actually reported increases in desire and stronger orgasms. Or, for amineptine, occasionally spontaneous orgasms. Dopamine agonists are the usual choice to manage sexual dysfunctions of this sort, however. For instance cabergoline (Cabaser, etc), which has been known to shorten the male orgasm refractory period to approximately nil in some people, as well as giving heightened libido in women, although it will inhibit lactation. quote:
Some people experiencing problems with SSRIs are taking smaller doses of DARIs to counter the sexual side effects. Lots of people are mixing SSRIs with lots of other stuff, not just DARIs. Most of the time, it is because the doc is more comfy with stacking stuff than switching meds. quote:
Others have shifted totally away from the SSRIs to the DARIs. Which is not a good idea. If you respond well to an SSRI, you should not drop it until you achieve remission. And universally trying DARIs is no better than universally trying SSRIs. The docs have little clue what does what, although the research does have some predictors, if one takes the time to read it. Roughly speaking, you have four main classes of depression that aren't comorbid to something else: - Responds best to SSRIs.
- Worsened by SSRIs, improved by mood stabilizers, anticonvulsants or (much more rarely) antipsychotics.
- No effect from SSRIs, improved by DARIs, NARIs, Wellbutrin, some TCAs, CNS stimulants, etc.
- Little effect or some worsening from SSRIs, little effect from NARIs, TCAs etc, some effect from DARIs, CNS stimulants, etc., good response with MAOIs.
Anyway, that's overly simplified, of course. I'm trying not to get into writing hundreds of pages on this stuff in my posts. At least not quite yet.
< Message edited by Aswad -- 4/19/2007 10:40:31 PM >
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"If God saw what any of us did that night, he didn't seem to mind. From then on I knew: God doesn't make the world this way. We do." -- Rorschack, Watchmen.
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