Dysfunctional effects associated with Sertraline, Vs Venlafaxine??

[JohnBoy2000]

I have looked into studies as to dysfunction associated with SSRI/SNRI class medication, in contrast with one another.

Just to clarify - when I say dysfunction, I mean - anorgasmia, erectile dysfunction, decreased libido.

It appears, in contrast to what I had previously assumed, Sertraline gives rise to perhaps the highest rates of dysfunction, with Escitalopram the lowest (within the SSRI/NRI class).

Venlafaxine, slightly lower than sertraline - but still highly prevalent.


My personal experience is, escitalopram is extremely mild in this sense.

Venlafaxine is crippling.

I have never been on sertraline.


I'm just looking for further insights or opinions on this?

Is that above outlay in regards to sertraline about right? It would be just as bad, if not worse than Venlafaxine?

 

[Abject]

Is that above outlay in regards to sertraline about right? It would be just as bad, if not worse than Venlafaxine?

Not entirely, especially comparing different studies. Just because different studies show sertraline caused higher incidence of dysfunction than a study on venlafaxine doesn't mean you'll respond as the participants in both studies did.
Ime SSRIs caused decreased libido, whereas the SNRI I tried (duoloxetine) made it harder for me to reach orgasm, but my libido itself (the desire to get off, not how aroused I became) was increased. I did things to get off on the SNRI I wouldn't have done otherwise.
Only way to know how you'll react is to try it, but sexual dysfunction is pretty much a given on SSRI/SNRIs.

 

[JohnBoy2000]

That's also my primary complaint - anorgasmia.

Libido - not so much.

Mild anorgasmia with Lexapro.

Crippling with Venlafaxine.

The Dr that scripted me Venlafaxine initially - noted that in particular - so, it does seem to go beyond individual experiences.

How Sertraline stands on that spectrum, I would be curious of.

 

[Abject]

You said escitalopram is extremely mild for you regarding sexual dysfunction; what's the issue with it? Why do you want to change to sertaline specifically?

 

[d1nach]

You got to give them a few weeks and it can go away. If both bind to SERT i dont see why either would be different.

When i started ssris i had ed for a few weeks now im fine

 

[JohnBoy2000]

You said escitalopram is extremely mild for you regarding sexual dysfunction; what's the issue with it? Why do you want to change to sertaline specifically?

The drugs I am looking at are:

- Escitalopram
- Sertraline
- Venlafaxine

As a means to augment a current combination of,

- Atomoxetine and
- Mianserin

I am considering each of the three according their interaction potential, ability to increase exposure to the current drugs - which have very narrow therapeutic indices.

Atomoxetine responds similarly to desipramine in terms of increase in AUC giving CYP2D6 inhibition.

From that point of view,
- Escitalopram increases AUC of Metoprolol (another sensitive CYP2D6 substrate), by 89%
- Sertarline increases AUC of same by 48 to 67%
- Venlafaxine - by 30 to 40%

Sertraline may also have interaction according to plasma protein displacement but - this is less likely as it binds to albumin which is plentiful..

Sertraline - inhibits p-glycoprotein - which I believe Atomoxetine is not a substrate of - but Mianserin, it's difficult to get information on.

Venlafaxine has the best interaction profile, lowest CYP2D6 inhibition, low protein binding and no p-glycoprotein inhibition - but it inhibits additional noradrenaline - which may not be desirable given I have basically saturated the noradrenergic transportes with high dose atomoxetine.

Thus - venlafaxine may require dose reduction of one of the other combination agents.


And then - I must consider which has the lowest sexual side effect impact - and like I said, venlafaxine is crippling.

What I'm reading is, Sertraline isn't a whole lot better - but that's according to two studies only.

Escitalopram would be my favoured choice - but obviously offers high interaction potential like CYP2D6 inhibition.

 

[JohnBoy2000]

This is the ultimate study relative to my own question:

To assess the incidence of serotonin reuptake inhibitor (SRI) antidepressant-induced sexual dysfunction (SD) and to compare the sexual side effects of SRI.Naturalistic, prospective, observational study.Two urban health centers.235 outpatients (164 women, 71 males) who began treatment with some of the following SRI: fluoxetine, sertraline, paroxetine, citalopram and venlafaxine, who had engaged in regular sexual practices with stable partner, who were suffering from different mental disorders who were being treated with SRI. The assignment to each group was according to clinical criteria.Patients completed questionnaires that allowed reporting of both SD induced by the illness and the treatment, evaluating changes in libido, arousal, and orgasm. The patients were observed over 6 months of treatment.147 patients (62.6%) reported one or more SD related to SRI treatment. There were differences in the incidence between the different SRI: 39% with fluoxetine, 75.5% with paroxetine, 78.8% with sertraline, 28.9% with citalopram and 80% with venlafaxine. In 78.2% of patients the SD showed no improvement by the end of this period. In a predictive logistical regression model of the presence of SD induced by the SRI, the female category and the presence of previous sexual problems were favourable predictors and the treatment with paroxetine, sertraline or venlafaxine were increased the risk of SD.SD is one of the most frequent and persistent SRI adverse effect. We recommended to inquiry about SD in patients who were treated with SRI. Significant differences were found in the occurrence of SD between the different SRI. Such data would be particularly valuable to physicians when choosing a specific antidepressant from this therapeutic group.



To make an addition to that:

http://www.antoniolatorre.it/immagini/antidepressivi.pdf

This paper analysis all the studies.
​

 

[clubcard]

For what it's worth, sertraline is the best understood of the SSRIs and was honed for a long, long time. I am impressed by the development cycle (something I almost never say). Being primarily an SDRI, it has the best profile. The parent drug tametraline was halted in stage 2 trials because of the euphoria it caused!

Never think 2 medications are better than 1. The side-effects and interactions multiply, not add.

 

[JohnBoy2000]

Instead of making another thread - perhaps someone is in a position to comment on the sedative effects of Citalopram??

Its profile is quite a appealing to me in terms of lack of interaction - but being a mild anti-histamine - case reports on review websites indicate a lot of lethargy.

 

[JohnBoy2000]

Well - as they say, I guess everyone responds differently and, in my case - sertraline, seems to be the right one.

Lexapro and venlafaxine induced awful sexual dysfunction.

Sertraline - enhances it.

It's curiously similar to my experience on Wellbutrin; I understand this would be relative to a DRI property.

Now I know it's hotly contested, as to whether either of those two, actually has any DRI properties.
Well - going on this effect - they definitely do.
Unquestionably.

Whether that's more pronounced due to synergy with Mianserin/Atomoxetine - I don't know.

But it's there.

 

[JohnBoy2000]

For what it's worth, sertraline is the best understood of the SSRIs and was honed for a long, long time. I am impressed by the development cycle (something I almost never say). Being primarily an SDRI, it has the best profile. The parent drug tametraline was halted in stage 2 trials because of the euphoria it caused!

Never think 2 medications are better than 1. The side-effects and interactions multiply, not add.

And I'm curious about this drug Tametraline, also.

So - it had potentially beneficial clinical profile - but was ceased due to abuse potential?

Amphetamine etc - they have abuse potential - but were never halted.

 

[Speed King]

The drugs I am looking at are:

- Escitalopram
- Sertraline
- Venlafaxine

As a means to augment a current combination of,

- Atomoxetine and
- Mianserin

I am considering each of the three according their interaction potential, ability to increase exposure to the current drugs - which have very narrow therapeutic indices.

Atomoxetine responds similarly to desipramine in terms of increase in AUC giving CYP2D6 inhibition.

From that point of view,
- Escitalopram increases AUC of Metoprolol (another sensitive CYP2D6 substrate), by 89%
- Sertarline increases AUC of same by 48 to 67%
- Venlafaxine - by 30 to 40%

Sertraline may also have interaction according to plasma protein displacement but - this is less likely as it binds to albumin which is plentiful..

Sertraline - inhibits p-glycoprotein - which I believe Atomoxetine is not a substrate of - but Mianserin, it's difficult to get information on.

Venlafaxine has the best interaction profile, lowest CYP2D6 inhibition, low protein binding and no p-glycoprotein inhibition - but it inhibits additional noradrenaline - which may not be desirable given I have basically saturated the noradrenergic transportes with high dose atomoxetine.

Thus - venlafaxine may require dose reduction of one of the other combination agents.


And then - I must consider which has the lowest sexual side effect impact - and like I said, venlafaxine is crippling.

What I'm reading is, Sertraline isn't a whole lot better - but that's according to two studies only.

Escitalopram would be my favoured choice - but obviously offers high interaction potential like CYP2D6 inhibition.

When you say
Venlafaxine has the best interaction profile, what are you referring to?

I have read that it interacts with a whole mess of drugs.

 

[JohnBoy2000]

When you say
Venlafaxine has the best interaction profile, what are you referring to?

I have read that it interacts with a whole mess of drugs.

It has negligible CYP2D6 inhibition, very low protein binding, and no p-glycoprotein inhibition.

But - yes - despite this profile - it does seem to interact with some drugs fairly heavily.