Antidepressants - SSRIs, SNRIs ect - sexual side effects? other questions

[raveageddon]

Hey all. I am looking for information about anti-depressant drugs based on people's personal experience. Here's the backstory:

My partner (26 years old) struggles with PTSD, depression and sometimes anxiety. Despite this she has lots of friends and participates fully in the community. She has recently been doing a lot to deal with her problems: she has quit drinking and recreational drugs except on rare occasions as they can exacerbate the depression/anxiety and be used for evasion. she has been going to counseling as well as really taking time with me to better understand the causes of her problems and how they affect our relationship.

Some of her symptoms include becoming stressed out/upset easily, short tempered, becomes easily discouraged, lacks the confidence to stick up for herself, often self blames, often unmotivated to get enough sleep/eat well or leave the house, during particularly bad times some real breakdowns/panic attacks occur, she also has suicidal thoughts but says she has never actually seriously contemplated suicide and has no actual desire to die. However as a young teenager she did self harm (mild cutting, once OD'd on tylenol). In the year that I have known her she has self-harmed (small cut) only once but was on codeine at the time and says opiates bring that out in her and from now on she won't do them (she never did them enough to become addicted). She does sometimes feel self-destructive tho and during those times may do something blatantly counter-productive such as have a night of binge drinking.

When I first met her she started doing MDMA and for a while found it had therapeutic value for her but later found that she wasn't getting that from it anymore and stopped. However this may have been, in part, a catalyst for her developing a more constructive approach to thinking about her problems. Her cessation of drinking/drugs and going to counseling has promoted a lot of positive changes in these tendencies but has not eliminated them by any means. However she now has the added difficulties of feeling socially isolated due to most of her friends being party animals and dealing with the hardship caused by facing painful memories in counseling. So while she is on the right track and things have improved, she is still having a pretty rough ride.

At this point she is considering going on anti-depressants as she hopes that they may make it easier for her to deal with school, difficult counseling experiences, seasonal affective disorder during winter and just make day to day life easier. I too feel that this option may have potential but she/we have some pretty serious concerns:

1. Sexual Side Effects - While some people who are depressed may lose interest in or feel unable to enjoy sex, this is not the case at all with her. She is highly sexual and enjoys having lots it! Without going into too much detail, sex is an extremely important part of her life and actually critical to her happiness. She achieves orgasm very easily and find sex to be very therapeutic as well. If taking anti-depressant significantly reduce her enjoyment of sex they would NOT make her happy and it would be a major distress for her. But are the sexual side effects more common in people who had little interest in sex to begin with due to their depression?

2. Suicidal Ideation - For obvious reasons, based on what I said above. This is a major concern.

3. Withdrawal Symptoms - She does NOT want to be on anti-depressants for life unless it was absolutely necessary (whatever that means). She hopes to be able to use anti-depressants to get through school (last year before grad so very important), and help her cope with the intensity of counseling. The goal would be that once she gets through the really intense stuff counseling is making her face, she could get off the drugs. The withdrawal symptoms of some of these drugs sound very intense and I don't think she would cope too well with them from the sound of some of the testimonies I've read at least not right now. So if she had bad side effects and wanted to get off right away it could be messy.

So based on everything I've written what do people who have experience with anti-depressants think? Are there any particular drugs to avoid at all costs, any that might be worth trying. At this point we're looking for any thoughts that might shed some light on the issue.

 

[raveageddon]

sorry if this post is too intense for this forum. I'm still getting used to selecting the right one.

 

[effie]

That's okay. It's awlays difficult knowing where these sort of posts should go..

Ultimately your girlfriend needs to talk to a doctor and get some medical advice on what to try first. I'm sorry she's having such a tough time, but I'm really pleased to hear that she does seem to have the right attitiude towards this and is doing all the right things. Make sure you tell her how well she is doing

She has some biological signs of depression, certainly, as well as the psychological signs. Antidepressants can be really helpful in treating the biological symptoms and providing a bit more energy and motivation, which helps you to live your life again, an ultimately that is what really helps (IMO). I'm glad to hear she's getting some counselling too. Antidepressants aren't for everyone, and I'd encourage her to speak to her doctor about it, but they certainly could help.

Broadly speaking, there are a few classes of antidepressant:

SSRIs - fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) etc.. plus newer drugs like escitalopram (Lexapro). These are often first-line.
SNRIs - venlafaxine (Effexor) is the most common
Tricyclics - amitriptyline, lofepramine, dosulepin etc. These have been shown to be as effective as SSRIs in clinical trials, and have been around for longer, but tend to produce more severe side efffects (dry mouth, blurred vision, urinary retention, constipation, drowsiness) and are therefore less well tolerated, plus have a higher risk of serious consequences/death in overdose.
Tetracyclics - mirtazepine is the most common.
MAOIs - not really used anymore.

SSRIs and SNRIs are the ones that can have sexual side effects. This doesn't happen to everyone, but it is more common with them. Usually they go away when the drug is discontinued, but very occasionally they can last longer. It's a difficult one, as they are often first-line and can be very effective, but I completely understand what you are saying about how it would affect your girlfriend..

This trial found that paroxetine was the worst (compared to fluoxetine, fluvoxamine and sertraline) and here in the UK sertraline has a reputation for having fewer side effects than the other SSRIs, although I don't know how evidenced based this is (will look it up later).

This trial found that venlafaxine has a lower rate of sexual dysfunction than sertraline (and men were affected more than women, so good news for your girlfriend!)

This trial found that bupropion (Wellbutrin) had a lower rate of sexual side effects than SSRIs and SNRIs - it is an atypical antidepressant and I have to admit I don't know much about it's efficacy, but wikipedia seems to think it is okay! Link
I don't think mirtazepine causes sexual side effects, but it is very drowsy and causes an increased appetite - good for some people, less so for others.

As for the other parts of your question, I have to go and eat my dinner now so I'll answer later

 

[Allein]

Its not to too intense for BL matey I just didn't have the time last night to answer as it ws quite a complex question and effects will vary based on what type of AD and from person to person.

I'm a male 40,married and been on and off ADs for about 2-3 years now and am on my 6th one so I've tried most of the main groups:-

1.) I definitely have a lower sex drive than I did before my big break down last year, how much of this is down to ADs is very difficult to tell although many do list it as a possible side effect. Thats not to say I have totally lost interest but my interest is significantly less, for example I used to enjoy watching pornography with my partner and occasionally alone and don't do that anymore. I would say we have about half as much sex as we used to. But thats been OK, we've bee together 25 years things never stay the same maybe they will change in the future.
I think on this this one you may be thinking a little backwards if your gf wants less sex she is likely not to be so bothered about it. I have concentrated on ensuring we maintain closeness and affection, frequency of sex will often eb and flow in a relationship but keep talking and keep kissing and cuddling and I'm sure all will be fine even if the AD does reduce her interest.

2.) I have suffered quite badly from both thought of Suicide and Suicidal Ideation when off ADs I recently went onto venlafaxine and started a CBT course and both have left me at the moment. They list this as a possible side effect on many ADs that can happen in the first few weeks so its something to be aware of, but remember there is great deal of difference between thinking and doing. These thoughts are often a symptom of depression and most people do not go on to act upon them. Keep talking to her about how she feels if those symptoms become really acute she should go straight back to her doctor who will most likely change the AD. The symptoms of this as far as I am aware seem to affect the young more then old farts like me.

3.) The bad side effect are usually experienced within the first couple of weeks so WDs are not an issue, if she needs to be on an AD and in the long term she builds up side effects the doctor will taper her down. I'm no doctor but know many people including myself that have stopped SSRIs and tricyclics after many weeks of use with no taper and no WD effects were experienced, not all ADs are as easy to come off, but this is something in the future to deal with then and varies so much between one person and another. She needs to deal with her depression now and if that means taking an AD I'd worry about getting back off them until the time comes Your not going to know if she is going to experience any kind of problem until then and its then you can help her deal with it.


Feel free to ask fruther questions, you are in the right place for getting peoples views and experiance

 

[effie]

^ woo atm! Was hoping you'd have something to add

In terms of suicidal thoughts - yes there has been shown to be an increase in suicide, but not suicidal ideation. The theory (that I agree with, haha) behind this is that when you are really severely depressed you might have suicidal ideation constantly, but you don't have the energy or the motivation to plan and carry out the act. Antidpressants often improve energy and motivation before mood, so they give someone the tools to carry out the deed before they help lift the mood to prevent the desire in the first place. It's too early in the morning to dig out studies but I'll come back later and add them if I have time..

As atm said, keep talking to her and make sure she keeps talking to you. Keep a really close eye on her, and if you get worried take her to the hospital (if there's an immediate danger) or back to see the doctor that started the antidepressants (if not). I'd also have a good chat with her about suicidal thoughts before she starts - it sounds like she's being honest with you and is aware of the issue, but just make sure you're both on the same page about talking and what to do if she does become suicidal. The incidence of suicide settles down after the first couple of weeks (which is about the time that people tend to start to feel a bit better..)

As for withdrawal symptoms - antidepressants are not addictive, you don't have cravings for them, they don't produce tolerance and you therefore don't have technical withdrawal symptoms. However, SSRI/SNRI discontinuation syndrome can happen. It doesn't happen to everyone (incidence rates are reported to be 20-25%, but may be higher if you count very minor symptoms) but it is more common in drugs with a short half life (eg paroxetine, venlafaxine) than those with a long one (fluoxetine) and often if they are bad doctors will swap someone on to fluoxetine while they come off antidepressants.

The one I am on, venlafaxine, is notorious and if I miss a pill I get headaches, aches and pains, brain zaps, really grumpy and irritable and generally feel rubbish. However, it works so well for me, that I am prepared for things to be a little unpleasant when I stop. I have a friend on venlafaxine who doesn't notice a thing if she stops it however. I know this is anecdotal, but thought I'd let you know - not everyone gets it, even with those in which it is more common. For most people it's a temporary thing, but for a very small minority it lasts for longer. SSRI discontinuation syndrome (or wikipedia it)

Hope that was coherent, I've not had much sleep! Will come back and add sources later.

Good luck to you and your girlfriend

 

[raveageddon]

Thanks a lot for the responses! It is very helpful and much appreciated. Wellbutrin sounds like it may have potential for her but of course the first step will be for her to go to a doctor and explain her situation, concerns and see what they recommend. Luckily she was put in contact with a doctor who has been vouched for by a couple of her close friends who are having success with ADs. She has already made the appointment. effie I remember reading a study that explained the suicidal thoughts issue just the way you did and it really does make a lot of sense. I'll will post again if I have further questions and anyone else who wants to chime in is most welcome.

 

[Addyman]

If anything, try Wellbutrin first (works on dopamine and norepinephrine, least amount of occurence of sexual side effects)

If fails, you're choice on trying SSRIs or SNRIs

 

[laCster]

go with 60mgs DXM daily. it's like a super drug in low doses. SSRI, SNRI, sigma-1 receptor antagonist, and NMDA antagonist (and very little affinity for mu, kappa, and delta receptors). NMDA antagonism is my favorite quality that DXM possess because of its potential to reduce tolerance. low doses of NMDA antagonism have been shown to create better behaviors, reinforce memory functioning, and brain health during a period where an anti-depressant would play a legitimate therapeutic role. multi-vitamins , proper diet and exercise help too....

 

[Opaner]

I have GAD (Generalized Anxiety Disorder) I suffer from severe panic attacks almost every day, which I have been hospitalized a good amount of times. I have been through the whole bucket list of medications (Effexor, Lexapro, Celexa, Zoloft, ect.) Medications such as effexor and lexapro gave me a negative experience. The side effects were way to difficult for me to handle and IMO made me worse then I already was. Recently, my doctor and I decided to take a shot on Zoloft. I was a little skeptical due to my recent run ins with all the other medications. I got on a very good dosage schedule and I was very shocked to find out that it actually worked! I felt very very mild side effects for 2-3 days. Which included being a little more tired then normal, having trouble balancing when I would stand up from laying down. But these didn't last long and after a few days were undetectable. I was put on 150 - 200mg a day and I can say it really did work very well for me.

But all medications will effect everyone differently. But I can say with confidence that Zoloft is a great medication to experiment with. Without any severe side effects, and you really don't even notice your on medication. Make sure you talk with your doctor and have good communication. Good luck!

 

[Doug2113]

Effie, you said that SSRI's and SNRI's are the ones that have sexual side effects, but I've heard that tricyclic anti-depressants can cause a shrinkage of...well...I'm sure you could guess lol. Is that possible lol?

Anyone? Anyone at all? lol

bump-bumpity-bump-bump-bump

 

[raveageddon]

Well I thought I would give an update on how she's doing. The doctor has her taking Cipralex (aka Lexapro) started her on 5 mg dose for four days then moved to 10 mg for four then had a check in appointment. Still on the 10 mg. She has been on this stuff for about 2.5 weeks now. The result has been GREAT! The amount of time she spends feeling stressed out about her life has been at least cut in half. She has way more motivation. Easier to get along with. Just all around more go with the flow. But she's still acting like herself - this is just how she is when she is doing well. She has not experienced any of the negative side effects we were worried about! The only negative side effect she IS experiencing is appetite suppression but she is coping with it well. Making sure to eat balanced meals throughout the day. She says she is able to eat but just doesn't feel much of a need. All in all this is going well and she is really happy with the results. Thanks everyone for your support and help before. It was very important that we had a good understanding of anti-depressants going into this. I think it made her feel much more empowered in making the choice to use them.

 

[Allein]

Effie, you said that SSRI's and SNRI's are the ones that have sexual side effects, but I've heard that tricyclic anti-depressants can cause a shrinkage of...well...I'm sure you could guess lol. Is that possible lol?

Anyone? Anyone at all? lol

bump-bumpity-bump-bump-bump

I was on Lofepramine for over 3 months maybe more can't really remember the exact dates, no "shrinkage" was experienced on this or any other AD and I've been on a fair few now.

I wouldn't recommend an AD to anyone as the effects on different people seem to vary more than any other from of medication I've ever come across, as an example someone at work started taking Citilopram and swore she had no side effects at all, when I took it it put me in bed for 2 weeks taking to people that weren't even there. I guess I was sin a pretty bad way at the time but the Citilopram almost pushed me over the edge IMO.

Now I'm on Venlafaxine (Effexor) and getting on really well with it where as Sertraline (Zoloft) gave me internal bleeding.

Along side me giving up the booze in July and the appetite supresion of all the ADs I've lost about 2 stonein weight but am stioll eating regularly and well so thats been a win

 

[Corin_is_great]

i do not mean to hijack this thread but i have an unusually high sex drive and i really hate it, i also suffer from dysthymia and have never wanted to go on AD's for fear of permanent side effects and damage of wellbeing (which is quite stupid really) but would anyone have any kind of vauge idea as to whether it would be completley out of the question for a doctor to put someone on AD's for depression but pick a certain type known to reduce labedo if their patient wanted it? i didnt think this was worth starting a new thread for and i wont get in the way of the initial question, i do apologise if this has pissed anyone off.

 

[raveageddon]

I was on Lofepramine for over 3 months maybe more can't really remember the exact dates, no "shrinkage" was experienced on this or any other AD and I've been on a fair few now.

I wouldn't recommend an AD to anyone as the effects on different people seem to vary more than any other from of medication I've ever come across, as an example someone at work started taking Citilopram and swore she had no side effects at all, when I took it it put me in bed for 2 weeks taking to people that weren't even there. I guess I was sin a pretty bad way at the time but the Citilopram almost pushed me over the edge IMO.

Now I'm on Venlafaxine (Effexor) and getting on really well with it where as Sertraline (Zoloft) gave me internal bleeding.

Along side me giving up the booze in July and the appetite supresion of all the ADs I've lost about 2 stonein weight but am stioll eating regularly and well so thats been a win

What symptoms did you experience as a result of the internal bleeding? Just wondering what to watch for.

 

[effie]

^ I can't answer for atm, but in general bleeding from your GI tract can give you a range of symptoms. If it's a small, slow bleed sometimes you don't get anything except anaemia developing slowly over time - which can make you tired and look pale. If the bleed is from the stomach or higher up in your intestines (which it would be in this case - stomach specifically) you can sometimes get black, tarry stools - this is caused by altered, partially digested blood mixing with your stool. If the bleed is lower down (not relevant to this example) you can get actual blood in your stools.

The bleeding in this case is usually from your stomach and it can cause a lot of pain. If it is a big bleed you can vomit blood, or sometimes something that looks like coffee grounds (again, altered blood). It is a rare side effect but obviously potentially very serious

Internal bleeding can also mean bleeding from other areas, but in the case of SSRIs it is an upper GI tract bleed.

Article on SSRIs and GI bleeding in the British Medical Journal

 

[Allein]

^^^

Sorry I should have been more specific than raise such a sever reaction and then not explain, you know I'm not shy about such things Effie.


I had a full stomach bleed, was in real pain vomited what looked like coffee grounds and then after constipation my stools were jet black... I apologise to anyone trying to eat !!

To be fair I was drinking a fair amount at the time, but ceasing the Sertraline resulted in no further bleeds, I had a hospital appintmant and saw a specialist , they offered to put a camera down my throat just to check but I politely declinned however I will have to have this done if it ever happens again.

I'm ot saying Sertraline will make you have a stomach bleed at all it was just an example of the variatioon in side effects

 

[Supeudol]

This is an interesting thread.

I started out taking Paroxetine 10mg/day for Severe Panic Attacks when I was 17, then moved up to 20mg the second week. This was a very good result and cleared up my Panic Attacks ASAP.
I thought I didn't need the Paroxetine anymore after about 2 months or so, so I abruptly stopped taking it because my Doctor never mentioned anything about SSRI Discontinuation Syndrome.
That's when things fell apart, and took me about 2 weeks to recover, still NOTHING compared to Benzodiazepine Withdrawal Syndrome, as this has been ongoing for me still after 6 weeks of being off.

Anyways, fast forward a few months later, went back on Paroxetine because the Panic Attacks came back, and so fast forward years later, on and off Paroxetine and Escitalopram.
So, fast forward on to present day, as I am now 25 and my doctor has me tapering off Venlafaxine XR from 150mg/day down to 75mg/day and starting Paroxetine at the same time.
I asked to switch back to Paroxetine because I thought it worked better than Venlafaxine, but I am going through Benzo withdrawal at the same time!

Now, I think I should have just stayed with the Venlafaxine because it was working pretty good, and I have been on and off Paroxetine so many times that I don't think it will work for me anymore.
I have also been on an off different doses of Venlafaxine, but not as many times as the Paroxetine.

What do you guys think about this situation I'm in? Should I go back and see my doctor and go back on the Venlafaxine? Its just too much for me at the moment while still in Benzo W/D and trying to taper off Venlafaxine, and at the same time re-starting Paroxetine? I think it is a bit dangerous to be taking Venlafaxine XR 75mg/day with Paroxetine 10mg/day. <-- Not sure why my doctor suggested I do it this way.

Any Suggestions guys? 8(