muddypaws: PSSD priapism and sleep-related painful erections after taking paroxetine and a benzodiazepine in combination

[muddypaws]

Hi everyone. I hope you are coping okay and moving in a positive direction towards recovery.

 

I'd like to share my experience if you don't mind and would like to hear from anyone who may advice or relevant experience.

 

In November of 2021, I was prescribed the SSRI paroxetine and the benzodiazepine clotiazepam for anxiety and rumination. I didn't know what the medicines were exactly, but cautiously decided to take one as prescribed, I chose (basically at random) the clotiazepam. After two weeks taking the benzodiazepine, I discovered what the medicine was and decided to stop taking it. I suffered severe withdrawals.

 

I consulted the doctor again who advised me to take both medicines and taper off the benzo. So I reinstated the benzo and began the paroxetine. After a few weeks of taking both medicines I started having bizarre, painful erections in the night. But I was suffering so many unpleasant side effects I didn't think much of it.

 

In February this year, after about three months tapering the benzodiazepine and taking a costant dose of around 2.5mg paroxetine, I decided to start tapering the paroxetine too. When I dropped the dose of paroxetine to 2mg, I began suffering painful erections all night. This got worse when I completely stopped the paroxetine.

 

Now, in June, I have painful erections all night. Basically, as soon as I fall asleep I get an erection. These are not normal erections, they are constant and painful and are not associated with sexual arousal. I wake up every hour or so to try to get the painful erection to go down by moving around and apply a cold towel. It has severely impacted my sleep. I have discovered the condition is called Sleep-related Painful Erections (SRPE).

 

I am seeking assistance to recover from the injuries I feel I have suffered from paroxetine and a benzodiazepine.

[Altostrata]

Welcome, @muddypaws

 

Do you have any other symptoms you associate with going off clotiazepam and paroxetine?

 

Your priapism symptom sounds related to PGAD, which has been reported as an adverse effect from antidepressants. 

 

 

It sounds like when you first went off clotiazepam, withdrawal from that might have sensitized your system to the paroxetine, which you started taking with reinstated clotiazepam. Then you got this priapism symptom from paroxetine or the combination of the 2 drugs, which persisted and maybe worsened with withdrawal, which additionally sensitized your nervous system.

 

It's possible you had a fairly immediate severe adverse reaction from paroxetine, see Adverse reactions to an antidepressant within a few doses -- how long for recovery?

 

Not much is known about PGAD or PSSD, after-effects of antidepressant use. We have seen these conditions, like protracted withdrawal syndrome, very slowly fade.

 

 

To help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

[muddypaws]

Thank you very much for your reply @Altostrata

 

Yes, I think my CNS was highly sensitized when I was experiencing withdrawal from the clotiazepam. At that time, I had many of the classic symptoms of benzodiazepine withdrawal as listed on the Wikipedia benzodiazepine withdrawal syndrome page, including severe symptoms like suicidal ideation. I had gone from perfectly functional two weeks earlier, working and looking after my family, to completely dysfunctional and fighting for my life.

 

Once I had reinstated the clotiazepam and started the paroxetine, the symptoms did not go away, they simply changed in nature and intensity. However, many did subside over the subsequent months as I tapered the medicines. 

 

Since discontinuing both drugs, the main symptoms I am left with are an unpleasant, piercing tinnitis, which started a few weeks after taking both medications, the dreadful erections throughout the night, and an increase in the neuropathic pain I have in my legs from a longstanding chronic pain condition. The increase in pain began when I stopped the clotiazepam in November last year and has been made worse by my inability to sleep properly as I wake almost every hour throughout the night with a painful erection.

 

Your mention of persistent genital arousal disorder (PGAD) make sense. I have constant pain and sensitivity in my genital area now, although I'm not sure if it's due to the medicine directly or a consequence of having the extreme erections. I didn't have any pain or sensitivity before the night of the first painful erection, which suggests it could be the latter. Strangely, I also have a degree of erectile dysfunction now when trying to engage in sexual activity, which I'd never had before I'd taken the medications; it takes me much longer to get aroused. My understanding is that the official side effects for paroxetine include both erectile dysfunction and priapism, and I seemed to have gotten both! What they don't make clear is that these can be prolonged side effects, as I've experienced, and not just an effect that occurs while you're taking the medicine. So, I'm not sure if I have PGAD or PSSD, or a kind of hybrid. My sexual function has been very messed up, that's my simple assessment.

 

I do find it difficult to understand how paroxetine was responsible for causing the uncontrollable erections, but at the same time reduced the intensity of them, evidenced by the fact that when I stopped paroxetine the erections went from once or twice a week to all through the night, every night. Paroxetine is well known to suppress the nerves involved in generating an erection, and I wonder if some of the nerves in those pathways were damaged by serotonin toxicity, but because I was still taking the paroxetine, which continued to act to suppress erections, the injury didn't manifest in full. Then, when I stopped the paroxetine, the nerves that remained intact where no longer able to properly regulate erections during the night and the full impact of the damage became evident. As you can see, I'm grasping at straws to explain what happened.

 

Any further advice or referral would be much appreciated.

 

Thank you again for your support.

[Altostrata]

I'm sorry, @muddypaws, that sounds like an awful combination of post-drug effects. 

 

Please look at the PGAD topic, I believe some people have sought medical treatment. 

 

Since clotiazepam might be involved in your withdrawal reaction, you might reinstate a little and see if that helps, being that it's a muscle relaxant.