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  1. Branyan's success story: branyan-pssd-successchallenges First posted this today in the Symptoms forum, but since it is my first post I will post it here in hopes i can get some replies Keep in mind, that in addition to the sexual side effects (which in all honesty are the biggest deal to me, considering i lived with all the other symptoms while on the Lexapro itself and maintained a good life) I deal with cognitive difficulty, food and drink sensitivies, etc etc. "Hey all. New here. Since coming off Lexapro (after being on from Mid 2007 to March 2010) I have experience a slow decline in my sexual function which platuead in about Febuary. Generally speaking I feel unaware of my penis and sexual realm. I feel that has something to do with the pudendal nerve. Even when I can achieve an erection it is mostly numb. I cannot get visually aroused 98% of the time, and would be unable to have sex or feel intimacy at this point. This after enjoying 2 very good sexual relationships while on Lexapro. Keep in mind that the sex declined as the years went on on Lexapro. And I am only 23! Interestingly enough, the only facet of my sexual function that is somewhat intact is the actual orgasm which still feels really good. Anyway. I have been over to the YAHOO PSSD group and seen the despair over there. It sounds like this is a permanent deal, although I have had many people try to convince me otherwise. Any success stories out there> "
  2. 2014 the beginning of November I went to a psychiatrist and got misdiagnosed with psychosis and depression and was prescribed Rispolept (Risperidone) 3 mg and Cipralex (Escitalopram) 10 mg. I took these drugs at home, then in the psychiatric hospital until around the end of December, so for about 1.5 month, until I was discharged, then cold turkeyed. Antipsychotic - 3 mg/day, SSRI - 10 mg/day. I felt very bad, suicidal that whole time, at first not even realizing it was the drugs affecting me and in fact almost committed suicide. While on medication I experienced akathisia, severe fatigue, anhedonia, weak emotions, almost non existent libido that gradually got worse, slowed reaction time, thinking, talking, moving, poor memory, what I'd call derealization, zombie like state, frequent urination, dizziness , headaches, one side of brain, frontal lobes especially, abnormal gait, strange feeling in frontal lobes, increased appetite, too high body temperature, especially after running, nerve pain in left leg, arm, numbness in left arm, leg and left side of face I think. After quitting the drugs I thought everything would go back to normal, but it didn't. After about a month drug free I had: severe sexual dysfunction (post antipsychotic sexual dysfunction-PAPSD), my left hand was somewhat numb, and to a lesser extent, my left leg. I also started noticing dystonia in my left cheek and eyelid. Slight tremor in left arm fingers. Dizziness when turning head. I also noticed I had developed slight gynecomastia. After two months the painful tingling in my left arm was very severe some days lasting the whole day. Very bad pain. Dizziness disappears. Month 3: painful dystonia in middle of back, left side of spine appears, more pronounced in the evening. Weak morning erections appear. Month 4: (2015-04-09) tingling in left arm subsided, but it's still numb. I think the tingling is the nerves recovering. Hoping for recovery. Will update. I'm optimistic about the dystonias, paresthesia (but probably won't recover sensation fully), sexual dysfunction, as far as I know my new man boobs should also reduce in size with time. But I heard that the neuroleptic induced parkinsonian tremor does not always disappear, and I'm not seeing a reduction in the tremor, so I'm worried about that. Also, obviously worried about the sexual dysfunction. I used to be very sexually active, but now have very infrequent orgasm, because they're so very difficult to achieve and not so rewarding. My pre-neuroleptic emotionality has fully returned after stopping the drugs, I think. I also heard Risperidone can permanently reduce testosterone, but I haven't seen a reduction in facial hair growth. Been drug free for 4 month now. Never took any psych drugs before in my life. Now only taking fish oil, multivatamin and mineral tablets, sometimes magnesium 300 mg. I tried Vitamin B Complex but I think I'm allergic to it. Psychiatrists truly are ignorant.
  3. More documentation of Post-SSRI Sexual Dysfunction (PSSD), lasting long after discontinuation of the drugs. J Clin Psychopharmacol. 2015 Jun;35(3):273-8. doi: 10.1097/JCP.0000000000000300. Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H. Abstract at http://www.ncbi.nlm.nih.gov/pubmed/25815755 Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.
  4. Hello everyone, 36 year old male, suffering from depression since 2010 brought on by a death in the family-someone I was terribly attached to. Since then, lost a lot of interest in the things in life that used to make me happy. Contracted severe OCD as well; would make the sign of the cross and touch table surfaces upto 8 times anytime an intrusive thought came into my head, and would hum prayers under my breath which became (at times) embarassingly noticeable to those around me. In 2012 things got better; I left a depressing, dead-end job and decided to take time off work to do my MBA in Spain (I live in Dubai btw). Didn't have much time to be depressed doing my MBA since it took so much of my time and I felt I was doing something worthwhile, but I had a massive hit in self-esteem when I lived there. I felt pretty alienated and lost in a foreign land with a foreign language and developed social phobia as a result. My sex drive also suffered as a result. At the end of 2013 I moved back to Dubai to find a job. It wasn't until April 2014 that I finally got a job offer, but with a company and a prospective manager I had serious doubts about. As a result, I visited a pyschiatrist and mentioned that I need a coping mechanism for the next one year (the period I assumed I would have my hands cuffed to this job after 2 years of wonderful independence). I was prescribed citalopram (Celexa) for mood stabilisation, and clonazepam for social anxiety. Citalopram worked fairly well for me; I noticed I was a lot calmer, less prone to mood swings, less prone to depressive thoughts and behaviour. However in September 2014, I got this wonderful brainwave to go off Citalopram cold turkey. Yes, I know It was almost close to what I would expect a heroin withdrawal to be like, with the emphasis on mental vs. physical symptoms. For 2 weeks I suffered, and my actions during those weeks came back to bite me 2 months later. In the meantime, the doctor prescribed me to go back on Citalopram. It helped immensely; I was back under my normal, subdued, antidepressant greyish cloud. In November 2014, I visited him again and told him the sexual side effects (yes, we're finally getting to why I am on this board ) were not great. Even to the extent that Cialis couldn't counter it! I had read a lot about Bupropion (Wellbutrin) being able to counter the sexual side effects of anti-depressants, so I asked him to prescribe it for me. He did, but I have only recently started taking them (4 days ago as a matter of fact). Later that same month (November 2014), I was called into a meeting with my bosses, and told that they had decided to terminate my contract. As I suspected back when i first took this job, my direct line manager turned be a boorish, arrogant, bossy tw*t, and our showdowns which intensified during my unfortunate cold turkey phase had led to him plotting to remove me from my position, because he couldn't try and forcefeed me the daily bullsh*t he was giving. I, unfortunately, played into their hands. Nevertheless, not working for that company has been brilliant. However, it's now February 2014 and I am still unemployed. I feel like the situation and the antidepressants have completely robbed me of my sexuality. I have developed OCD in terms of unwanted sexual thoughts. My loving and understanding girlfriend and I haven't made love since November last year. I've started tapering off the Citalopram since December, and have recently added Bupropion to the equation, hoping that I can get my sex drive back, heck even get a solid and firm erection and have a reasonable fantasy about a woman and masturbate. Incidentally, during my cold turkey phase, I did get some of my sex drive back. By the end of this month, I plan to get completely off Citalopram and give Bupropion a real go. But I'm really, really worried about PSSD.....not least because my sex drive was anyway suffering for the past few years, and I have history of using 'disco' stimulants in the past.
  5. Pharmacol Biochem Behav. 2014 Jun;121:138-45. doi: 10.1016/j.pbb.2013.12.003. Epub 2013 Dec 11. Antidepressant-related sexual dysfunction - Perspectives from neuroimaging. Graf H1, Walter M2, Metzger CD3, Abler B4. Abstract at http://www.ncbi.nlm.nih.gov/pubmed/24333547 Full PDF text here https://xa.yimg.com/kq/groups/14420181/1954044300/name/SSRI+and+FSD+-+MRI+2014.pdf Abstract: Sexual dysfunction is not only a common symptom in major depression but also a frequent side-effect of antidepressant medication, mainly of the selective serotonin reuptake-inhibitors (SSRI) that are often prescribed as a first line treatment option. Despite of the increasing incidence and prescription rates, neuronal mechanisms underlying SSRI-related sexual dysfunction are poorly understood and investigations on this topic are scarce. Neuroimaging techniques, mainly functional magnetic resonance imaging (fMRI), provide a feasible approach to investigate these mechanisms since SSRI-related sexual dysfunction is most likely related to central nervous processes. This review summarizes the recent literature regarding the basic clinical findings and imaging correlates of antidepressant-related sexual dysfunction linking brain regions and networks potentially involved two phases and subcomponents of sexual processing and antidepressant action. In particular, fMRI studies on SSRI antidepressants including paroxetine and SNRIs including bupropion are highlighted. .... Conclusion: Recent investigations focusing on antidepressant-related sexual dysfunction could demonstrate that neural networks and subcomponents of sexual processing are affected specifically according to the drugs' impact on neurotransmission. Whereas serotonergic drugs like SSRIs led to decreased activation in reward and emotional networks, dopaminergic medications led to enhanced activations within these brain regions, thus, providing evidence and neural correlates for the clinical observation of SSRI-related sexual dysfunction that is absent under dopaminergic drugs. Although further research is necessary, neuroimaging studies thus could link clinically observed antidepressant-related sexual dysfunction to a plausible explanatory neurobiological model. Moreover, it seems reasonable that these approaches may not only be helpful for the selection of specific drugs according to their receptor profiles but also for developing new medications.[/size] Direct Download: https://xa.yimg.com/kq/groups/14420181/1954044300/name/SSRI+and+FSD+-+MRI+2014.pdf SSRI+and+FSD+-+MRI+2014.compressed.pdf
  6. Drs. Leiblum and Goldmeier have written several papers on PGAD. J Sex Marital Ther. 2008;34(2):150-9. doi: 10.1080/00926230701636205. Persistent genital arousal disorder in women: case reports of association with anti-depressant usage and withdrawal. Leiblum SR1, Goldmeier D. Abstract http://www.ncbi.nlm.nih.gov/pubmed/18224549 Full text requested from Dr. Goldmeier Little is known with certitude about the triggers of persistent genital arousal disorder (PGAD) in women, although there appears to be certain common features of the disorder. Women complain of unbidden feelings of genital arousal that are qualitatively different from sexual arousal that is preceded by sexual desire/and or subjective arousal. The majority of women find PGAD distressing and report only brief relief with orgasm. In this article, we describe five women who believe they developed PGAD either after withdrawing from selective serotonin reuptake inhibitor (SSRI) anti-depressants or while using them. We discuss these sexual symptoms in relation to what is already known about prolonged SSRI withdrawal syndromes and the possible etiologies of these conditions. While not a common cause of PGAD, it is possible that use of, and withdrawal from, pharmacological agents contributes to the development of PGAD.
  7. SSRI usage or withdrawal is implicated in many cases of PGAD. Int J STD AIDS. 2009 Jun;20(6):373-7. doi: 10.1258/ijsa.2009.009087. Persistent genital arousal disorder: a review of the literature and recommendations for management. Goldmeier D1, Mears A, Hiller J, Crowley T; BASHH Special Interest Group for Sexual Dysfunction. Abstract at http://www.ncbi.nlm.nih.gov/pubmed/19451319 Full text PDF ‎‎http://www.bashh.org/documents/2428.pdf Persistent genital arousal disorder is a newly recognized condition that is poorly understood. There is a paucity of research in this area and there are concerns as to the validity of the results of what little research there has been. This article aims to draw together current literature on this topic and provide readers with guidance on the management of this condition. This includes a working definition, an exploration of possible aetiologies within the confines of current knowledge, practical advice regarding assessment, management and auditable outcomes of practice. From the paper: .... Role of antidepressants Of the first 364 women who took part in the above web surveys,8,11,12 five clearly identified the onset of PGAD with selective serotonin reuptake inhibitor (SSRI) antidepressant usage or withdrawal in response to the question ‘what do you believe may have contributed to the initial development of your PGAD?’.9 The authors acknowledge that clinical details of these women are incomplete.9 In three of the cases, the PGAD onset was contemporaneous with venlafaxine with- drawal (in one of these only lasting for a few weeks), in another secondary to sertraline withdrawal, and in the fifth woman the PGAD occurred in sequential response to being on fluoxetine, venlafaxine, sertraline and escitalopram. A brief letter from a PGAD sufferer reported that 10 of 15 women using the PSAS chat room on line had suffered PSAS (sic) after coming off SSRI antidepressants.24 A further case reported PGAD symptoms while on high-dose (350 mg per day) venlafaxine for depression. She was also talking the anti- psychotic quetiapin, which may have been implicated in that it has alpha adrenergic blocking activity.15 Some features of PGAD may overlap with clitoral priapism. This may be precipi- tated by the use of trazodone, citalopram, nefazodone or olan- zapine.4 Cessation of trazodone associated with non-priapism PGAD has been reported to cause marked improvement of PGAD in one case.4 The mechanism of antidepressants causing PGAD, in particular the SSRIs, might be part of a withdrawal syndrome upon stopping them.9 Another hypothesis is an increase in atrial natriuretic peptide (a profound vasodilator) that is produced on cessation of SSRI antidepressants.25 .... also see http://survivingantidepressants.org/index.php?/topic/4587-persistent-genital-arousal-disorder-pgad/
  8. Reduced quality of life is an issue with antidepressant treatment. Int J Neuropsychopharmacol. 2002 Jun;5(2):147-51. Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs inhibit emotional responses? Opbroek A, Delgado PL, Laukes C, McGahuey C, Katsanis J, Moreno FA, Manber R. Source Department of Psychiatry, University of Arizona Health Sciences Center, USA. Abstract at http://www.ncbi.nlm.nih.gov/pubmed/12135539 Full text http://www.toxicpsychiatry.com/storage/Antidep%20SSRI%20emotional%20Blunting%202002%20Opbroek.pdf Anecdotal and published case reports suggest that some patients taking selective serotonin reuptake inhibitors (SSRI) experience diminution in emotional responsiveness. This study aims to define the individual components of emotion disturbed in these patients. Fifteen patients reporting SSRI-induced sexual dysfunction completed the Laukes Emotional Intensity Scale (LEIS), a questionnaire about various emotions. Compared to controls, patients reported significantly (p<0.05) less ability to cry, irritation, care about others' feelings, sadness, erotic dreaming, creativity, surprise, anger, expression of their feelings, worry over things or situations, sexual pleasure, and interest in sex. Total score on the LEIS did not correlate with total score on the Hamilton Depression Rating Scale. In our sample, 80% of patients with SSRI-induced sexual dysfunction also describe clinically significant blunting of several emotions. Emotional blunting may be an under-appreciated side-effect of SSRIs that may contribute to treatment non-compliance and/or reduced quality of life.
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