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PSSD Post-SSRI sexual dysfunction

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AppleOfSodom

But osk, my PSSD gets 90% better (acutely) with a large dose of yohimbine and cialis. Doesn't that exclude nerve damage? At least in my case?
The underside of my glans is very pale which indicates a lack of bloodflow. But if it was any kind of physical damage I guess yohimbine + cialis wouldn't have that effect on me.


I can't take sides on the science side. The more avenues are explored the better, as far as I'm concerned.

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oskcajga

I'm not a medical doctor, and unfortunately much of my intellectual capacity has been sapped (I hope temporarily :( ) so I feel uncomfortable making any authoritative statements these days.  That being said, my understanding of how cialis works is that it inhibits a nitric oxide mechanism, which then creates an erection.  However without this medication, erections are dependent upon psychological and also tactile sensations.  If the tactile sensations are no longer received by the brain, due to some sort of hypothetical neuropathy, this would make erections difficult to attain (the same mechanism that cialis uses to create erections is the same one that normally occurs during tactile stimulation or psycological input). 

 

Here's a wiki article on the subject:  https://en.wikipedia.org/wiki/PDE5_inhibitor

 

I would think that the neuroapthy theory would be consistent if the glans remained insensitive while erect while taking cialis. 

 

But again, I'm not an expert on the subject - it could very very well be something as simple as a desensitized 5HT receptors.  I don't think anyone knows.

 

 

I honestly don't want to get too carried away with this topic - I have a tendency to get carried away with things on the internet like this, and I honestly don't want to stir any feathers.  I just want to try to use some of my own knowledge (what remains of it, that is) to help the situation as best I can.  I got a little excited about Gh0sts post :P

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Offeverything27

Well, suggesting that desensitation is behind this, in a way it changes the equation. It leads to other options, other possible types of treatments. If it is desensitation, well then people or researchers or students begin looking into different regions, and hopefully stumbling upon the answer.

 

I'm sure neuroscience offers many theories, but until there's a cure or treatment, there is no wrong theory or direction of research

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Gh0st

Yea the reason that Buspar and all of the other things mentioned work in the case of PSSD is because they are 5HT1A Agonists. They show that nothing (beyond a reasonable doubt) is messed up besides the serotonin system on the presynaptic side. I don't know why Healy is going off of all these tangents when it's quite obvious that Serotonin is the cause if you follow what people with PSSD are saying, and think about the kinds of drugs SSRIs are. Last I heard he is doing some kind of study with Ion channels on organic chickens?

 

That being said, I don't understand Healy's research that much, and maybe will want to read over it and have a phone interview or something with him. I'm always open to new theories.

 

The reason that things can get worse is the same reason that they can get better. Gene expression is always changing. It changes every day as a result of everything that you do. Reasons why things change or get better or worse is probably best explained on a case by case basis, taking patient history into account.

 

I don't think all PSSD will have a single cure, but rather an approach that treats each patient individually while making sure that their mental health is optimized too.

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escitalopramsucks

I am.not.gonna have anymore antidepressants. But I surely would.need them.

 

It is something that it affecting me so much. I have lost my joy... I am.most of the time depressed.and it takes.me a big effort to go to work cos I have to deal with customers and workmates and I feel so so sad and I have to disguise my anxiety and I lose a lot of energy in that. I would like to be at home every time just crying but I do t allow.myself.

 

I assure you I try... but I feel my tears near my eyes every time.

 

The idea of not feeling nothing like desire and butterflies is terribly scary and I feel impaired. I would like to be able to like men even if I have weak orgasms or my body function is.not perfect.

 

I would like to be able to focus in another issues f.my life but I'm too broken now. I hate sending this messages but I'm doing all I can do to cheer up ( exercise... study... work...) and nothing works.

 

Can you tell.me how do you cope with this? Can you tell.me if some of you not only recovered the body function but the attraction and capacity of falling in love ,please? Do you think the lack of libido is the guilty of the impairment for falling in.love?

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Theon

take one day at a time, or hour by hour, or whatever helps you go through the day. 

 

Was this more or less what lead you to take antidepressants the first time??, if so, I think you have a good chance that when you recover naturally from this episode of anxiety/depression, your libido and capability of falling in love will come back.

 

Wishing you the best.

 

Theon

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oskcajga

For those who are considering using inositol to help re-sensitize their 5HT receptors, please note that I've looked around for some anecdotal reports of the effects of this substance, and found the following side effects reported at doses of as small as 2g/day:

 

Here's one particularly thorough report I found from someone taking 2g/day (note this is from someone who is not hypersensitive to medications, so the effects could be even more pronounced and long lasting for those of us who are):

 

  • It DID help with anxiety in a sense. Social anxiety was pretty much gone. As a result, I talked to people a lot more. For the first time in my life, I initiated conversations with professors. Getting my schedule set up for next semester was very easy.
  • Lack of caring about others.
  • Dampening of reflective and deep thought. I was very "in the moment". I could do things, and they would roll off me. I also had trouble writing.
  • EXTREME agitation. I was having to try my very hardest to not mouth off to my parents and professors. I could not stand to listen to others talk. I was occasionally cutting people off when they were talking.
  • The sweating got very bad, to the point where I would come home and have to change clothes because I was covered in sweat.
  • Probably related to the sweating, my right ring finger began to look like it had water damage constantly. Like when you take a long bath, and your hands look wrinkly.
  • Extreme need to get pleasure, translating to high amounts of masturbation and increased video game playing.
  • Increased need to move.
  • Little to no change in attention to detail (still very bad).

Source:  http://www.longecity.org/forum/topic/60327-small-warning-about-inositol/

 

This person indicated that the effects took about 1.5 months to go away!!  Even if this is not the case for everyone, and a post on a message board is not authoritative, it still indicates that this possibility may exist - and to be exercise caution in the intake of insotiol.

 

Please be very careful with inositol and do not start with huge doses like OP in this thread indicated - that could be absolutely disastrous for our recovery!

 

SA recommends starting with a very very small dose and then very slowly working our way up from there.

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AppleOfSodom

He took 2 grams, not 2 miligrams.

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AppleOfSodom

"Yea the reason that Buspar and all of the other things mentioned work in the case of PSSD is because they are 5HT1A Agonists."

Have you seen it work consistently for all people? I haven't.

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oskcajga

Yea the reason that Buspar and all of the other things mentioned work in the case of PSSD is because they are 5HT1A Agonists. They show that nothing (beyond a reasonable doubt) is messed up besides the serotonin system on the presynaptic side. I don't know why Healy is going off of all these tangents when it's quite obvious that Serotonin is the cause if you follow what people with PSSD are saying, and think about the kinds of drugs SSRIs are. Last I heard he is doing some kind of study with Ion channels on organic chickens?

 

That being said, I don't understand Healy's research that much, and maybe will want to read over it and have a phone interview or something with him. I'm always open to new theories.

 

The reason that things can get worse is the same reason that they can get better. Gene expression is always changing. It changes every day as a result of everything that you do. Reasons why things change or get better or worse is probably best explained on a case by case basis, taking patient history into account.

 

I don't think all PSSD will have a single cure, but rather an approach that treats each patient individually while making sure that their mental health is optimized too.

 

I think I'm going to have to value Dr. Healy's (a Cambridge educated professor, and author of tens of books and peer-reviewed articles) opinion over a 19 year old undergraduate student with no clinical experience and no experience conducting research.  I think your theory is interesting - but condescending a leading expert in the field without even bothering to investigate is not the most judicious way to proceed.

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escitalopramsucks

Oh... i do not think the lack of libido is due to anxiety. Its not that. Thanks. Have a good day

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apace41

 

Please be very careful with inositol and do not start with huge doses like OP in this thread indicated - that could be absolutely disastrous for our recovery!

 

SA recommends starting with a very very small dose and then very slowly working our way up from there.

 

Thanks, Osk.  This is sound advice.  If you intend to try inositol, I would suggest the powder because it is easier to create smaller increments of increase with a measuring tool of some sort.  The pills seem to come in 650mg size.  Cost also militates in favor of the powder.  A slow titration up to see where benefits/side effects occur is definitely advisable.

 

Andy

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Theon

Oh... i do not think the lack of libido is due to anxiety. Its not that. Thanks. Have a good day

 

I think you didn't understand me,

 

What I meant is that the fact that you are experiencing anxiety means that the emotional numbness is getting away, and as the emotional numbness and the pssd often goes together, there are chances that the pssd is going to get better too...

 

Sorry if I didnt express myself correctly

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Gh0st

 

Yea the reason that Buspar and all of the other things mentioned work in the case of PSSD is because they are 5HT1A Agonists. They show that nothing (beyond a reasonable doubt) is messed up besides the serotonin system on the presynaptic side. I don't know why Healy is going off of all these tangents when it's quite obvious that Serotonin is the cause if you follow what people with PSSD are saying, and think about the kinds of drugs SSRIs are. Last I heard he is doing some kind of study with Ion channels on organic chickens?

 

That being said, I don't understand Healy's research that much, and maybe will want to read over it and have a phone interview or something with him. I'm always open to new theories.

 

The reason that things can get worse is the same reason that they can get better. Gene expression is always changing. It changes every day as a result of everything that you do. Reasons why things change or get better or worse is probably best explained on a case by case basis, taking patient history into account.

 

I don't think all PSSD will have a single cure, but rather an approach that treats each patient individually while making sure that their mental health is optimized too.

 

I think I'm going to have to value Dr. Healy's (a Cambridge educated professor, and author of tens of books and peer-reviewed articles) opinion over a 19 year old undergraduate student with no clinical experience and no experience conducting research.  I think your theory is interesting - but condescending a leading expert in the field without even bothering to investigate is not the most judicious way to proceed.

 

I think you misunderstood me a bit. I'm not attacking Healy, but simply questioning him. That's how science works. You are always questioning. "I don't know why... ". I made no attacks at his character or research. If you've ever been to a scientific lecture, you will know that there are always dissenters in the crowd. It's actually how scientists expand their theories - from hearing the other side of the argument.

 

Also notice how I acknowledged that he had more experience in that field, and therefore I wanted to talk to him. " I don't understand Healy's research that much, and maybe will want to read over it and have a phone interview or something with him. I'm always open to new theories."

 

On the other hand, you personally attacked me by claiming I have no experience. There you are wrong, In fact I have worked in multiple labs. Further, you also posted an anecdotal report from a random person on the internet, who doesn't even have our condition. While I have scientific citations that back up all of my claims (which I will give to anyone if they ask).

 

I hope this clears up my intentions.

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Gh0st

"Yea the reason that Buspar and all of the other things mentioned work in the case of PSSD is because they are 5HT1A Agonists."

 

Have you seen it work consistently for all people? I haven't.

No I haven't. That's because it's not 100% specific to Agonizing the pre or post-synaptic side. Also, Buspar treatment further desensitizes pre-synaptic receptors (Blier and de Montigny, 1994). When you agonize both, you really don't go anywhere. There are Serotonin receptors on both sides. Also, I am assuming for PSSD cases. I haven't studied the mechanisms of other antidepressant induced problems.

 

If you'd want me to send you some more peer-reviewed articles explaining this, I would be more than happy to.

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oskcajga

Gh0st, I feel uncomfortable with the manner in which you choose to present your "authority" on this subject to the world. 

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bluebalu86

I join the club because I also have sexual problems. Loss of love feelings, loss of attraction for men, no arousal, no libido, loss of desire to kiss and cuddle. Hard to masturbate (I'm a virgin) and when I do I get very weak orgasms. 

This all started a couple of months ago. I'm still on the drugs after CT attempts and subsequent reinstatement. 

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AppleOfSodom

You don't have pssd, go away :)

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Gh0st

Gh0st, I feel uncomfortable with the manner in which you choose to present your "authority" on this subject to the world. 

My intentions are only to help people understand Inositol. Sorry if that makes you feel uncomfortable, but this is the way that I am. If my work is criticized, I will defend my research scientifically because I have spent every day for over a year collecting it. I am desperate to end PSSD's misery in the life of myself and others.

 

Can we get this thread refocused on Inositol please?

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Altostrata

Please stop squabbling.

 

Dr. Healy is a psychopharmacologist. He is speculating about what might work. There is a long way from theoretical effect of a drug to actual effect. To date, he has not found anything that works reliably to reverse PSSD.

 

To my knowledge, Dr. Healy has never mentioned inositol.

 

Like many neuroactive substances, inositol often works for a while but then stops working or goes paradoxical.

 

Gh0st, it is true that, across the board, serotonergics cause desensitization (also known as depopulation or downregulation) of serotonergic receptors. However, under normal circumstances, they upregulate and downregulate all the time, that's how they maintain normal homeostasis. See Andrews, 2011 Blue again: Perturbational effects of antidepressants....

 

For some people, after going off an psychiatric drug, it seems there is a lag time before downregulated receptors re-adapt. During that time, other types of dysregulation occur. These types of dysregulation are poorly understood and are probably highly individual, depending on pre-existing subclinical conditions, environmental factors, and genetic inclinations, etc. They may involve many other hormonal systems, such as thyroid and sex hormones. Even a very small modification, not visible to current testing, can throw off the finely orchestrated mechanism of the human body.

 

That is what we're calling withdrawal syndrome and post-acute or prolonged withdrawal syndrome. When those symptoms show up, the downregulation caused by the drugs moves to the background. Fixing it (the area Dr. Healy tends to investigate) won't necessarily fix the disrupted system.

 

It is possible that through trial and error,  one might hit on a supplement or other treatment that accelerates adjustment, but no one has found anything that's a reliable treatment yet. It may be that people who respond to inositol have need of B vitamin supplementation, and inositol fills that gap.

 

That said, PSSD, how are you feeling now?

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oskcajga

In regards to my reference to Dr. Healy's hypothesis, here's the relevant Yale University Symposium in which it was proposed:

 

 

Topic begins at ~ 29:00 of this lecture video.

 

This discussion goes on for about 10 minutes, and hits on relevant topics such as PSSD, protracted withdrawal, reversible neuropathy, etc.

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Offeverything27

Good video osk thanks.

 

So according to him, he believes it's C fiber neuropathy. But, they don't teach scientists or doctors about this in college. So. . Now what??

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Offeverything27

I just sent him an email, let's see what he says ????

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Gh0st

"It's not protracted withdrawal" - Dr. Healy at 36:30 in that video. 

 

Great video, Osk! I really enjoyed it!

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Offeverything27

Alright. Well, I do agree and have read of many who experience genital numbness. I myself do not experience numbness. In my case, there's an emotional block.

 

Effexor worked for me by numbing my emotions. The first time I took Effexor in 2006 it did this very well. It number my Emotions, and killed my sex drive. When I discontinued it came back

 

This last time it worked again, and killed my sex drive. But it persisted after treatment

 

My generals are not numb. I have no numbness. I understand that people do experience numbness though. Not me.

 

So he isn't exactly wrong, but he's not helping my side of pssd by looking into neuropathy

 

I have emotional numbness. It goes hand in hand with arousal; and wanting sex. I don't get aroused because I'm missing the emotional connection

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oskcajga

Correction, it seems that this is not just David Healy's opinion, it's a team of experts studying this subject:

 

  • Professor Dee Mangin — Dee is a Professor in Family Medicine at McMaster University who has run the biggest ever RCT of withdrawal and is responsible for the de-prescribing tools on RxISK.org.
  • Dr. Joanna Le Noury — Jo is Senior Research Psychologist at the Department of Psychological Medicine in North Wales.
  • Professor David Linden — David is a Professor of Psychiatry at Cardiff University with expertise in genetics and neuroimaging. This David Linden is not the author of the book Touch by David J. Linden which features elsewhere on the site, but is the author of Brain Control.
  • Johanna Ryan — Jo is RxISK’s chronicler of the underbelly of the Psychopharm Dream – the nightmare elements.
  • Professor David Healy — David is a Professor of Psychiatry and one of the founders of RxISK.org. He has been struck by the frequency with which withdrawal concerns turn up on RxISK and the ability of people with serious withdrawal difficulties to remain sane in the face of denial by the authorities.

This information, and much much more is available on that website I posted, here: 

http://withdrawal.rxisk.org/

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Theon

Alright. Well, I do agree and have read of many who experience genital numbness. I myself do not experience numbness. In my case, there's an emotional block.

 

Effexor worked for me by numbing my emotions. The first time I took Effexor in 2006 it did this very well. It number my Emotions, and killed my sex drive. When I discontinued it came back

 

This last time it worked again, and killed my sex drive. But it persisted after treatment

 

My generals are not numb. I have no numbness. I understand that people do experience numbness though. Not me.

 

So he isn't exactly wrong, but he's not helping my side of pssd by looking into neuropathy

 

I have emotional numbness. It goes hand in hand with arousal; and wanting sex. I don't get aroused because I'm missing the emotional connection

 I have exactly the same problem as Offeverything27.. I don't have any problems achieving erections either, they are as strong as always, the only problem is just the emotional numbness, lack of attachment, and not getting excited when thinking about sex... the rest is fine.

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Offeverything27

Well maybe I do have this because I can't smell anymore. That's something I noticed. I can't believe this happened to me and no one is going to ever pay me for the damages to my body. The fact I haven't killed myself yet is a miracle. There has t been any cures yet. There is no treatment. Atleast if I had AIDS I could take immune boosters and be somewhat normal

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Theon

And do you dream? offeverything? I noticed a completely lack of dreams  while on prozac and when I went off, but now they are coming back, I started dreaming again 2 or 3 weeks ago

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Offeverything27

I do dream but they aren't normal dream they're dreams about me doing research on pssd and my dreams are empty like my soul. With no feelings or smells of emotions or girlfriends

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Altostrata

I have a tremendous amount of respect for Dr. Healy, but I think his focus on skin sensation is not the whole story. (I also disagree with his description of the hallmarks of prolonged withdrawal syndrome. He thinks it is primarily a pain syndrome. I see a much wider range of symptomology.)

 

At any rate, even skin sensation is controlled by the autonomic nervous system, so his explanation of C fibers etc. is not nearly as precise as it sounds. (The co-authors of the theory are his team on Rxisk.org, not a consortium of experts.)

 

I have updated post #1 in this topic with this information:

 

See journal articles about PSSD in Papers about Post-SSRI Sexual Disorder (PSSD)

 

Please note that SurvivingAntidepressants is a site for tapering and recovery from withdrawal syndrome. While we see PSSD sometimes as an aspect of withdrawal syndrome (and we see gradual recovery from it as well as withdrawal syndrome), this site is not specifically for discussion of treatment of PSSD or its neurological origins (which at this time are highly speculative).

 

If you wish to discuss symptoms, theories, and treatment of PSSD, please go to these sites:

 

PSSDforum http://www.pssdforum.com/

 

Yahoo group SSRIsex (log in to http://Yahoo.com to join)

 

Various pages on Rxisk.org

 

I strongly urge those who want to debate theories, treatments etc. to go to a PSSD site (such as Gh0st's http://www.pssdforum.com/ ) and share your ideas with many more people who are interested in the topic.

 

Discussion of PSSD is not the primary purpose of this site and we cannot support the dissension and disrespect for other members arising in this topic. For many reasons, we also do not support discussion of what prescription drugs to try.

 

Any more squabbling will earn warnings. I strongly advise that, when it comes to PSSD, all participants should be humble about the extent of their knowledge because no one understands it very well.

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AppleOfSodom

Good news!

I received the following email:

Hello everyone, 

 
I am glad to announce that the study has been officially approved by the Institutional Review Board of the Geha Mental Health Center. 
 
There are some preparation we have to make before the study can take place, and I will email you again once the study is about to begin. 
 
Please note that we are still accepting new enrollments if you know others who may be interested. 
 
 
Sincerely, 
 
Joseph Ben-Sheetrit, MD

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Petunia

Here are some PSSD recovery stories from here and other sites. Some may have been posted previously, but as a small collection they may offer encouragement and show that people do recover over time, and some even come back to post about it.

 

TheAutomator's PSSD Recovery Story

 

Lossleaders Recovery From Protracted Zoloft Withdrawal and PSSD

 

I am cured from ejaculatoryanhedonia.com

 

RECOVERED from PSSD AND ANHEDONIA from Dr. Bob.org

 

Curing Pssd, Getting Off All Meds, And Feeling Fantastic. from depression forums

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johnson

It's nice of you to take the time to post links to PSSD "recovery" stories. However after reading through each one the men "recovered"

by either taking Inositol, licorice root, a chinese herb or wellbutrin.

 

The link below of Lossleaders recovery is probably the best recovery story because he never took anything

to recover from PSSD. Or at least it wasn't written in his recovery story.

 

Lossleaders Recovery From Protracted Zoloft Withdrawal and PSSD

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