Borisboris: ED after decrease of citalopram

[Borisboris]

Hi all, I've already told my story on a pssd forum, but I am not sure I have pssd so I write it here also.

 

My story : 

 

 In 2008 I started citalopram at high dose to treat depression, 60 mg/day. My libido was immediatly increased by this drug. i know it is not common, but it was a big effect on me, increased libido and very good erections. My ejaculation was a litlle retarded, but not so much.

In 2015 I started being worried about taking a so high dosage so I decided to go down to 20 mg. At this time my libido was still high, but not so high as at the beggining of the treatment. So I went to 20 mg and... it was disastrous for my sexual function : my libido decreased and my erections became weak. Furthermore, and that was a very strange and unpleasant effect, my glans became very irritable, so that it was impossible for me to have sex without a condom. I would not say it was a genital numbness, it was more like a paresthesia.
I though it was only a temporary effect so I just decided to let the time pass, staying on 20 mg citalopram. But 2 years later there was absolutely no change so I asked my doctor to bring me back to 60 mg.

So in 2017 i went back to a high dose of citalopram (60 mg). After 2 weeks of treatement my sexual function was better. I did not have paresthesia any more, my libido increased a little and my erections were better. Unfortunately the erectile improvement did not last very long, maybe 2 ou 3 months, and it went back to weak erections.
 

About 1 year later (or maybe 2 years, i am not sure), my doctor decreased my treatement from 60 to 40 mg. I didn't feel any difference, sexually and for my mood. This summer I started a very slow lowering to go down to 20 mg. No change. I've also started a buspirone treatement, but it brought no improvement.

So my situation today : 20 mg citalopram, 25 mg buspirone, my libido is correct but my erections are weak. I cannot get a correct one if i haven't taken viagra. Fortunately I am still cured of glans paresthesia. 

I'm 40 years old.

 

 

I had relief with : 

 

- viagra/ cialis : it doesn't bring me full erections, but they are improved. I feel a physical discomfort when I take it, so it is not really a good medicine for me.

- Inositol : slight temporay improvement

- Mucuna : nice erectil improvement, but only for 2 weeks

- yohimbe : it works sometimes

 

 

My plans for the near future :

- Continue to decrease (very slowly) citalopram to 0, because I feel this medicine doesn't bring anything positive any more.

- Try a millepertuis cure. It may help me for my mood and, from what I've read, it may improve sexual function.

- Make others mucuna and inositol cures, maybe these 2 products in association.

 

So my questions are : what do you think of my case ? An improvement in sexual function is rare as a side effect of ssri so I know it may be surprising. 

What do you think of my plans ?

 

Thanks for reading me, and tell me if you have some ideas for I could do !

Edited December 27, 2020 by manymoretodays
name added to title

[Borisboris]

(ED = erectile dysfunction)

[manymoretodays]

Hi Borisboris,

And welcome aboard.

 

And okay, well first off I think that you have suffered an adverse effect of the citalopram. 

It does sound like your sexual difficulties came about after the usage of citalopram, and that is not so uncommon.  I think that the percentages that are often quoted, in the drug manufacturers literature is often low too, as far as to how many do indeed suffer from side effects like yours from an SSRI.  Usually those percentages come from initial studies that were done, with a limited number of participants.

 

I think that the response when you went back up to 60 mg of citalopram might have been just that, an initial response with the ED and other, and probably inconsequential for expecting any long term help.

How did you do your reductions from 60 mg to 40 mg of citalopram, and then from 40 mg to 20 mg.

(you can summarize in your signature, you'll see a link to doing that below)

 

And did you have any WD(withdrawal) symptoms?

Dr. Glenmullens withdrawal symptoms checklist

 

The term PSSD, refers to post SSRI sexual dysfunction .

 

PSSD Post-SSRI sexual dysfunction

 

And so, I think that as you have always been on a SSRI, while experiencing the sexual dysfunction, it may not apply.  It applies more to those who get these symptoms once off their SSRI drug.

 

And good, very good that you have experienced some improvement since lowering your dose.  That's promising.

 

Are you interested in tapering off, and/or minimizing medications in the future?

 

When did you add the buspirone 25 mg?

 

And then would you: Please summarize your withdrawal history in your signature to help us out.

you'll see what we like to see there, and instructions on how to do a signature in the link above

 

We take a harm reduction approach to tapering off medications:

Why taper by 10% of my dosage?

 

Tips for tapering off Citalopram(Celexa)

Tips for tapering off busipirone(Buspar)

 

And I know this doesn't offer much in the way of a solution to your ED. 

I did just want to get you approved and started today though.

 

Another thing that I noticed is your potential drug interactions.

 

Would you go to Drug Interaction Report- Drugs.com

And then copy and paste the results in a reply please.  I've already plugged your drug(s) in there.

And then, keep Drugs.com on file too, you may want to use it in the future, before you try any new drug(s).  You can plug in individual drugs by name at the top, and learn more about them, as well as checking drug interactions there.  It's a great site I think.

 

I don't blame you a bit for not wanting to use Viagra.  You don't have to, if you don't like it, or how it makes you feel.

 

And welcome again Borisboris.  This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, and just keep a record of your journey.

 

Love, peace, healing, and growth,

moderator manymoretodays(mmt)

 

 

 

 

Edited December 28, 2020 by manymoretodays
additional

[Borisboris]

1 hour ago, manymoretodays said:

Hi Borisboris,

And welcome aboard.

 

And okay, well first off I think that you have suffered an adverse effect of the citalopram. 

It does sound like your sexual difficulties came about after the usage of citalopram, and that is not so uncommon.  I think that the percentages that are often quoted, in the drug manufacturers literature is often low too, as far as to how many do indeed suffer from side effects like yours from an SSRI.  Usually those percentages come from initial studies that were done, with a limited number of participants.

 

I think that the response when you went back up to 60 mg of citalopram might have been just that, an initial response with the ED and other, and probably inconsequential for expecting any long term help.

How did you do your reductions from 60 mg to 40 mg of citalopram, and then from 40 mg to 20 mg.

(you can summarize in your signature, you'll see a link to doing that below)

 

The first decrease was an abrupt one, I just decided decided to take 20 mg instead of 60 (I was not aware of the risks of a quick decrease). The second decrease (decided by my doctor) was abrupt too, from 60 to 40. The third one was very slow, I respected the rule of decrease of 10 % every month to go from 40mg to 20 mg. 

 

 

 

Quote

 

And did you have any WD(withdrawal) symptoms?

Dr. Glenmullens withdrawal symptoms checklist

 

After my first decrease, from 60mg to 20 mg overnight, my unpleasant memories were more present. I had a lower mood. It brougt me also erectil dysfunction (that I still have) and glans parethesia. I did not have other withdrawal symptoms. The 2 others decreases I made later did not impact me, both sexually and on my mood.

 

 

Quote

 

The term PSSD, refers to post SSRI sexual dysfunction .

 

PSSD Post-SSRI sexual dysfunction

 

And so, I think that as you have always been on a SSRI, while experiencing the sexual dysfunction, it may not apply.  It applies more to those who get these symptoms once off their SSRI drug.

I've read somewhere that pssd could occur after only a decrease of an ssri, and my glans paresthesia that came after an abrupt lowering of citalopram made me think of genital anethesia, that many people who suffer of pssd experiment. 

 

 

Quote

 

And good, very good that you have experienced some improvement since lowering your dose.  That's promising.

I experimented only temporary improvements with inositol, mucuna and yohimbe. And viagra/cialis help me, but I don't tolerate them very well.

 

 

Quote

 

Are you interested in tapering off, and/or minimizing medications in the future?

 

When did you add the buspirone 25 mg?

Yes, as I told in my story I plan to continue tappering off citalopram to 0, because I think this medicine doesn't bring anything any more, and who knows it might give me back a better sexual function. I am currently on 20 mg. 

 

I started buspirone 4 month ago. I uppered the doses very slowly to avoid side effects. No improvement so far. I think I am going to start a tapper off soon.

 

Quote

 

And welcome again Borisboris.  This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, and just keep a record of your journey.

 

Love, peace, healing, and growth,

moderator manymoretodays(mmt)

 

 

Thank you for your response !

 

Quote

 

 

[Borisboris]

My situation 3 months later : I continued to decrease citalopram very slowy, I'm currently at 10 mg and there is no change at all, I have still the same erectile dysfunction. I've tried some new suplements but it didn't work: citrulline, pycnogenol, mucuna, forskolyn, buspirone etc... Only yohimbe high dose brings me a big improvement, but the violent effects of this herb makes it hardly a cure. I'm beggining to think that I don't suffer from too much ssri but from not enough ssri. It seems that I now need ssri effects to have a good working sexual function, the current problem is that citalopram has lost its efficacity since I lowered it, that's weird. My doctor told me about vortioxetine, I wonder if I should try this one or another ssri first. I'd like to get again the sexual boost I had when I started citalopram, because I need it now, but I am afraid that it doesn't work like it did before. Are there some people here who experimented a decrease of efficacity of an ssri after several years of use and switched to another one ? 

[Borisboris]

Just one question : 

 

My doctor (a general practitionner) told me that switching to another ssri would not work, because if citalopram doesn't work anymore after all these years, or doesn't work as well as it used to, another ssri would not do better because it is the same mechanism of action. What do you think of that ? 

I've read that switching to another ssri after a long time could be useful, so I don't know what to think.

[Borisboris]

Hi, I am currently making a citalopram tapper off, which I have been taking for 12 years. My dose for now is 8 mg. My doctor told me about vortioxetine and I would like to try it, but I would like to have some advices for the switch. I am thinking of starting vortioxetine when I reach the dose of 2 mg citalopram, and continue the slow citalopram taper off. What do you think of this plan ? Could vortioxetine + very low dose citalopram increase the risk of serotoninergic symdrom ?

 

Another option would be to reach the dose of 2 mg citalopram, stop it and immediatly start vortioxetine, but I am not sure that vortioxetine would prevent the withdrawal effects of citalopram... I 've been taking it for a very long time so I have to be careful. The best way would be probably to continue the taper off until the end, and then starting vortioxetine, but I think I will not be patient enough for that (see my introduction post).

 

What do you think ?

[Altostrata]

On 4/10/2021 at 12:05 PM, Borisboris said:

I'm beggining to think that I don't suffer from too much ssri but from not enough ssri. It seems that I now need ssri effects to have a good working sexual function, the current problem is that citalopram has lost its efficacity since I lowered it, that's weird.

 

Why do you conclude you need more SSRI? Any doctor would gladly help you with that.

 

Yes, less citalopram is going to have a less powerful effect.

 

Vortioxetine is not a miracle drug. We do not provide support for the purpose of changing psychiatric drugs in order to continue them. That's what your doctor gets paid for. Sorry.

[Borisboris]

Just now, Altostrata said:

 

Why do you conclude you need more SSRI? Any doctor would gladly help you with that.

 

 

I think I need more ssri because I am a rare case of someone whose sexual function is improved by ssri. I've tried for one year many natural suplements to cure my erectile dysfunction but none of them helped me (except yohimbe). My first idea was to stop completely antidepressants, i'd like to, but i am not sure any more it is the best option for me unfortunately.

 

 

Quote

Yes, less citalopram is going to have a less powerful effect.

 

Sure... But I was not very clear.

When I say that citalopram has lost its efficacity since I lowered it, I mean that when I went back to a higher dose the efficacity did not come back (it just gave me a mild improvement in sexual function). 

 

 

Quote

Vortioxetine is not a miracle drug. We do not provide support for the purpose of changing psychiatric drugs in order to continue them. That's what your doctor gets paid for. Sorry.

 

I don't expect a miracle drug, I want the sexual boost I had when I started citalopram, because I need it now. Citalopram doesn't work on me any more so another ssri might work better. Vortioxetine is a little different from classical ssris so it is maybe the best option.

But ok, if you don't want to help me I'll look for answers elsewhere. Thanks anyway, continue the good job.

[Altostrata]

Sorry, we can't give you the advice you're looking for. I don't know what increasing dosage or taking a new drug will do for your sexual functioning. This is outside this site's mission and expertise.

[Borisboris]

Just a quick update, i've just read about antidepressant discontinuation syndrome, and it might be what I suffer from actually. That could explain why my genital paresthesia, which had started after the brutal decrease of citalopram, disappeared when I went back to a high dose. That makes more sense than PSSD, but these syndroms have some symptoms in common so it may be confusing.

 

I'm currently on 8mg citalopram, still decreasing very slowly, the genital paresthesia is still cured but the erectile dysfunction is still there, and it's been 7 years now. It is a very long time for ssri discontinuation syndrom. It is said on the wikipedia page that it can't last more than 18 months. while on the french page it said that it can last up to 8 years and even more, so I don't know what to think of that.

[Borisboris]

Continuation of my story :

 

After ending decrease of citalopram I started vortioxetine. It brought an improvement in my erectile dysfunction but unfortunately it was only a temporary improvement, so I tappered the drug and stopped after 2 months. Then I tried venlafaxine, on the second day it reactivated my restless leg syndrom so I stopped it immediatly.

 

So now I am still on the same state : depressed and bad sexual functionning. The difference is from today I am drug free. I still take a little bit of lorazepam every day but no antidepressant any more.

 

I'm starting to think it would be better for me to stay like this and see what happens in the next weeks/months.

 

 

How long do you think it might take for a "brain reset" and recover my sexual functionning ?

Have some people here recovered from long term antidepressant discontinuation syndrom ?

[Altostrata]

See our Success Stories forum.

 

If you are taking lorazepam every day, it could be causing some of your symptoms, such as "depression". When you want to go off it, you probably will need to taper it.

 

If your "depression" is emotional anesthesia, that's an effect of psychiatric drugs that often is unmasked when you go off them. If you don't do anything else to promote it, it probably will fade over some months.

[Borisboris]

15 hours ago, Altostrata said:

See our Success Stories forum.

 

If you are taking lorazepam every day, it could be causing some of your symptoms, such as "depression". When you want to go off it, you probably will need to taper it.

 

If your "depression" is emotional anesthesia, that's an effect of psychiatric drugs that often is unmasked when you go off them. If you don't do anything else to promote it, it probably will fade over some months.

 

Ok I will try to stop gradually lorazepam. I take a small dose so it shouldn't be so difficult.

 

Do you think my sexual function might recover after only some months without antidepressant ? Or it might take a longer time than emotions ?

 

[Borisboris]

Another question :

 

I've researched the term "genital hypersensivity" on the forum and got no result. That's weird, because it is on the symptoms list of antidepressant withdrawal syndom. I am the only one here who experienced genital hypersensivity as a withdrawal symptom ?

[Altostrata]

10 hours ago, Borisboris said:

Ok I will try to stop gradually lorazepam. I take a small dose so it shouldn't be so difficult.

 

 

How long have you been taking daily lorazepam?

 

No one can predict the recovery of your sexual functioning. You have been on antidepressants for a very long time. It probably will be very gradual, over many months rather than weeks. Try not to worry about it, the worry can take over your mind. You need to take care of your mind and body, not add stress with worry about something that cannot be predicted or controlled.

[Borisboris]

13 hours ago, Altostrata said:

 

How long have you been taking daily lorazepam?

 

 

 

10 years. Prior to it I took clonazepam for 4 years.

[Altostrata]

You are at high risk of withdrawal syndrome from lorazepam. You will need to carefully taper off lorazepam -- but if you are experiencing antidepressant withdrawal symptoms, it would be best if you postponed going off lorazepam until the withdrawal symptoms settle, or they could be compounded.

 

What is your current daily lorazepam schedule, with times o'clock and dosages? Do you have odd symptoms at any particular times of day?

[Borisboris]

6 hours ago, Altostrata said:

You are at high risk of withdrawal syndrome from lorazepam. You will need to carefully taper off lorazepam -- but if you are experiencing antidepressant withdrawal symptoms, it would be best if you postponed going off lorazepam until the withdrawal symptoms settle, or they could be compounded.

 

What is your current daily lorazepam schedule, with times o'clock and dosages? Do you have odd symptoms at any particular times of day?

 

I am currently at 0.75mg daily (0.25 in the morning and 0.50 in the evening). I plan to soon reduce to 0.5 and stay on this dose. Do you think I should do it gradually ?

No odd symtoms.

 

[Borisboris]

Sorry I have one more question :

 

I still have to finish vortioxetine decrease. I started it at the end of June when I switched from citalopram 5 mg (end of a one year decrease) to vortioxetine 5 mg. Then I was on 15 mg for 2 weeks and decreased abruptely to 10 mg. After that I made a 1 month decrease from 10 to 5mg, took venlafaxine for only 2 days and the day after I went back to 5mg vortioxetine.

(I had some WD symptoms 10 days after going from 15 mg to 10 mg : Dizziness, headache, nausea and fatigue. It lasted 4 days.)

 

 

I have liquid form of citalopram but not of vortioxetine, so it would be easier to take low doses of citalopram, so my question is : can I finish my withdrawal with citalopram instead of vortioxetine ? If yes, at which dose should I start ? I am currently at 5mg vortioxetine.

 

Thank you for your support, it's great.

[Altostrata]

 

On 9/18/2021 at 11:13 AM, Borisboris said:

The difference is from today I am drug free. I still take a little bit of lorazepam every day but no antidepressant any more.

 

On 9/21/2021 at 11:03 AM, Borisboris said:

I still have to finish vortioxetine decrease.

 

I am very confused. Last week, you said you were off vortioxetine.

 

On 9/21/2021 at 11:03 AM, Borisboris said:

my question is : can I finish my withdrawal with citalopram instead of vortioxetine ?

 

No one can predict what a citalopram substitution for vortioxetine would do. You might end up with worse vortioxetine withdrawal and adverse effects from citalopram as well. 

 

A direct taper from a drug is always better than a switch. 

 

Please stop changing your drugs right now. You have already suffered adverse effects from the drugs and from going off them. You have been lucky that they haven't been worse. We can help you taper, but we cannot fix it if you give yourself severe symptoms.

[Borisboris]

11 hours ago, Altostrata said:

 

 

 

I am very confused. Last week, you said you were off vortioxetine.

 

 

No one can predict what a citalopram substitution for vortioxetine would do. You might end up with worse vortioxetine withdrawal and adverse effects from citalopram as well. 

 

A direct taper from a drug is always better than a switch. 

 

Please stop changing your drugs right now. You have already suffered adverse effects from the drugs and from going off them. You have been lucky that they haven't been worse. We can help you taper, but we cannot fix it if you give yourself severe symptoms.

 

Yes, sorry, I was not clear at all.

 

Last week I still thought that vortioxetine was safer to quit than other antidepressants because it's what my doctor had told me. Then I read on SA the thread for tapper off vortioxetine which explains that it must be tappered at the same timing as other antidepressants, so I went back to vortioxetine 5 mg to start a very slow tapper off.

 

Ok so I stay on vortioxetine and start tapper off, and I stay for the moment on the same dose of lorazepam. Thanks very much for the response.

[Borisboris]

Could someone tell me on which dose I will be able to jump off to 0 ? I didn't find the information on the forum ?

 

[Borisboris]

(Ok I've found the response for jump off)

[Altostrata]

Please update your signature with the current vortioxetine information.

[Borisboris]

There is something that bothers me, it is that after the abrupt decrease to 20 mg of citalopram that gave me erectile dysfunction I stayed on this dose for 2 years with no improvement at all. Does that mean I'll have to wait more than 2 years after quitting to get improvements in my sexual function ? Or could it be faster because I'll be drug free ? 

Sorry but I really worry for what's next, especially for the long time that it might take for the recovery. I'm also worried by the fact that I took a very high dose (60mg) for several years.

[Altostrata]

Nobody can predict the course of your recovery. It could be faster.

 

You are still taking psychiatric drugs, isn't that so? Any of them can cause sexual dysfunction.

[Borisboris]

51 minutes ago, Altostrata said:

Nobody can predict the course of your recovery. It could be faster.

 

You are still taking psychiatric drugs, isn't that so? Any of them can cause sexual dysfunction.

 

Yes I am still on 5 mg vortioxetine, tappering off, and lorazepam 0.75 mg.

My case is a little bit weird because my sexual function was higher on citalopram, and sexual dysfunction appeared when I lowered it, so it is not at all a side effect, it is a withdrawal symptom (that lasts for 7 years now). It was the same with vortioxetine that improved my erectile dysfunction (but only sligthly so I decided to tapper). 

It looks like my body (the nerves probably) have to learn to work again like it used to, but I am afraid of how long it might take. So I just wonder if it will do faster when I am off drug.