Tricyclic and Permanent Sexual Dysfunction

Hi Everyone

Need your help! ... I have been on SSRIs on and off for last six years for GAD and depression ... None of them has really helped me ... I went to my doc and he prescribed me Luvox ... that was the only one I have not tried ... Now the problem is I have extreme fear of taking SSRis due to horrible stories that I have heard that they may cause permanent sexual dysfunction also known as PSSD ... For that reason I am going to request my doc to prescribe me either TCA or MOAI ... Now my question is does TCA cause PSSD in the same way as SSRIs ... if not I would go for TCAs ... please help

[JGF25]

How long did you try the wellbutrin for?  It usually takes a good 4-6 weeks in order to see the full benefits and one of the side affects is hightened anxiety.  I had it myself but I perservered through it with the help of this forum and some klonopin as needed.  For the most part, you are going to have side affects with anything you take including the SSRIs.  

From what I have read, the SSRIs have the most sexual side affects but only a very, very small percentage of people that go off of them retain those sexual side affects.  So it is definitely far from the norm.  

Here is a list I got off the web of drugs that have the least sexual side affects.

There are a number of medications that help mood similar ways to SSRIs that don’t have as many or as bothersome sexual side effects.  Unfortunately, each of these has different side effects of it’s own.  I have listed them below.


● Bupropion (Wellbutrin) – This medication is often used for depression and has been found to be as effective as SSRIs.  It is used widely and is generally safe.  Of all the anti-depressants it appears to have the lowest incidence of sexual side effects.  In fact, in most studies it had no more of these effects than a sugar pill (placebo.)  Unfortunately, it can be associated with an increase in anxiety which, for many patients with mood disorders, is a difficulty they already have and do not want to get worse.  Other side effects include sleep difficulties and increase in blood pressure.

● Mirtazapine (Remeron) – Another good anti-depressant.  It also seems to work as well as SSRIs.  With respect to its sexual profile, in one large study about one quarter of all patients taking Mirtazapine experienced sexual side effects.  Two other drawbacks to this medicine are that it causes drowsiness and weight gain.

● Duloxetine (Cymbalta) – This is a newer medication used to treat depression.  It’s manufacturers have touted it as having fewer sexual side effects than other, similar medications.  As more information becomes available, this seems less promising.  The most recent study found that about half of all patients taking Duloxetine experienced sexual side effects, only slightly less than the percentage with SSRIs.

● Nefazadone (Serzone) – This was an anti-depressant that worked well for mood problems, but was associated with rare occurrences of liver failure (fewer than 1/10,000 cases).  For this reason physicians tend not to use it as a first-line agent.  However, it is still prescribed and works as well as the SSRIs.

Hopefully someone will post about the tricyclics since for the most part they have been replaced by what people thought was a better drug in the SSRIs or SNRIs.  

Sorry if this is no help to you.  

[JGF25]

I really am not qualified to say anything about the tricyclics or MOAIs...however here is a link for Wellbutrin

http://www.streetdirectory.com/travel_guide/108575/depression/wellbutrin_a_safe_and_effective_depression_medication.html

I take it for OCD/anxiety that when left unchecked leads to depression.  I take the 300 mg XR tablet.  I have had no seizures and my sex life is unchanged.  Maybe something to bring up with yoru doc to see if it would be right for you.

[AliBhai]

I have tried wellbutrin and it has hightened my anxiety. I have no problem with SSRIs as long as they don't cause permanent sexual dysfunction. But I have read lots of anecdots that they may cause permanent sexual dysfuntion. The word 'Permanent' really scares me off.
I was just wondering whether TCAs also cause permanent sexual dysfunction. I have not read similar horror stories about TCAs. Perhaps that may be because they are not often prescribed anymore.  

[JGF25]

How long did you try the wellbutrin for?  It usually takes a good 4-6 weeks in order to see the full benefits and one of the side affects is hightened anxiety.  I had it myself but I perservered through it with the help of this forum and some klonopin as needed.  For the most part, you are going to have side affects with anything you take including the SSRIs.  

From what I have read, the SSRIs have the most sexual side affects but only a very, very small percentage of people that go off of them retain those sexual side affects.  So it is definitely far from the norm.  

Here is a list I got off the web of drugs that have the least sexual side affects.

There are a number of medications that help mood similar ways to SSRIs that don’t have as many or as bothersome sexual side effects.  Unfortunately, each of these has different side effects of it’s own.  I have listed them below.


● Bupropion (Wellbutrin) – This medication is often used for depression and has been found to be as effective as SSRIs.  It is used widely and is generally safe.  Of all the anti-depressants it appears to have the lowest incidence of sexual side effects.  In fact, in most studies it had no more of these effects than a sugar pill (placebo.)  Unfortunately, it can be associated with an increase in anxiety which, for many patients with mood disorders, is a difficulty they already have and do not want to get worse.  Other side effects include sleep difficulties and increase in blood pressure.

● Mirtazapine (Remeron) – Another good anti-depressant.  It also seems to work as well as SSRIs.  With respect to its sexual profile, in one large study about one quarter of all patients taking Mirtazapine experienced sexual side effects.  Two other drawbacks to this medicine are that it causes drowsiness and weight gain.

● Duloxetine (Cymbalta) – This is a newer medication used to treat depression.  It’s manufacturers have touted it as having fewer sexual side effects than other, similar medications.  As more information becomes available, this seems less promising.  The most recent study found that about half of all patients taking Duloxetine experienced sexual side effects, only slightly less than the percentage with SSRIs.

● Nefazadone (Serzone) – This was an anti-depressant that worked well for mood problems, but was associated with rare occurrences of liver failure (fewer than 1/10,000 cases).  For this reason physicians tend not to use it as a first-line agent.  However, it is still prescribed and works as well as the SSRIs.

Hopefully someone will post about the tricyclics since for the most part they have been replaced by what people thought was a better drug in the SSRIs or SNRIs.  

Sorry if this is no help to you.  

[AliBhai]

Thanks a lot for all the information. Yesterday after posting on medhelp, I went to my doc and he prescribed me Remeron 7.5 mg. It has lifted my mood and to some extent controlled my anxiety. But it is very sedating at low dosage. I have read that at dosage above 15mg its starts losing it sedating effect. Hopefully if everything goes well, I will gradually incease the doage to 30mg. I am really hoping that it will work.
There is another option that I really want to try but no doc is willing to put me on it. I want to try Nardil. I have spoken to two different docs and both said that in their whole career they have never prescibed it for this purpose which seems to be very odd as I have read that Nardil is the best antidepressant ever created. There are people out there using it for more than two decades and it seems to very well for them.

[JGF25]

Good for you!  Post again if you need to while taking the Remeron.  There are people on here that are taking it and would be a good source of information for you if you need any.  

[AliBhai]

Just to update. Remeron proved to be one of the worst drugs I ever had. I nearlly lost my job due it. I couldn't function whole week.
My doc has now put on Serequel. Lets where I fall this time.

[JGF25]

Uh oh...I'm sorry to hear that.  I hope the Serequel is better for you.  I know I mentioned the Wellbutrin and you did say you took it but I don't remember you saying for how long.  Did Wellbutrin also turn you upside down?  What types of side effects are you having?