Can't stay on my antidepressant.

December 14, 2006 9:47 PM

Can't stay on my antidepressant.

I've had a long history of therapy and have been taking medications for years. My symptoms are basically depression with some more aggressive symptoms (anger, outbursts) as well as intense anxiety. I have tried a number of different drugs (Effexor, Wellbutrin, Lexapro, Celexa, Prozac, Paxil, etc.). The only drug that makes me feel like "myself" is Celexa.

When I am on Celexa, I feel calm. I have no temper to speak of. This is important because feeling angry, even if I'm able to keep it inside, I feel really horrible. With Celexa, I'm just "me" and I'm able to laugh things off and not let them get to me. I feel like I'm a nicer person to be around when I'm on the medication. I like myself, and this helps my self esteem.

Problem is, I cannot tolerate the sexual side effects I experience with this medication. Basically, I feel completely numb down there and orgasm is an impossibility. What this means is that I don't stay on the drug. My doctor has tried to wean me off Celexa and try other meds, like Wellbutrin, but every time I start to feel the scary bad feelings and I run back to Celexa. Then I have the side effect and feel the need to go off it.

I guess my question is this. What diagnosis do my symptoms indicate (ie. the depression along with my activated, angry symptoms) and what medications would be more likely to help? Also, what neurotransmitters is Celexa working on? Might there be an antianxiety or mood stabilizing med that would give me the calm, relaxed feeling I have on Celexa? Lastly, has anyone dealt successfully with a situation like the one I'm describing?

posted by anonymous to health & fitness (12 comments total)

I totally feel your pain on this one.

Have you talked to your doctor about taking weekends off from Celexa? In my experience it only takes a day or so off the meds for my brain to properly operate my sexual organs, and a two-day break isn't enough to significantly diminish the overall benefits of the medication (in my case, at least).

It's not ideal, but maybe it'll make it a little less crappy for you.

Best of luck in this, and please let us know if you find a good solution.
posted by stefanie at 10:15 PM on December 14, 2006

Your doctor should definitely be able to help you figure something out. There an anti-anxiety meds like clonazepam that might be helpful, but IANAD. Very much not.

My doctor did once suggest taking a break for a few days from anti-depressants, but that requires being in a good place before you do so.

Make sure your psychiatrist knows how important the sexual side effects are to you -- some people don't mind them as much as others do. And keep a list of your own about which meds you've taken and how you've felt on each. It's good to have such a thing for future reference.
posted by brina at 10:20 PM on December 14, 2006

I'm not sure about your symptoms and a possible diagnosis - you need a decent psychiatrist for that. Certainly anger and anxiety can be part of (unipolar) depression, but low mood, anger and anxiety can come with a number of other mood disorders.

I can tell you that Celexa (citalopram) is an SSRI (selective serotonic reuptake inhibitor, which means it blocks serotonin being recycled by your brain so more is floating around - it possibly affects some other neurotransmitters to some degree as well, but neurochemistry isn't my field). Celexa seems to be good for anxiety - certain meds have their own strengths with certain aspects of depression (fluoxetine/Prozac is known for its energising effect, paroxetine is good for people who are prone to panic attacks, and so on). So that would explain the calmness you feel. To be honest, the exact mode of antidepressants is still unknown and predicting likely side effects and to what degree you'd be affected is still pretty much impossible. I'm sure a doctor/pharmacologist will be around to argue the toss, but from a psychological point of view (my degree is in psychology) we have little idea of why one drug works and another doesn't.

Sexual dysfunction is a known side effect of SSRIs, including Celexa. I'm not sure that taking a break is a good idea due to the cumulative effect of such drugs and the risk of discontinuation effects, but SSRIs have a short elimination half-life so they're out of your system fairly quickly - the side effects should disappear relatively rapidly. There is a thing called Post SSRI Sexual Dysfunction, where the sexual problems can hang around for ages following discontinuation of treatment, but it sounds like that isn't a problem for you.

Basically, you need to have a long chat with your psychiatrist; keep a diary of your mood and your anger/anxiety levels, let him/her know the degree to which the sexual problems bother you, ask if taking breaks is a good idea. There are a number of different drugs and formulations out there and there may well be something more suitable for you. I'm sure an expert is hanging around here somewhere to give you some more specific advice, but I'm fairly sure that they will also tell you an in-depth discussion with your own psych is the best option, as ever :)
posted by terrynutkins at 1:52 AM on December 15, 2006

I was on Celexa for a couple years, and I understand completely the side effects you are describing -- pretty much precisely. I would like to say, though, that the discontinuation syndrome I had when I took days off of Celexa was one of the most unpleasant things I've ever experienced. At one point I went to the doctor because I had no idea what was causing it; they EKG'd me and did a full workup, and then a week or two later I talked to my psych and he suggested it was because I had skipped some doses.

I am personally undergoing something very similar. I have started taking SSRIs after break of a couple years, and I am seeing my symptoms slip away the same time my libido does. I think that what the others have suggested is a pretty good plan of action -- talk. to. your. doctor. Make sure you keep track of how long it takes for the side effects to start showing up, and how long it takes for your symptoms to come back if you try out a new medicine. I've been told by doctors that many SSRIs take a while to build up potency in your system -- some as long as six to eight weeks. But, again, I'm just repeating what doctors have said to me. Your doctor knows you best, and I think that a fairly open and honest conversation about your options is the best way to go.
posted by MilkWithTabasco at 4:13 AM on December 15, 2006

Has your doc considered you could have bipolar type 2?

If so, I found Lamictal to be a wonder drug. Took care of my depression and NO sexual side effects.

(I know what you mean, as I had that on zoloft.)
posted by konolia at 4:14 AM on December 15, 2006

The anger may imply that you have some form of ADD. My father has spent his entire life with depression and associated outbursts of anger/frustration. He was recently dxed with adult ADD and put on medication for that, which seems to be helping that side of the symptoms a lot-- the depression still needs to be treated, but the irritability & anger have abated. No idea of sexual side effects, for obvious reasons. :)
posted by miss tea at 4:29 AM on December 15, 2006

There's no way to diagnose your condition from the information you've provided here. Those could be symptoms of a brain lesion, or of a stubbed toe. It's impossible to know.

Celexa is an SSRI which works on serotonin. SSRIs are roughly similar, although they do seem to have slight differences in action, but they all seem to have the kinds of sexual side effects you describe. Wellbutrin is not an SSRI, but sometimes helps people with mixed depression and anxiety, as well as some impulsivity. The experience of panic you have when going off Celexa may indicate a discontinuation syndrome rather than a relapse to baseline.

There are medications for anxiety, benzodiazepines, like valium, klonopin, xanax, etc, which people are prescribed and take as needed. They aren't good longterm medications, and easily lead to dependence and a cycle in which the lack of the drug leads to increased anxiety only controlled by the drug. I would not recommend them to anyone for long-term use, but they're out there.
posted by OmieWise at 5:50 AM on December 15, 2006

I have heard of some people on Celexa adding Wellbutrin as a complementary medication to deal with sexual side effects, etc. I don't know how it would reverse the sexual side effects of Celexa, but you might want to talk to your doctor about it.
posted by tastybrains at 9:00 AM on December 15, 2006

How long were you taking the Celexa before the sexual side effects began... and how long have you been taking it since they began?

Have you and your doctor discussed possibly lowering your dosage? Or even upping it a little?

Only from my personal experience (IANAD, but IAUDOM - I am Unipolar Depressed on Medication), sometimes it's the dosage that makes certain side effects more or less prevalent. I've currently titrated up to 150 of Effexor XR (more stable, extended-release version) and felt the best I have in my life - but at lower dosages I suffered through the same low libido and anorgasmia (the same trouble-impossibility of orgasm).

Since the Effexor was working so well for me, we decided on tweaking the dosage, and now my libido is still slightly lower than it used to be, and it's not quite as easy for me to get off, but it's well within managable ranges.

YMMV, of course.

I'll nth what everyone else is saying - have a long heart to heart with your med manager, or even your PCP. Give them as much information as humanly possible - too much is never enough in these cases.
posted by Adelwolf at 9:40 AM on December 15, 2006

Gingko biloba works GREAT for that particular side effect. I was taking 120 mg of gingko twice a day, but have backed down to 60 twice a day, with the same effect.

Check out this article:
http://www.priory.com/pharmol/gingko.htm
posted by lawhound at 2:52 PM on December 15, 2006

My 'friend' has the same results as you have with Celexa. She added Wellbutrin, continuing the same dose of Celexa, and it helps a lot. Lamictal also helps her libido, but the insurance company isn't interested.
posted by wryly at 6:43 PM on December 15, 2006

Like some posters said above, maybe talk to your doctor about an anti-anxiety med like Clonazepam. I am currently on a mix of Wellbutrin + Clonazepam + Lamictal/Lamotrigine. On this mix, my sexual drive isn't seriously affected, but every person is different. I'm not sure that I can add anything new but the best thing to do is of course talk to your doctor and hopefully he can help you with the sexual side effects.
(Also a note, I was on Lexapro which is pretty much the same as Celexa and it had the same sexual effects--but no good effects--so I went off of that....)
posted by theposterboy at 12:34 AM on August 16, 2007