Anorgasmia and Antidepressants
December 18, 2013 7:00 PM Subscribe
I am having unpleasant sexual side effects from my antidepressant. I am wondering what my options are. I am a 28 year old male.
This week marks my final week in outpatient following a depressive episode two months ago. As far as I can tell, I am fully out of the episode. I feel pretty good.
(As an aside, this was not my first depressive episode. When the above episode hit, I had been on 10 mg Lexapro, which I went on after a depressive episode that occurred around the same time last year.)
After this most recent episode, my Lexapro was increased to 15 mg and lithium was prescribed. Currently my doctor is targeting a 0.8 lithium level (1500 mg CR). My doctor believes that I have benefited from the "lithium boost", whereby the lithium potentiates the Lexapro. At one point my lithium level was at 1.0 but that gave me tremors bad enough where it had to be decreased.
After being on the Lexapro + lithium I started to notice that I had particularly low sex drive and that I couldn't orgasm when I did have sex. (Sometimes I cannot orgasm during masturbation as well.) So, I was prescribed 300 mg Wellbutrin XL. This increased my sex drive to just slightly above normal.
However, the Wellbutrin was not able to fix the anorgasmia. I can orgasm sometimes, but more often than not I cannot. My partner understands the situation and has been supportive. I do think that she sometimes feels sad about the situation. For me, the situation is just very frustrating. It makes me want to not desire sex, and part of me wonders whether I should ask about being taken off the Wellbutrin.
I mentioned my concern about this to my doctor earlier today. She wants to take a conservative approach whereby my meditation isn't changed for 6 - 9 months. As I said, this isn't my first go with depression, and neither of us want to risk triggering a relapse by going off the Lexapro too early. At the same time, it's going to be very difficult for me to accept this as status quo for the next 9 months. I'm wondering what else there is I can do to help fix this problem and/or cope with it.
This week marks my final week in outpatient following a depressive episode two months ago. As far as I can tell, I am fully out of the episode. I feel pretty good.
(As an aside, this was not my first depressive episode. When the above episode hit, I had been on 10 mg Lexapro, which I went on after a depressive episode that occurred around the same time last year.)
After this most recent episode, my Lexapro was increased to 15 mg and lithium was prescribed. Currently my doctor is targeting a 0.8 lithium level (1500 mg CR). My doctor believes that I have benefited from the "lithium boost", whereby the lithium potentiates the Lexapro. At one point my lithium level was at 1.0 but that gave me tremors bad enough where it had to be decreased.
After being on the Lexapro + lithium I started to notice that I had particularly low sex drive and that I couldn't orgasm when I did have sex. (Sometimes I cannot orgasm during masturbation as well.) So, I was prescribed 300 mg Wellbutrin XL. This increased my sex drive to just slightly above normal.
However, the Wellbutrin was not able to fix the anorgasmia. I can orgasm sometimes, but more often than not I cannot. My partner understands the situation and has been supportive. I do think that she sometimes feels sad about the situation. For me, the situation is just very frustrating. It makes me want to not desire sex, and part of me wonders whether I should ask about being taken off the Wellbutrin.
I mentioned my concern about this to my doctor earlier today. She wants to take a conservative approach whereby my meditation isn't changed for 6 - 9 months. As I said, this isn't my first go with depression, and neither of us want to risk triggering a relapse by going off the Lexapro too early. At the same time, it's going to be very difficult for me to accept this as status quo for the next 9 months. I'm wondering what else there is I can do to help fix this problem and/or cope with it.
Is it at all easier to orgasm right before you take your next dose? Sometimes with this family of drugs you can work around the sexual side effects a little by scheduling sex for when your blood concentration is lowest. Lexapro seems to have a half-life much shorter than e.g. Prozac, but not as short as Effexor, so YMMV. I feel your pain, though, this is one of the most frustrating aspects of S(S/N)RIs.
posted by en forme de poire at 8:08 PM on December 18, 2013
posted by en forme de poire at 8:08 PM on December 18, 2013
Background: I've ridden this med/side-effects rollercoaster. I had a depression diagnosis for 20 years before the bipolar DX, which brought lithium and more serenity.
It can take quite a while to get meds balanced with BP. I learned the hard way that you have to give a med a good trial the first time around, because once you've gone off it, it may not work for you again. Lamatrogine (Lamictal™) is notorious for this.
Wellbutrin is claimed to counteract the sexual side effects of SNRIs (Lexapro) and SSRIs (Paxil etc etc). Check in with your doc whether that's why Wellbutrin is in your mix; if it is, and it's not working, it's surely worth discussing.
If your depressions are at all seasonal and you live in the Northern Hemisphere, be aware that this is the worst week in the year as we reach the shortest day of the year. I try hard not to make psych decisions in December or January.
Log log log! Just one word morning and night on the calendar can help you understand a lot.
Many interesting conversations, essays, rants & raves for the "mentally interesting" over at Crazy Meds:
http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage
"Finding the treatment that sucks less."
posted by Jesse the K at 8:21 PM on December 18, 2013
It can take quite a while to get meds balanced with BP. I learned the hard way that you have to give a med a good trial the first time around, because once you've gone off it, it may not work for you again. Lamatrogine (Lamictal™) is notorious for this.
Wellbutrin is claimed to counteract the sexual side effects of SNRIs (Lexapro) and SSRIs (Paxil etc etc). Check in with your doc whether that's why Wellbutrin is in your mix; if it is, and it's not working, it's surely worth discussing.
If your depressions are at all seasonal and you live in the Northern Hemisphere, be aware that this is the worst week in the year as we reach the shortest day of the year. I try hard not to make psych decisions in December or January.
Log log log! Just one word morning and night on the calendar can help you understand a lot.
Many interesting conversations, essays, rants & raves for the "mentally interesting" over at Crazy Meds:
http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage
"Finding the treatment that sucks less."
posted by Jesse the K at 8:21 PM on December 18, 2013
Reduce your dosage. You will know if it causes your depression to return.
Efficacy and side effects vary so widely from one person to another to the extent that doctors know less than their patients when it comes to drugs. I think they tend to reinforce each other's beliefs rather than listen to their patients. For instance, they keep saying I needed to take Lexapro for weeks before I got better. But I could feel it working immediately, including the side effects. So I decided to adjust my dosage myself. I now take it as I need it instead of continuously as most of them say. I managed to keep the attacks away this way.
You will also need some form of therapy like CBT or meditation, which combined with drugs work better than either of them alone.
posted by KwaiChangCaine at 8:53 PM on December 18, 2013
Efficacy and side effects vary so widely from one person to another to the extent that doctors know less than their patients when it comes to drugs. I think they tend to reinforce each other's beliefs rather than listen to their patients. For instance, they keep saying I needed to take Lexapro for weeks before I got better. But I could feel it working immediately, including the side effects. So I decided to adjust my dosage myself. I now take it as I need it instead of continuously as most of them say. I managed to keep the attacks away this way.
You will also need some form of therapy like CBT or meditation, which combined with drugs work better than either of them alone.
posted by KwaiChangCaine at 8:53 PM on December 18, 2013
It's good that you found something that helps the depression and I understand why you'd be concerned about going off lexapro. However, if the Lexapro requires you adding two other drugs to be effective AND it's still producing serious and highly distressing side effects, it's not much of a wonder-drug for you. That's a lot of downsides and it's concerning to me that your psychiatrist doesn't see that and wants you to put up with this for another 6-9 months! I'd get a second opinion if I were you. There are other antidepressants out there.
posted by horizons at 1:10 AM on December 19, 2013 [1 favorite]
posted by horizons at 1:10 AM on December 19, 2013 [1 favorite]
Ask your doc if you can take Cialis along with the other stuff you're taking. It worked for me. Although (at least where I am), it's reasonably expensive, so you're basically paying $20 for a good time... although that good time can last a whole weekend.
posted by Diag at 2:58 AM on December 19, 2013
posted by Diag at 2:58 AM on December 19, 2013
I've been dealing with this as well. I'm female, so my experiences may be different from yours. A couple of times my neurologist and I have tried adjusting my meds, and the effects have been bad enough that I have chosen, for now, to put up with the anorgasmia. My primary reason for taking an SSRI is chronic daily headache, although it has also done wonders for my mood and evened out some horrible mood swings I was having with perimenopause.
That said, I have a really supportive doctor and he's been willing to experiment. Some people have good success with Viagra; I tried it, and the raging I headache I got wasn't worth it. However, I was able to orgasm when we tried a short medication holiday approach: I took a lower dose of my Effexor for three days, a dose my doctor hoped would allow me to orgasm while not triggering withdrawal. I was able to orgasm, oddly enough, not while on the lower dose but on the first day back on the higher dose. Again, I had a big uptick in my headache and I haven't been willing to do it again.
The Effexor allows me a really healthy sex drive, and I have found that even without an orgasm I can experience a kind of peak and then that all-body relaxed good post-orgasm feeling. It took awihle to figure this out. I can also skate along just pre-orgasm for a long time, which is really pleasurable--I never quite go "over the top" but enjoy this feeling of being almost there. I've had to make some adjustments to figure this stuff out. My position, how intense the stimulation is (I need a vibrator to make this work), and so on are all diffferent than they used to be. I sort of had to do a lot of experimenting and let go of what I thought I know about what worked for me.
The most promising thing I have stumbled upon is pot. I smoked for the first time late last summer, and liked it well enough to keep doing it from time to time. I've found that it works really well for my arthritis pain, but I have also surprised myself by getting closer to orgasm--so much so that I'm not sure I'm not coming, if maybe I'm having orgasms that are just different from what I used to think of as an orgasm--and also have come a few times, which has been a happy surprise.
That's all just my experience. Whenever I've gotten really frustrated about not having orgasms and asked to try new meds or adjust the ones I'm on, the results have been so unpleasant that I've decided I'm better off sticking with what I know works and having good sex without coming. I finished one such experiment about a month ago, and right now am determined to just stick with the status quo at least until the spring, as the lesser of evils.
posted by not that girl at 8:00 AM on December 19, 2013
That said, I have a really supportive doctor and he's been willing to experiment. Some people have good success with Viagra; I tried it, and the raging I headache I got wasn't worth it. However, I was able to orgasm when we tried a short medication holiday approach: I took a lower dose of my Effexor for three days, a dose my doctor hoped would allow me to orgasm while not triggering withdrawal. I was able to orgasm, oddly enough, not while on the lower dose but on the first day back on the higher dose. Again, I had a big uptick in my headache and I haven't been willing to do it again.
The Effexor allows me a really healthy sex drive, and I have found that even without an orgasm I can experience a kind of peak and then that all-body relaxed good post-orgasm feeling. It took awihle to figure this out. I can also skate along just pre-orgasm for a long time, which is really pleasurable--I never quite go "over the top" but enjoy this feeling of being almost there. I've had to make some adjustments to figure this stuff out. My position, how intense the stimulation is (I need a vibrator to make this work), and so on are all diffferent than they used to be. I sort of had to do a lot of experimenting and let go of what I thought I know about what worked for me.
The most promising thing I have stumbled upon is pot. I smoked for the first time late last summer, and liked it well enough to keep doing it from time to time. I've found that it works really well for my arthritis pain, but I have also surprised myself by getting closer to orgasm--so much so that I'm not sure I'm not coming, if maybe I'm having orgasms that are just different from what I used to think of as an orgasm--and also have come a few times, which has been a happy surprise.
That's all just my experience. Whenever I've gotten really frustrated about not having orgasms and asked to try new meds or adjust the ones I'm on, the results have been so unpleasant that I've decided I'm better off sticking with what I know works and having good sex without coming. I finished one such experiment about a month ago, and right now am determined to just stick with the status quo at least until the spring, as the lesser of evils.
posted by not that girl at 8:00 AM on December 19, 2013
Both times that I've been on antidepressants (both SSRIs) I had some anorgasmia at first. I also had anorgasmia after having my dosage increased. In each case it eventually passed after a month or so. How long has it been since your medication was changed? Are you still taking the lithium? (Is stopping the lithium an option? That drug is nasty, you don't want to take it if you don't have to.)
Anorgasmia is not a common side effect, to my knowledge, of either wellbutrin or lithium. It is a common side effect of lexapro however, and it can take some time (weeks, months) to get that totally out of your system and for your body to readjust, especially (I imagine) if you're taking other medications that are hitting some of the same neuroreceptors. If it hasn't been more than a month or two since you stopped taking the lexapro, my advice to you would be to just hang in there because it'll probably pass.
I would also talk to my doctor about it again. If it's something that's really messing up your quality of life, she may be willing to reconsider the medication adjustment timeline. However, she's certainly right that it's not really a great idea to just bounce you around to different medications and dosages on a whim, and since some of these side effects (including the anorgasmia) are generally transitory I think she's probably right to wait on it a little bit. It takes time for your body to fully acclimate to new medications, and it can take longer for side effects to stabilize than for therapeutic effects to stabilize.
Be patient. It will probably pass. It passed for me.
posted by Scientist at 10:10 AM on December 19, 2013
Anorgasmia is not a common side effect, to my knowledge, of either wellbutrin or lithium. It is a common side effect of lexapro however, and it can take some time (weeks, months) to get that totally out of your system and for your body to readjust, especially (I imagine) if you're taking other medications that are hitting some of the same neuroreceptors. If it hasn't been more than a month or two since you stopped taking the lexapro, my advice to you would be to just hang in there because it'll probably pass.
I would also talk to my doctor about it again. If it's something that's really messing up your quality of life, she may be willing to reconsider the medication adjustment timeline. However, she's certainly right that it's not really a great idea to just bounce you around to different medications and dosages on a whim, and since some of these side effects (including the anorgasmia) are generally transitory I think she's probably right to wait on it a little bit. It takes time for your body to fully acclimate to new medications, and it can take longer for side effects to stabilize than for therapeutic effects to stabilize.
Be patient. It will probably pass. It passed for me.
posted by Scientist at 10:10 AM on December 19, 2013
Are they checking your testosterone when they do bloodwork for your lithium? A friend of mine is on lithium and he gets this checked pretty regularly. He has been prescribed testosterone in the past, and says it worked *too* well for improving his sex drive.
posted by momus_window at 12:37 PM on December 19, 2013
posted by momus_window at 12:37 PM on December 19, 2013
BTW, wow, somehow I missed you were on Lexapro! My personal n=1 here is that I have actually been on escitalopram and during that time I could not have an orgasm at all. When my doc heard that I was having that much difficulty she took me off Lexapro quite quickly and substituted Effexor, which has had much fewer (though not zero) sexual side effects for me.
I think it might be time for a second opinion; there are a lot of other antidepressants out there and not all of them have equally bad (or even any - e.g. Remeron) sexual side effects.
posted by en forme de poire at 1:18 PM on December 20, 2013
I think it might be time for a second opinion; there are a lot of other antidepressants out there and not all of them have equally bad (or even any - e.g. Remeron) sexual side effects.
posted by en forme de poire at 1:18 PM on December 20, 2013
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In the short term, trust your partner. She says she's OK with it. Believe her.
It might also help to mix up your sex routine--try new things, try things differently. It may not fix the orgasm problem, but it might give you something else to look forward to, and may break some negative associations. Like when you have insomnia, sometimes you can get more sleep on the couch instead of in bed, because you've unconsciously begun associating your bed with a bad night's sleep, while the couch remains a reliable place for a good nap.
If you're data-minded, you could also try tracking orgasms and see if there is a pattern you can reproduce.
But most of all, therapy.
posted by elizeh at 7:33 PM on December 18, 2013