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Thread: SSRIs and libido

  1. #1

    Default SSRIs and libido

    (Mods - I believe this post is mature, tactful, and PG-13, but it is about sex, so feel free to edit/delete/PM me if it's not appropriate).

    First, I am very pro-antidepressant, so I'd slightly prefer that this not turn into a "antidepressants are evil" thread. I think they've helped me a lot, but also realize that they're not for everyone. I also realize the slight irony in me posting this given some of my posting history endorsing antidepressants, but oh well. Finally, I do plan on asking my psychiatrist about this as well. However, I believe (as does my doctor) that other patients are a valuable source of information, especially when it relates to dealing with side effects.

    With all those disclaimers out of the way, onto the post...

    I've been taking zoloft for several years for depression. It helped a lot, but I figured it was time to get off of it since I'd been feeling better for a while. Even with a very gradual taper I had pretty bad withdrawal symptoms, so my doctor suggested I try switching to prozac, which should be easier to stop because of the longer half life. I switched to prozac a couple months ago, and really liked it. I felt better than I did on the zoloft - both less depressed, and less anxious (I think the zoloft was causing some anxiety). I realized I didn't mind feeling better, so with my doctor's permission decided to stay on the prozac, technically at a slightly lower equivalent dose than the zoloft, if the conversion tables for cross-tapering SSRIs are to be believed.

    The problem has been with the sexual side effects of SSRIs. When I first started zoloft I had pretty bad anorgasmia. I was still able to get and maintain an erection, but doing anything useful with it was incredibly difficult. At first the frequency between orgasms was a couple weeks or more. It was frustrating, but I also wasn't depressed, so it was a worthwhile trade. The anorgasmia also started almost immediately after I started taking it. I know everyone says it normally takes a month or more for antidepressants to work, but in my case I started feeling an improvement almost immediately, which is apparently somewhat common.

    Eventually the sexual side effects of the zoloft tapered off. Yeah, maybe things weren't quite the same as when I was a teenager, but for the most part I didn't have any complaints.

    When I started the prozac, things continued on about the same as before. What I'm concerned about is that the sexual side effects are getting worse, not better, and also appear to be slightly different - instead of anorgasmia, it's difficult to get (let alone maintain) an erection. I'm also just not as interested anymore. I suppose I could have the anorgasmia again, but to be honest it rarely gets far enough along for me to know.

    With one possible exception I don't believe anything else has changed in my life that would explain this. The one exception is that I decided it was silly to fight by AB/DL side and was much better to accept it about two or three weeks after I started prozac. That timing seems highly suspicious to me, but I'm not inclined to believe that accepting my AB/DL side would lead to decreased libido. In fact, so far I'm mostly a DL, and diapers are (or were, at least) somewhat sexual for me, so if anything self-acceptance seems like it should increase libido.

    What I think is more likely is that the prozac actually let me accept my AB/DL side. I'm not entirely sure why that would be the case, but I think it kind of makes sense. This is the first time in my life I haven't been fighting my AB/DL desires, so the timing of the medication switch doesn't really seem like a coincidence.

    My doctor has suggested "medication holidays" where you stop taking it for a couple days to deal with the sexual side effects. I didn't need to do that with the zoloft, but it doesn't seem like it would work with prozac given it's much longer half life (the doctor agrees with this, btw).

    The gradual onset of the side effects are actually my primary concern. Prozac inhibits its own metabolism, which means that the concentration of it increases the longer you take it since it's half-life increases when there are more of its metabolites around. Prozac's metabolism is complicated, and that's a poor explanation, but my point is that I'm afraid it's going to continue to get worse.

    So I guess I have some questions (finally - if you read this far you deserve a cookie!). Has anyone else dealt with low libido as a side effect of SSRIs, especially if you have experience with multiple SSRIs, and some not causing low libido but causing other sexual side effects? Does it get better eventually? Is there something that helps with it? I'm aware that some people have success with adding something like buspar or wellbutrin. I'd rather not add another daily drug, but wouldn't be opposed to taking something else occasionally, as needed. And has anyone suddenly accepted their AB/DL side (or anything else, really) when starting or switching an SSRI? After a liftime of shame about my AB/DL side, I find the change rather sudden (but nice).

    The other obvious solution is to stop the prozac. I'm hesitant to do that because of the increased self-acceptance about my AB/DL feelings since I started it. To be honest, that's been really nice. I realize that I will probably have to stop the prozac eventually, and it will be interesting to see if the self-acceptance sticks around, but I don't want to do that experiment quite yet.

  2. #2

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    I've been on citalopram for a few months now and the first month was riddled with side effects. One strange one was the inability to ejaculate (that doesn't affect me much but it still feels a bit weird). That wore off in 3-4 weeks. I also had nausea etc. I do have a below average libido and I don't believe it's been too dramatically affected by this medication.

    The best thing to say is that there are other options out there. I was on prozac briefly and I didn't like it. If you think this is a major problem you should at least try something else.

  3. #3

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    Can't help you, but an interesting read. Much more useful than the official disclaimers, should I ever decide to go that way. I'm pretty sure I could get prescribed if I ever went to the doctor and asked, but I'm OK with the unvarnished 'me', even if the rest of the world isn't.

  4. #4

    Default SSRIs and libido



    Quote Originally Posted by offsidetrap View Post
    I've been on citalopram for a few months now and the first month was riddled with side effects. One strange one was the inability to ejaculate (that doesn't affect me much but it still feels a bit weird). That wore off in 3-4 weeks. I also had nausea etc. I do have a below average libido and I don't believe it's been too dramatically affected by this medication.

    The best thing to say is that there are other options out there. I was on prozac briefly and I didn't like it. If you think this is a major problem you should at least try something else.
    Inability to ejaculate went along with the anorgasmia on Zoloft for me. I probably should have mentioned that, but was overly concerned about being tactful and didn't want to use the word ejaculate, which probably would have been fine. It did get better after a couple months on Zoloft for me too.

    The loss of libido side effect isn't quite as much as issue if you are depressed and starting an SSRI, since low libido is a symptom of depression. In that case, the meds can actually help.

    Other than this I really really like Prozac, so I'm hesitant to switch. My original goal in switching to Prozac was to taper and eventually stop it (I tried to stop Zoloft, and was going as gradually as I could without switching to the liquid form, but still got some scary withdrawal symptoms), since theoretically it's the easiest to stop taking due to the long half life. That's another reason I'd prefer not to switch to something else.

  5. #5

    Default SSRIs and libido



    Quote Originally Posted by Maxx View Post
    Can't help you, but an interesting read. Much more useful than the official disclaimers, should I ever decide to go that way. I'm pretty sure I could get prescribed if I ever went to the doctor and asked, but I'm OK with the unvarnished 'me', even if the rest of the world isn't.
    Thanks - that's exactly why I'm interested in other people's experiences with this, since you can find out things that aren't part of the "official" information. I have some first hand experience about this because I started wellbutrin originally for my depression and had a very interesting reaction the first couple days - it made me euphoric, which was amazing for someone who was depressed. It stopped after a day or two though and I went back to being depressed. My doctor has no experience with that, but in looking online it appears to be pretty common.

    Interestingly, SSRIs were not thought to commonly cause sexual side effects when they were first released. That's because doctors were relying on self-reported side effects, and people don't like talking about sex. When they started asking specifically about sexual side effects, they suddenly became a lot more common (from 10% to 50% or higher).

  6. #6

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    I am on prozac and have had similar side effects. I didn't mind much because I was originally hypersexual, masturbating 2-3 times a day, and now my drive is more normal. I took wellbutrin in addition to prozac for about a year but recently had to stop after some self harming incidents. I felt like it helped me a lot in terms of giving me energy through the day, but I am not sure if it had a big impact on my sex drive. I am now on Risperdal which is also supposed to decrease sex drive and maybe has a little for me. All in all, I think medication has helped me feel better in more of a general sense, whereas therapy helped me do better in terms of self-acceptance (though I still struggle).

    Is there a particular reason why a decreased sex drive is a problem for you? Best of luck!

  7. #7

    Default SSRIs and libido



    Quote Originally Posted by cr5311 View Post
    Is there a particular reason why a decreased sex drive is a problem for you? Best of luck!
    Good question. I have an SO. She is sympathetic and doesn't mind, but I still feel bad about it. I mean, there are still things we can do, but I feel bad that I'm not that interested in general.
    Last edited by LittleAcorn; 11-Dec-2012 at 16:59. Reason: typo in quote

  8. #8

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    OK. I figured that was the reason, just wanted to make sure. For what its worth I really did like Wellbutrin. I was struggling with getting out of bed ever while I was on prozac and so my doctor added it to give me some more pep and it seemed to help. I am borderline ADD and it also helped me focus a lot better. The downside is that it can you make you more impulsive (which is the reason I was taken off of it). I have heard that it helps counter the prozac effect and I think it may have to some extent with me.

  9. #9

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    Quote Originally Posted by cr5311 View Post
    OK. I figured that was the reason, just wanted to make sure. For what its worth I really did like Wellbutrin. I was struggling with getting out of bed ever while I was on prozac and so my doctor added it to give me some more pep and it seemed to help. I am borderline ADD and it also helped me focus a lot better. The downside is that it can you make you more impulsive (which is the reason I was taken off of it). I have heard that it helps counter the prozac effect and I think it may have to some extent with me.
    My first couple days on Wellbutrin were absolutely amazing. I woke up and immediately felt refreshed when I got out of bed, even though I hadn't had coffee yet. Normally it takes me a while to get going in the morning - I've always been like that, so it's not the Prozac. I went for an amazing run, faster and longer than normal, and it felt great. I was able to concentrate on things at work and was incredibly productive. After two days I was back to my normal, depressed self, but man, those two days were awesome.

    This thread has made me think about it more - maybe I'll ask my doctor about trying it again (or adding it to the prozac) if the sexual side effects don't get better.

  10. #10

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    My ex was probably on every antidepressant on the market, including medications that date so far back they are generally no longer prescribed. Almost everything had sexual side effects, except for the Wellbutrin, I believe. He also took the Wellbutrin in combination with something else for a while, to counter the sexual side effects of whatever else he was taking.

    Of course, everybody's body chemistry is different, so this might not apply to you at all. But after trying everything, Lexapro was the only SSRI which made him feel better emotionally and, although he experienced difficulty reaching an orgasm, he could still get there eventually. It just took a little longer/more effort. I also take Lexapro, which has worked wonders for me, and I'm pretty sure I haven't had any sexual side effects. Also, it never effected either of our libidos.

    Worth a try, maybe?

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