Posted on 01/24/2005 9:22:03 PM PST by neverdem
CASES
As a psychopharmacologist, I know that every patient responds slightly differently to medication. But it wasn't until I met Susan that I understood just how differently.
She'd come to see me because she was depressed, and I'd successfully treated her with a course of Zoloft, a popular antidepressant. But as often happens, Susan's desire for sex had vanished along with her depressed mood.
"I kind of miss it, but I feel really bad for my husband, who's getting very frustrated," she said.
The sexual side effects of antidepressants like Zoloft and Prozac - the class of drugs known as selective serotonin reuptake inhibitors, or S.S.R.I.'s - are well known. The drugs frequently cause diminished libido, erectile dysfunction in men, and delayed orgasm or an inability to climax at all in women. The same flooding of the brain with serotonin that alleviates depression leads to sexual effects in many patients.
Early on, the rates of sexual side effects from S.S.R.I.'s reported in the medical literature were quite low, in the range of 10 percent to 20 percent. But clinicians knew better. Most of their patients reported some sexual effects, and it quickly became clear that the early reports were wrong.
The reason for this error was simple. Early clinical trials of the drugs did not look for sexual side effects; they just recorded problems that patients spontaneously reported. Because most patients are reluctant to bring up any sexual side effects on their own, the researchers got the false impression that these drugs had little effect on sexuality. When the subjects were specifically asked about sexual side effects, the rates rose to 40 percent to 50 percent.
Susan fell into that unlucky percentage, and she asked me if anything could be done. There were three possible approaches, I told her. She could stop the drug from time to time, a strategy that might temporarily restore her sex drive but could cause discontinuation symptoms; she could lower the dose of the antidepressant, which might provoke a relapse of depression; or we could try to counteract the side effects with another medication.
A temporary escape didn't appeal to Susan, so we decided on the third approach, an antidote. The question was, Which one? Serotonin-blocking drugs like Periactin, an antihistamine, treat sexual side effects, but they can also undo the drugs' antidepressant effects. I decided to prescribe Wellbutrin, a different class of antidepressant that has shown some ability to counteract sexual dysfunction caused by S.S.R.I.'s.
Little did I know.
Two weeks later, Susan called from her cellphone to say that the antidote was working. While shopping, she said, she spontaneously had an orgasm that had lasted on and off for nearly two hours . She was more delighted than alarmed, but I was stunned. I have had my share of therapeutic surprises, but this was hard to believe.
Was this a medical emergency or unrepeatable fluke that Susan needn't worry about? When I saw her the next day in my office, she was calm and somewhat amused by my concern. After all, since when is an orgasm a cause for alarm?
I was worried, though, that the addition of Wellbutrin had set off an episode of mania, an effect that antidepressants can have in up to 5 percent of patients. In that case, her prolonged orgasm might be a symptom of hypersexuality, common in mania. But Susan didn't seem either manic or depressed.
It seems that for her, the Wellbutrin just had an extreme sexually enhancing effect. Several colleagues told me about patients of theirs who had experienced heightened sexual desire on Wellbutrin, but none of the reports came close to Susan's. That Wellbutrin can enhance sexual pleasure isn't surprising: it increases the activity of dopamine, a key neurotransmitter in the brain's reward pathway. In fact, drugs of abuse, like cocaine, alcohol and opiates, release dopamine in this circuit - and so does sex.
A year has passed without a recurrence of this surprising side effect. But Susan is enjoying sex now - clearly more than she did before she became depressed. Because this was her first episode of major depression, the chance of a recurrence was only about 50 percent, so I suggested stopping the antidepressant. She liked that idea, but then paused and asked, "Do I have to stop the Wellbutrin, too?"
We both laughed.
Huh? I can see the bennies if Chaste and having no sexual desire.
My meds for mania tore up my tummy and then with diet. lifestyle changes my need for anti hyper meds dropped and Serequel works in a small dose, BUT my sex drive came back like a rabid dog and I fell but got right back up and know to stayaway from trigger situations.
But I don't get your point with Married Catholic Couples.
A two hour Climax?
Clutching my heart!
Now that's deserving of a Just Damn!
How could she stand up on her legs after that!
How did she not look high or look like she was having a seizure?
I don't beleive it. Not two hours of Oh Baby! Oh Baby! In Public? No way!
LOL!
She was probably just pushing the cart around aimlessly and really fast for a couple of hours. :D
I fully expect Doctor's phones to be ringing all over this country after folks read this article.
really? So withdrawel is a no no?
Which IMO is not normal the withdrawel idea.
It's like chewing then not swallowing.
Incomplete satifaction for both partners maybe a better way to say it.
Can men get vasectomies as Catholics? Curious.
Wedding cake causes severe sexual dysfunction in women. What's the antidote for it?
What really p!sses me off is that I have been trying to quit smoking for years now, and Wellbutrin worked. Not only did I quit, but the smell of smoke, the thought of smoking, made me gag--literally. I had to stop taking it, though. My weight had dropped down to 85 pounds. At one point, I went nearly four days without any sleep at all. It was horrible!
Divorce. Causes weight loss, and hypersexuality.
Sounds like you were on too high a dose...be interesting to see what half the dose would do.
That is pretty hard to believe.
Wouldn't a person go home after the first couple of minutes? Call your husband or something? Sheesh! Talk about an attention getter!
Guess she didn't feel too bad - she stayed at the store for two hours!
Drugs for the overindulgent. Time for another tsunami Oh, Lord! Put this one in all the "BLUE" states my Lord!
The letter 'B' and the letter 'J' have much to do with it. Takes maybe five minutes and keeps a man happy for days or weeks.
-ccm
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