My personal anecdote: I'm on Venlafaxine which is an SNRI (also cited in the article), and I definitely suffer some of those side-effects. It sucks. At times it makes me want to shy away from sex completely. Other times I think I'm doing OK, only to find out I can't finish, or I finish weakly with no adrenalin rush.
So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really.
Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;)
As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.
There are two medications on the market that have FDA approval for the claim that they have lower incidences of sexual side effects than other similar medications.
One is vortioxetine and the other is vilazodone. In addition to acting as SSRIs, they have high affinities for 5HT1A autoreceptors, activation of which disinhibits the release of neurotransmitters. SSRI sexual side effects are hypothesized to be the result of 5HT2C activation, which inhibits the release of neurotransmitters. The idea is that 5HT1A activation might help with the effects of 5HT2C activation.
There's also bupropion, an NDRI, and mirtazapine, which blocks 5HT2C. Buspirone acts as a 5HT1A activator, as well. They might help with those side effects.
Vortioxetine (Trintellix) is expensive as fuck, most insurance plans have it under multiple restrictions (step therapy (ST), prior auth (PA), others). They have a manufacturer discount card to take off $100 max but if your prescription benefits don't kick in until after you're deductible you will max out every year pretty quickly. I just paid $900 for a 3 month supply.
But... Anecdotally, it does have less sexual side effects than escitalopram (Lexapro), and helps about the same amount with anxiety as escitalopram (Lexapro), though maybe a little bit less effective at that.
Have you been on venlafaxine before? If so, how would you compare it to escitalopram, not in terms of sexual side effects but in terms of efficacy with anxiety.
I can tell you from first hand experience that Venlafaxine does not inhibit the effects of LSD in all people. It might in some, but certainly not in all. I have one data point.
Also, it does limit, if not entirely mask, the effects of some common recreational dopamine reuptake inhibitors.
I am in a similar situation to mattowen_uk. Venlafaxine has been the best for me and I was eventually able to work through the side effects. Communication with your partner is key and if I find I can't reach orgasm, I can pay more attention to her. In some ways, it has been a very good thing, allowing me to be open and honest in the bedroom and out.
I too am older, so I totally understand how sexual side effects could be brutal for someone younger and in the active dating scene. If this is you, please know you are not alone. Depression is a literal killer. With a bit of work tuning the amount and type of medication, things will get better.
Wow! This was very educational to me. I'm also on venlafaxine, and have been off and on for more than 15 years. About 5 years ago I went on it more consistently, and at a higher dose.
I'm 38 years old. I... uh.... "concluded", based on my observations of myself that "I guess it's true, male sex drive must peak in the early 30s! Ah well, I had a good run, no regrets!"
Now I don't know what to think! Maybe it's the meds? Or age? Or both? Thanks for this! (meant in earnest, not sarcasm)
I had the same problem with Venlafaxine (Effexor XR). My psychiatrist had me switch to Duloxetine (Cymbalta) and my problems went away (but it worked as well as Venlafaxine for GAD and depression). FWIW I'm in my mid-40's but I had this problem about 10 years ago (when I switched).
I'm taking Venlafaxine also for GAD and depression. I think I will talk to my doctor & psychiatrist about Duloxetine at my next check-in. Thanks for the heads-up!
Cannabinoids are a promising future treatment for depression; however, right now they are unproven.
There is already stigma associated with being on antidepressants. The consequences of discontinuing SSRIs or SNRIs can range from catastrophic to deadly. Please keep in mind that posts promoting alternative treatments can add to that stigma.
Not the poster, but exercise and diet really helps with my side effects. Sometimes I think about tapering off or trying some other drug, but then I get scared. I don't want to go back into the tunnel of depression.
I'm also on venlafaxine, and have been for years. I've recently (4 months) started MMJ for my chronic pain, and it seems to offset the sexual side effects of the Effexor: (1) I have a libido again (2) I always finish now (3) and it feels pretty damn good.
The 3rd needs explanation for those who haven't experienced it; one nasty side effect is when you orgasm you ejaculate and feel NOTHING. It messes with the male psyche in a big way in my experience.
Hey I'm also on venlafaxine! It's worked very well for me as well, though I don't think I can really speak to the topic of the OP since I started taking it when I was relatively young. I haven't noticed.. much? I guess?
Are you overweight & do you exercise ? What are your test & free-test levels ? Did you try any other meds ? Maybe you don't hit the side effects bingo on other similar meds.
As someone dating in their 20s, it is getting hard to find people who aren’t having SSRI-related dysfunction. Recently met an older (early 30s guy) and it was seriously cool having a sexual experience that didn’t end with “don’t bother I’m just not going to finish no matter how long we go.” They really seem to be handing out these serious, almost-impossible-to-withdraw medications like candy on Halloween.
They don’t actually solve the problem long term, you can’t really come off them ever (I know a lot of people who have tried; only one who succeeded and they were on an exceedingly low dose to begin with - it took six months before the frightening neurological symptoms subsided), and they permanently damage ability to have human connection (I don’t understand how that doesn’t worsen depression and anxiety long term).
I get that I’m the asshole for suggesting that people take a second look at the side effect profile and consider whether these might be overprescribed. I get that they do make life better overall for some people. I’ve also seen my friends become psychotic and ruin their lives when they try to get off them (because the sexual side effects and weight gain were unbearable). So IDK, it feels urgent enough to raise as a concern. Especially when so many people are taking them.
I see a lot of people given SSRIs for anxiety that could probably be better treated by e.g. not smoking so much weed. It is hard to manage the underlying factors that drive people to alcohol and drug use, but I think probably easier than being rendered impotent by SSRIs.
I get that seemingly everyone is depressed these days, but I really question giving SSRIs, which have poor efficacy and devastating side effects, before demanding lifestyle change. Walking 10k steps and CBT are useful interventions that can be easily monitored by physicians with modern technology.
I guess good for half the 20-something cohort for not being able to orgasm really ever, but it’s not great for building the physical aspect of human connection, which I maintain is important. IDK what society looks like when half the prime age population isn’t able to have a fulfilling or enjoyable sex life.
I do wonder if there's a culture-wide bug/meme with regards to mental health (and beyond) that makes it hard to push for lifestyle changes at scale.
I think one such meme is around agency, with the underlying meme being that humans have no control over their circumstances or mental state. They have anxiety or they have depression. It's part of their identity, and these seem to be thought of as immutable diseases.
And it's a social faux pas to suggest to someone with anxiety (particularly someone you are not super close with) that if they altered their behavior and consciously tried to work on their thought patterns, that they could get better. In our culture now, that gets translated as 'blaming the victim', because with a victim mindset, such a suggestion implies that it's the fault of the person.
It's an unfortunate state of affairs. It feels like we are increasingly leaning into concepts such as an 'external locus of control' and 'learned helplessness' as a society. I don't know how we can push back on these ideas at scale, but if we don't, it's hard not seeing mental health issues and the externalities of the easy pharmacological solutions expand.
I was on SSRIs for a time until my thoughts became so irreversibly cloudy that I weened off and stopped. After that I coincidentally stopped drinking, my weight dropped, and now I've stopped using weed for the most part. My anxiety doesn't go away, even if I go ride my bike for hours.
The things that give me anxiety are largely social. How people think of me at work, my appearance, what women think of me, and how they perceive how I act. The only thing that helps is shutting these thoughts down with CBT. I've dubbed this my, "Nobody cares Mother Fucker™" routine.
I've noticed relying on my friends to vent just sours relationships. As much as people gloat about support systems, it's mainly a farce. People will only tolerate hearing so much of your internal dissonance, concerns, and stressors. People want to enjoy you, for the most part. Maybe a partner will be there for you, but not likely in my experience (though, I'm unmarried, so take what I say with a grain of salt.)
> I was on SSRIs for a time until my thoughts became so irreversibly cloudy that I weened off and stopped. After that I coincidentally stopped drinking, my weight dropped, and now I've stopped using weed for the most part. My anxiety doesn't go away, even if I go ride my bike for hours.
You may want to try a primarily anaerobic exercise like lifting weights to supplement your cardio. Your mileage may vary, but I personally get a huge endorphin rush from a heavy[1] deadlift. It's so powerful that it takes an effort to not start hugging other people at the gym.
> I've noticed relying on my friends to vent just sours relationships. As much as people gloat about support systems, it's mainly a farce. People will only tolerate hearing so much of your internal dissonance, concerns, and stressors. People want to enjoy you, for the most part. Maybe a partner will be there for you, but not likely in my experience (though, I'm unmarried, so take what I say with a grain of salt.)
More than anything else, people remember how you make them feel. If you're always dumping your negative issues on them, even if they like you, subconsciously they'll learn to associate you with feeling bad and avoid you.
A much better approach is to show an interest in your friends and try to sympathize with what's going well in their lives. And I mean really sympathize. Let yourself feel happiness on their behalf. Encourage them to keep it up. Then they will learn that being around you makes them feel good. Once you build up a good feelings battery in the relationship, you can draw down from it a bit when you're feeling down.
Dating is a different ball of wax. If you're having trouble with basic friendships then it's probably best to establish some healthy habits there first.
Transactional costs must also have a similar factor. Friends were difficult to make and retain the the suburbs as a kid. They've been nearly impossible as an adult.
Traffic and the dispersion of people across a wide area, driven by rent and jobs and just it being a huge metro region with some of the worst traffic in the country. The transactional costs in even the effort required to be there; let alone having time to make that effort.
thank you friend for sharing your experiences and stories.
> I've noticed relying on my friends to vent just sours relationships. As much as people gloat about support systems, it's mainly a farce. People will only tolerate hearing so much of your internal dissonance, concerns, and stressors.
i resonate with this a lot. have you heard of the author Francis Weller?
“At the core of this grief is our longing to belong. This longing is wired into us by necessity. It assures our safety and our ability to extend out into the world with confidence. This feeling of belonging is rooted in the village and, at times, in extended families. It was in this setting that we emerged as a species. It was in this setting that what we require to become fully human was established. Jean Liedloff writes, "the design of each individual was a reflection of the experience it expected to encounter." We are designed to receive touch, to hear sounds and words entering our ears that soothe and comfort. We are shaped for closeness and for intimacy with our surroundings. Our profound feelings of lacking something are not reflection of personal failure, but the reflection of a society that has failed to offer us what we were designed to expect. Liedloff concludes, "what was once man's confident expectations for suitable treatment and surroundings is now so frustrated that a person often thinks himself lucky if he is not actually homeless or in pain. But even as he is saying, 'I am all right,' there is in him a sense of loss, a longing for something he cannot name, a feeling of being off-center, of missing something. Asked point blank, he will seldom deny it.”
― Francis Weller, The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief
There's a place similar to 'college' but focused on adults. Admittance to that college is free. Anyone can attend. Room, board, meal plan. At least some classes must be attended; though the term 'class' is vague. For some a class might just be seeing a councilor to talk things over, or some other doctor prescribed treatment routine.
Some of the classes should be group activities that are cooperation based rather than rivalry based. The focus should be on establishing the expectation of positive interactions and experiences. Also about helping to train people to respond to others in the same way.
Suddenly, I think I'm describing kindergarten for adults from an amateur psychological perspective.
The problem is that college selects for intelligent, functional, successful people. Whereas this institution (yes I used that word) would select for dysfunctional people. So it would be less pleasant, and the likelihood of making high-quality friends lower.
You're describing situational depression. Very different than major depressive disorder or dysthymia for which these drugs are often prescribed. Common mistake.
'Major depressive disorder' is just situational depression applied to every situation. Common mistake. Many psychiatrists and psychologists make the same mistake. Many psychiatrists, by virtue of their education, are part of a class of people who are themselves more prone to depression and anxiety, so we probably shouldn't be looking to them for great advice.
Wrong again, a psychologist would not make that mistake. They know what those words mean; you just googled them. Luckily you didn't even try explain away dysthymia from your armchair because, well, you have nothing to stand on.
> Many psychiatrists, by virtue of their education, are part of a class of people who are themselves more prone to depression and anxiety
The fact that we trust those more prone to depression to solve depression should not be discounted.
When it comes to 'dysthymia'. The only reason we find it to be a disease is that we expect people to be happy all the time. We've labeled anything other than that as diseased. As I stated elsewhere, I do not believe in happiness. Most of my day is spent neither sad nor happy. Were I to be sad all the time, I don't think that's particularly interesting either. Our society is not set up with space for people to not be happy. Society is ill, not the people.
I've banned this account for breaking the site guidelines. Please don't create accounts to do that with; it will eventually get your main account banned as well.
It's particularly important not to be an asshole when you're arguing for a position which is actually true. Doing that discredits the truth, and that hurts everyone.
(I don't know if what you're arguing here is true, but since you seem to be sure that it is, you should be treating it more carefully.)
The parent seeks to discredit the legitimacy of all mental disease, based on a study of a handful of Mensa members from 2016. Does that "discredit the truth?"
Their original comment was flagged and removed. Sorry, who's the "asshole" again?
Buddhism has been working on this for a couple thousand or so years. There are many different practices and traditions that have evolved in it, but many of them at the beginning will teach you to sit and observe all sorts of phenomena, or may even ask you to bring up uncomfortable, strong emotions to learn how to work with them.
And yeah, for sure exercise. Just remember the practice of training your body is a marathon, not a sprint. Consistent effort over years is what you're going for rather than trying to go hard at the beginning. It's a lifestyle change.
In one of her books, Atwood describes a community which allowed people to be in a "fallow" state for as long as they needed it, taking care of their basic needs, being supportive of them, but otherwise allowing them to ruminate and do nothing as much as they wished.
I think depression is an evolutionary response to situations which demand too much of us. It sends us into a state where we must take an extended rest to recharge and rebuild ourselves internally: physically, mentally, emotionally.
I think not allowing for this is a huge shortcoming of our society, which considers continuous and stable productivity not only the norm, but a requirement.
> So why are depressive disorders so prevalent there
Because there's no such thing as 'depressive disorder'. We expect people to be happy, and when they're not, we call them diseased. Nothing is wrong with them.
Also, Ethiopia is in the midst of a civil war isn't it?
False, we expect people to be depressed when depressing things happen, this is normal and called "situational depression," you've confused it with a disorder.
Depression has been a problem in Ethiopia for much longer than the conflict in Tigray, despite the abundance of "community, shared culture, shared religion." Looks like it takes more than that...
I don't pretend to be an expert on Ethiopia, but I was under the impression that it's a multi-ethnic state of different tribes who don't necessarily share those things with each other.
Christians actually have a larger majority in Ethiopia than in the US. Looks like it takes more than "community, shared culture, shared religion." Oops!
> And it's a social faux pas to suggest to someone with anxiety (particularly someone you are not super close with) that if they altered their behavior and consciously tried to work on their thought patterns, that they could get better.
We seem more attuned to emotional distress. And illnesses like anxiety present as acute distress, usually. We naturally want to assuage the person. And a person with anxiety naturally learns all sorts of avoidant coping mechanisms.
We seem to have entered some sort of negative feedback cycle there. Medications do help some, but it goes best with therapy, and the mainstay is basically exposure therapy. Face your fears, and struggle through something uncomfortable, until you learn to tolerate it. People should be gently nudged in that direction, not encouraged to lean into their withdrawal from the negative triggers.
The doctors don't seem to care about the side effects. All the psych drugs have horrendous side effects which get basically ignored. I've even seen multiple suggestions that mass shootings might be a rare side effect from them.
SSRI withdrawals/side effects are the least worst out of medications like Xanax, beta blockers and other anxiety medicine. So… there are drugs with more devastating effects.
This problem isn’t just related to mental disorders. I think you are also undermining how difficult changing human behavior is, especially in relation to mental disorders and addictions. Ideally, SSRI’s are used to make behavioral changes easier.
I really appreciate your comment, and value honestly, but this:
> Recently met an older (early 30s guy) and it was seriously cool having a sexual experience that didn’t end with “don’t bother I’m just not going to finish no matter how long we go.”
Reading that was like reading that your worst nightmare is actually true. nervous laugh
As a guy in their 30s, on multiple occasions I've comforted myself with "self, it doesn't matter to them if we finish, they're probably so appreciative that we're more focused on them than ourselves. you're doing great, self." And your comment is just NOPE and slashes my self esteem to shreds!
And this too!:
> by e.g. not smoking so much weed...
CUTS DOWN MY MENTAL SUPPORT FRAMEWORK LIKE A SCYTHE. :) <3
I needed that solid slap across the face, I was in danger of becoming too comfortable with my sexuality, now I have the ammo to fuel my insecurity and shame, and push it back down where it belongs. A million thanks.
There do exist people out there that are selfish sexual partners and mis-value sex. It is possible you'll run into someone like this in the real world. But these people are at fault, not you. And I think if you look for sexual partners that display obvious compassion in all aspects of what they do you'll be safe from this kind of behavior.
This was one of the factors that made me think twice about going back on anti-depressants, until I made peace with the fact that my ability to orgasm wasn't going to pull me out of the hole I was in. It's a shitty choice but the desire to not be suicidal forces your hand.
It's literally like flipping a switch. One day, the plumbing works. The next day, it doesn't. Many times I'd just give up, out of boredom.
The side-effects are clearly stated but to use myself as an example, I vastly underestimated just how strong they would be.
That said, if you're dealing with the big black dog as it were, don't use it as a reason to avoid anti-depressants if you really need them. Keep your doctor up to date about the side-effects so they can adjust your prescription. And don't be shy just because you're talking about your private parts.
Have you considered augmenting with something like Wellbutrin? Some people find it helps with the side effects. I've tried it myself and while I found it was too anxiety-inducing (I felt too keyed up) there's truth to that at least.
No, not personally. I eventually was able to come off the medication. Took a couple of weeks to get back to some semblance of normal but I'm sure there's permanent damage still.
That said, it's not easy to walk away from suicidal depression (and attempts to commit suicide) without a decent helping of trauma, and potentially even PTSD. So, of course, there isn't really a 'normal' to go back to once you've got the awareness of that and how far down the rabbit hole you fell. Normal becomes something else.
Wellbutrin has no sexual side effects (the opposite, in fact) and is very effective for depression (but not anxiety). You might want to give it a try if you are still struggling. Of course, it comes with its own tapestry of possible issues.
You ever look into ketamine for treating depression?
Self medicated this past weekend and had some major breakthroughs with my long time depression/suicidal intrusive thoughts. Nice thing is you don’t have to stay on it unlike other antidepressants—I would never do a medication that you have to constantly take.
I appreciate the concern but, honestly, it's exhausting to keep fielding 'have you tried...', 'have you looked into...', 'have you explored...' questions.
I get that it comes from a good place, but I'm sharing my experience, not asking for advice.
The best help you and others can offer is to just listen, instead of offering another solution.
There are two replies to me in the 'have you tried' vein. I'm not aiming it at you specifically, just trying to stop a pattern.
For what it's worth, from at least one person's perspective it's exhausting to just read these replies, as if you or other OPs are eternally naive neophytes with no experience or understanding, or that providing a personal anecdote is automatically, implicitly, and irrevocably requesting advice. This tends to be the case with a lot of medical discussions online, but especially with mental health.
(It would be somewhat better if these questions were asking for advice themselves—"Have you tried $medication? It's been recommended to me and I'm interested in others' experiences"—but it's almost always "Surely you haven't tried ($medication || $lifestyle_change || $religion || just_grow_up()) because I have and it's a panacea.")
Thanks. I just want to share and be heard, and maybe someone can relate.
Good intentions all around, but people need to understand that you're not always someone to be helped or saved. It can feel quite disempowering at times.
I get what you’re saying. The only reason I suggested looking into it is because they are seeing hugely promising results (70%+ reported improving symptoms) but you only have to do a few sessions. It’s not another pill you have to take each morning.
Ketamine can be pretty rough on the bladder and kidneys. Please read up on the risks. It is definitely dangerous to take recreational doses several times per week - it seems that low/moderate doses every week or two avoids most of the problems while still providing therapeutic effects, but definitely keep an eye on the health of those systems, ideally with letting your doctor know so they can help.
Many of users on /r/researchchemicals using either ket or novel analogs at recreational doses regularly for both fun and depression relief end up with bladder issues after over-consuming for a period - so while it's a promising depression treatment, I'd recommend caution around dosage and frequency and titrating to find your minimum effective dose.
I just lost a friend to Ketamine, and there is another thread on the front page about someone famous who destroyed their life with it.
Ketamine seems like a miracle but a ton of people cant control their usage of it at all. Even if you think you know how addiction works, Ketamine sneaks up on you in a way cocaine, heroin, and oxytocin do not.
Of course, I am very responsible with my illicit drug use. Probably did < 50mg across several night and am not planning on doing it again for 6+ months. Good advice though for everyone!
I don’t usually post here, especially on such personal topics, but feel I should. I’ve been on SSRIs and SNRIs for some time now (Pristiq, and now Zolof), and can definitely attest to the some of the changes described in the article. I clearly remember reading the documentation in full that came with both drugs before starting each, and the mentioned side effects were only mentioned in passing, along with possibly every other side effect imaginable, so it was very easy to dismiss - especially when you are in a place you know you need help out of. There was also no real warning of long term side effects from both doctors that have prescribed me.
I guess I don’t have any real point, other than if you are considering anti-depressants do more research than I did before taking what you’ve been prescribed - and if in doubt get answers from your doctor, and failing that find a better doctor (if you can).
When I was in my mid-20s my doctor wanted me to take blood pressure medication because when I went to her office in the morning I had blood pressure of 150/110. I told her I wanted to see what I could do on my own first.
I cut out salt and caffeine, increased potassium and exercised every day. I went back in two months and my blood pressure was 120/80. She took it four times because she didn't believe it. I think the primary thing was the caffeine - it just gives me a temporary but strong spike in blood pressure.
Years later, a doctor prescribed me Lexapro. I actually picked up the prescription. But I never took it. I started exercising every day, started mindful meditation, removed sugar from my diet, read the book Learned Optimism and did the CBT-like work in there. Ended up never taking the SSRI but haven't had anxiety in 7 years. (btw Learned Optimism was recommended to me on HN).
Some people definitely need medication - I worked with a guy in his early 20s that had cholesterol of 400+. I saw him eat oatmeal every day for breakfast and lunch and then saw his cholesterol go up to 420. I'm sure there are people that need SSRIs. But it does seem like doctors at least prescribed it to me when I didn't need it.
Probably eating the oatmeal that made his cholesterol get higher.
There are now tons of research coming out about how cereals (wheat and corn specially) are basically the culprit of a lot of diseases that in the past were blamed on "fat", and also that this past blame was partially due to corruption (for example coca-cola literally gave six digits money to Harvard scientists so they would lie and say sugar was safe and the culprit for people problems was meat).
- The biggest influence on blood cholesterol level is the mix of fats and carbohydrates in your diet—not the amount of cholesterol you eat from food.
- Although it remains important to limit the amount of cholesterol you eat, especially if you have diabetes, for most people dietary cholesterol is not as problematic as once believed.
This seems to be a thing for pretty much every food/nutritional category. I've decided for myself to just "ignore" the science since the definition of "healthy" seems to change so often. Instead I try to use common sense for picking my meals.
any nutrition advice that makes sweeping statements about entire macronutrients (protein/fat/carbohydrates) should be ignored and is mostly used to sell fad diets. "Carbohydrates" could be HFCS or leafy greens. "Fats" could be shortening or avocado. The nutrition of the individual food is much more important than the macronutrients.
There's a U-shaped curve for all cause mortality with cholesterol levels, just like anything else. Cholesterol is not bad, it's literally the building block of steroid hormones, vitamin D, etc.
Similarly, there's a good argument to be made that most people actually eat too little salt. If you compare most sodium guidelines to data of sodium intake versus all cause mortality, you're more at risk of death following the guidelines.
Lifestyle changes are the best treatment there is. Shame they can't make a pill out of it. Statistically most people fail to maintain lifestyle changes over the long term. Especially dietary changes.
Pharmacological treatments allow doctors to help those people.
I have never had a doctor recommend lifestyle treatments to me. They don't make any money on those. I have osteoarthritis in my hip and multiple doctors recommended an immediate hip replacement. I did a ton of research and ended up on the anti-inflammatory index diet in combination with changing exercises from running and golf that put high impacts on my hip to cycling which does not. All of my pain was gone in three months and has stayed gone for the last two years.
As a herbal observation, it seems like such a scam that medical pamphlets will list possible side-effects, but not frequencies.
Knowing that one person in one thousand saw some issue is very different from 20% of people. Especially as almost every medication I've ever seen advertised has a list two pages long of possible side effects.
How is a person supposed to make an informed judgment?
I don't know if it's the law here in France or just nice manufacturers, but I've seen side effects broken down by occurence rate ( 1 in 100,000: X, Y, Z; 1 in 1,000,000: A, B, C, etc.) multiple times.
In my case (Pristiq), it was a net positive. My libido decreased (but never desapeared) and I've never had erectile disfuncion so far. Totally worth it for me, with my specific metabolism.
Sertraline (Zoloft) often causes more sexual side effects in males than it does in females. I have seen this used at the max dose to control hypersexual behaviour in a patient with dementia.
I spent about 18 months on sertraline. Even on the 'therapeutic' dose that I started off with, it basically nuked my ability to perform. Could still get an erection easily enough, the frustration was being unable to do anything with it.
It wasn't that much better with fluoxetine, but with that I found that I could at least wait a few days to sort of build up the energy.
As with another poster here, I'm happy being open about this stuff too. The first hurdle is opening up about mental health, I think that already puts you on a good track to take the shame away from the sexual aspect.
Anecdote: I had severe OCD from childhood through my first year in college, triggered by separation from my parents (who never got me therapy despite extremely obvious signs.) I had multiple panic attacks per day resulting in depersonalization/derealization, I was failing my classes etc.
Logically I knew that my mom wouldn't die if I didn't stop my room fan at its maximum rotation or if I didn't make the sign of the cross 2^n times. But mental illness is illogical. What "good coping skills" would fix that?
Psych put me on Prozac, which numbed every feeling but panic, which it didn't touch. I got relief from a bad trip on 2C-E, in which I had such a severe panic attack that it permanently destroyed that identity and left me with depersonalization. The old me was dead, so over the following months I built a new one. OCD apparently got erased with the rest of me. I successfully went off Prozac by quitting it cold turkey and stayed off SSRIs for a decade.
I guess the takeaway is: serious mental illness exists, platitudes about life wouldn't help, SSRIs didn't help either but didn't make me dependent, and psychedelics are a crapshoot.
I took SSRIs for a year in my late twenties. They had no effect on my depression, but resulted in permanent sexual dysfunction. My own fault for not properly researching the potential long-term side effects, I suppose, but it certainly wasn't raised as an issue by the prescribing doctor either. I hope someday there will be cure of some kind.
A close friend took an SSRI, citalopram, for a year in his early twenties and he got that too. It wasn't permanent, though ("full") recovery took almost a decade! Keeping in mind varying-milage and a sample size of one, he's vaguely suggested that his recovery was speeded by working out muscles in his hips. Perhaps a combination of our Western sedentary lifestyle, our proclivity to sit in computer chairs all day, and the effect of the SSRI? Far be it from me to dispense medical advice, but working to open one's hips and doing some squats probably can't hurt, even if it doesn't actively help.
Have you tested your hormone profile (blood test)? Testosterone, Free T, Estradiol, Prolactin, Progesterone, SHBG - you could check if all of those are in range because that might be the root cause of your issue. There were studies done where use of SSRIs was causing elevated levels of serum prolactin.
Interesting, thanks. I did do a basic consumer blood test which reported my testosterone as "normal" (whatever that means), but I should probably do a more in-depth one and check these things.
Endocrinologists are terrible at knowing what hormone ranges are good for your age and sex. As a man with thyroid problems, I am thoroughly disabused of the idea that most endocrinologists have any clue what they're talking about. Certainly, for a middle aged women, must can put it together, but barring that, you're better off on facebook groups.
I feel you. I was on escitalopram in my twenties too for a depressive episode. It wrecked my libido and 10 years down the line there is hardly any sign of improvement in sight.
I have a very understanding spouse, luckily, but I'm honestly devastated in not being able to accommodate this dimension of our relationship anymore.
Recently, my GP offered to prescribe me antidepressants again for an episode of burnout, but I'm absolutely not keen to go down that road again. I get that it's cheaper and more available than therapy, but I've been burned before.
When did the sexual dysfunction begin? During treatment, immediately after or was there a delay between the time you stopped taking the medication and when it began?
A different anecdotal experience from my own use (10mg Lexapro) - I've always had a problem with premature ejaculation. Was trying all kinds of tricks like doing math problems in my head during sex or trying different breathing techniques - all of that was useless, once I started taking Lexapro it's like it flipped some switch in my head and I can basically go as long as I like now, and finish almost on command. Absolute game changer, it's a fantastic improvement to my quality of life. I also take 5mg of Cialis daily, which definitely helps with erections.
Ummm I’m pretty sure the cialis is keeping the blood engorged where it needs to be. Why not try an experiment, lose the cialis and see if you can “keep it up” so to speak. (This is not medical advice, I’m speaking hypothetically fyi)
SSRIs need to be obsolesced already. Screw the sexual dysfunction, how about increaased risk of suicidal ideation? How about them taking two entire weeks to work?
The thing is the rest of the world doesn't seem to feel the burning desire to get as many people on them as possible and even have alternatives which aren't as limited. Reversible MAOI drugs like moclobemide have been around since the 90s and while they have a higher interaction profile (Can't mix it with anything serotonergic basically, so no amphetamines or cocaine or other antidepressants, which is fine), the reduced side effect profile is considered a bonus and the biggest reason for lack of adoption of this along with other treatments (It's astonishing how long we have known about the ketamine thing without using it) happens to just come down to marketing and doctors scared off by the early MAOIs where you need to strongly consider diet. The new stuff even reportedly improves sexual function. And you can't get it in the USA.
SSRIs took me from being unable to function and leave my home due to social anxiety to knocking out the bulk of my symptoms and having a solid 15 years of being socially and professional productive. I'd prefer we keep them.
Heroin, interestingly enough. IIRC they screened pain medicine recipients for depressive symptoms and in this way determined opiates relieve major depression more efficaciously than SSRIs.
Yes, and a close relative (oxycodone) is something I’ve had experience with and can confirm it’s quite good at curing the depression. The problem is the permanent brain damage and/or death it will cause when taken long-term. Link < https://www.drugabuse.gov/publications/research-reports/hero...>
I don't see opiates as a tenable longterm solution but I mentioned heroin because it's only long term side effect as far as I know is constipation, which can be managed. Same with morphine.
My point in bringing this up is why accept SSRIs if they have more side effects and are less efficacious than heroin?
Did you read your 2nd link? All of the typically bad sides in the second grouping are related to poor hygiene and needle sharing. The first grouping is more benign than most antidepressant sides.
Yes, I did. Nowhere does it say that. If you want to get a point of reference for what heroin might look like if it wasn't a street drug, oxycodone is quite similar yet distributed without the additives found on the street since it is manufactured by big pharma. Still, it is associated with respiratory depression.
I know it doesn't say that but it should be obvious most of them are due to poor IV administration. You don't need to administer heroin or morphine via IV.
True, people occasionally OD on prescription medication, but it's usually as a rebound after having the prescription withdrawn and then finding more drugs.
That can happen with prescription drugs too though. People lose access to their insurance and then end up going off the drug too fast.
The bottom line is, don't you think if they could sell more of this drug, they would? Opiates are a pretty terrible choice for an antidepressant for multiple reasons.
> Opiates are a pretty terrible choice for an antidepressant for multiple reasons.
You've failed to present this. That opiates are bad is just dogma left around from the first religious-linked anti-drug pushes. I think they are inappropriate, but in the same way SSRIs are inappropriate, and have explained my position.
E.g. a UK study found that if you just give people all the heroin they want they quit after 2 years. There are no other complications than constipation.
> There are no other complications than constipation.
You keep saying this, ignoring the fact that I showed (with a citation) that it is addictive, which is a complication. This is a pointless discussion, since the dogma is that you are pro-opiate past the point of reason. I seriously doubt you’ve even tried this drug.
MAOIs have potentially serious dietary interactions and side effects. They can cause serotonin sickness just by taking it with OTC tryptophan supplements.
SSRIs are not perfect but have a safer track record of being a first-attack against depression and anxiety, before having to resort to bigger guns like MAOIs.
This is actually the biggest thing keeping this line of treatment from being the preference, but when it comes to reversible vs irreversible MAOIs the dietary interactions are actually not a concern![1] It was actually my first comment when I was told about this, but as it turns out you're more looking at potential drug interactions with the reversible MAOIs. The dietary interactions definitely stand with the irreversible MAOIs in the first generation antidepressants, which I think are generally reserved these days for really serious depression cases that don't respond to other treatment, or parkinsons like symptoms, or people going on jungle treks to drink shaman brews. I think the benefit of treatment kicking in immediately is really key as well, 2 weeks is a long time to wait for a drug to work when you're potentially on the brink of suicide.
SNRIs have resolved my suicidal ideation. I credit Effexor with saving my life. The increased risk of suicidal ideation in young anxiety patients is probably offset by the reduction in self-harm amongst the major depression people.
I am in the US and I have never heard of the treatments you mentioned. I guess this is your point! This makes me very sad. I am glad a SSRI worked for me, but I know that a percentage of people will also be at great risk for self-harm.
I am not a doctor and do not know the difference between brain zaps and EHS (or whether there is one), but this article[1] summarizes it well.
For me, it is a loud sound but sort of within the head, accompanied by the sensation you get when you receive an electrical shock, which of course startles you awake. This unfortunately occurs just at the boundary between consciousness and sleep, which after it happens a few times in a row can put you off the idea of even trying to sleep. Occasionally I did awaken thinking there had been a literal explosion in the building.
I haven't taken SSRIs for 3 years and still get them, albeit less than when I was weaning off of them.
I think this article is a little alarmist. Warnings like these scared me away from SSRIs for a long time despite their likely efficacy in helping treat my symptoms.
I sent a number of articles like this one (and several of the medical publications it cites) to my psychiatrist. To her credit, she read them, and her response was that she agreed this kind of permanent change is possible, but it is extremely unlikely. (Anecdotally, she told me, she's treated thousands of people with SSRIs and had never had a report of something like this; she hadn't heard of it happening until I showed her case studies.)
I don't think that means my doctor is ignorant - I think that means permanent damage is indeed likely very uncommon.
Your psychiatrist may have had patients suffering from this that never told her.
They would have discontinued the medication, terminated the doctor patient realationship, then waited for things to "go back to normal" when they were off the drug but found it never did.
In fact they may have voiced concerns to her and she may have said "it will go back to normal if you discontinue the drug". But they never went off the drugs until they fired her as their doctor, so she would never know about the subsequent problems.
That's possible but it's an awful lot of speculation. She also might have had lots of patients who did so well on SSRIs they stopped seeing her and just had their GP prescribe the medication from then on. Or all her patients might have overdosed on an unrelated drug and died. You can come up with lots of scenarios other than the most likely one.
But this:
> They would have discontinued the medication, terminated the doctor patient relationship, then waited for things to "go back to normal" when they were off the drug but found it never did.
is not the way a good psychiatry practice (like the one I frequent, IMO) is designed to work. You try a lot of different things and you see what works. You're told upfront that this is part of the process and that if you don't like a medication, you don't have to keep taking it, and you should tell the doctor why and what you're open to trying next.
I tried buspirone (which I still take), duloxetine (intolerable GI side effects; didn't take for long enough to experience anything sexual), and bupropion (too stimulating, not right for my condition) before I settled on citalopram. I had been specifically avoiding citalopram because I was scared of it, and I feel a little foolish for that now.
So I think your scenario is unlikely in my case. I can't speak for other doctors.
You don't have to keep taking the drug, I agree. But the doctor will give you another instead, and if the dysfunction continues it will be assumed to be a "temporary" symptom of the subsequent drug like it was with the old drug.
You won't go "cold turkey" to see if things go back to normal unless you fire the psychiatrist because frankly, in America at least, psychiatrists are pill pushers and, unless you are wealthy and will pay out of pocket, you will only get insurance covered talk therapy with a cheaper psychologist or social worker.
Psychiatrist are often only there for quick discussions about medication. The time intensive talk therapy is done by someone less expensive. In my area psychiatrist will often partner with therapy practices and only handle the drug side of things. If someone stops taking drugs, there would be no reason to see the psychiatrist.
> You won't go "cold turkey" to see if things go back to normal unless you fire the psychiatrist because frankly, in America at least, psychiatrists are pill pushers and, unless you are wealthy and will pay out of pocket, you will only get insurance covered therapy with a cheaper psychologist or social worker.
This is just not my experience, sorry. Perhaps this is true of the majority and I got lucky, or perhaps you have had some very negative experiences worth sharing, but I have never felt pressured to do anything I didn't want to do. After I tried duloxetine, I waited several months before trying anything again (except the buspirone which, as I mentioned, I'd been on the whole time). I met with my psychiatrist regularly during that time. It was all covered by insurance.
In fact, going directly from one SSRI to another without cross-tapering is not standard practice and can be quite debilitating. If your physician did this to you, they were not doing their job correctly.
> Psychiatrist are only there for quick discussions about medication. The time intensive talk therapy is done by someone less expensive.
True, but not really relevant, I think. If medication is what you want, a psychiatrist is who you should have. Choosing the right one can be a challenge, I agree, but that doesn't make their profession not valuable.
I meant cold turkey as a synonym for no longer on drugs, I should have phrased it differently.
I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship.
You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug.
You are correct that some patients could stop taking an SSRI and still see a psychiatrist.
I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for.
> You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug.
The insurance company doesn't know what you are discussing in your sessions and isn't going to let you see or not see a specialist just based on whether they prescribe you meds. That's not how it works - or not how it should be working if your insurer is acting appropriately. I also saw this psychiatrist a couple of times before taking anything. I didn't walk out of my first session with a prescription for buspirone.
> I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship.
It is, but that doesn't mean you just immediately stop seeing them and never communicate again. That's not how it works - with a good psychiatrist at a good practice. You taper off, verify the taper worked and you have no further issues, and then stop seeing them if you want.
> I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for.
You need to provide some data for this assertion if you are going to keep making it. The point is that the psychiatrist, as the person overseeing your care, is the person you would naturally tell about a problem you were having. I don't think "go off the drug and just stop talking to the doctor" is the normal behavior, I think it's more like "tell the doctor you're going off the drug, confirm you went off the drug, the doctor asks if you want to try another drug, you say no, and then you stop talking to the doctor."
I'm sure some people do just stop taking whatever they're taking and never speak to their doctor's office again - but most practices are set up to prevent that, because you'd have to actually cancel an appointment and ignore phone calls in order to get to that point. Doctors hate risk by and large, and letting patients randomly discontinue drugs with no supervision is not something they generally want to incentivize.
"tell the doctor you're going off the drug, confirm you went off the drug, the doctor asks if you want to try another drug, you say no, and then you stop talking to the doctor."
This is completely consistent with the patient never telling the doctor that, to their surprise, after waiting months the SSRI side effects never go away.
I feel like you are arguing against my choice of phrase but not the substance of what I had to say.
When a patient terminates treatment doctors do not tell their patients "be sure to make a followup with me in 6 months after going off the drugs in the event you are permenently injured by the drug side effects in a condition that has no cure. I won't be able to help you but please pay me to chat about it."
The article this thread links to indicates there is no cure, so any patient who has done research would know discussing it with a psychiatrist would be useless.
And of course I have no data, you told an anecdote and I responded with a comment along the same lines.
I made a pretty small claim, that your psychiatrist may (not did have, may have) had patients with a condition they didn't discuss with her, that only became known to the patient after treatment had concluded. If you think a minor claim like that requires "surveys" or data, believe what you want, I don't know what to tell you.
> This is completely consistent with the patient never telling the doctor that, to their surprise, after waiting months the SSRI side effects never go away.
That's true, that could certainly happen. I'm more skeptical about the rate at which it happens -- but also, if it is happening, presumably a patient will eventually go back to someone in the medical system and mention it. Whether they connect the dots is a question, but one which can be studied.
> I made a pretty small claim, that your psychiatrist may (not did have, may have) had patients with a condition they didn't discuss with her, that only became known to the patient after treatment had concluded. If you think a minor claim like that requires "surveys" or data, believe what you want, I don't know what to tell you.
The claim that my psychiatrist might have done something or not isn't the claim I want data for. The claim I want data for is "I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for."
That's not an anecdote, that's a pretty bold claim.
> The article this thread links to indicates there is no cure, so any patient who has done research would know discussing it with a psychiatrist would be useless.
I don't think people think about things that way necessarily. I wouldn't read an article and conclude I shouldn't talk to my doctor because the article suggests the doctor can't help, because I don't necessarily put that much faith in a single article. And doctors will frequently ask these sorts of questions, so even if I had read the article, I don't think I'd lie about it to them.
In general, I think you are making a number of assumptions about how people - doctors, insurers, pharma companies, and patients - behave that aren't necessarily borne out in reality. If your assumptions are all correct, your conclusions are reasonable, but I am not sure they're correct.
Well, you might look for data on how many patients discontinue any sort of treatment for starters. "Patient compliance" would be a starter for such a search.
I get the impression that you have an "attachment" style relationship with your doctors, I don't mean that as an insult, I think that leads you to think that other people are interacting with them like you are, and would not possibly discontinue their long term interactions with the doctor even after deciding to go off drugs. Obviously not everyone is like you.
I'm not the one making the claim; it's not on me to provide evidence.
Conceding your analysis of my particular situation, "not everyone is like me" is a far cry from "nobody is like me." If this condition has high incidence, and even a fraction of people were like me, it would be much more common knowledge than it seems to be given the quality and volume of evidence available.
> The insurance company doesn't know what you are discussing in your sessions
That's not true. From what I understand, sessions are coded e.g. "Intake" or "Meds check" when billed to insurance. They know roughly what you're talking about.
> and isn't going to let you see or not see a specialist just based on whether they prescribe you meds.
You can't bill a meds check with no meds.
> That's not how it works - or not how it should be working if your insurer is acting appropriately. I also saw this psychiatrist a couple of times before taking anything. I didn't walk out of my first session with a prescription for buspirone.
And those sessions were probably billed as "intake", "evaluation" or the like. A psychiatrist cannot keep billing intakes and evaluations forever. Talk therapy is coded in its own way, and generally paid at a lower rate.
> That's not true. From what I understand, sessions are coded e.g. "Intake" or "Meds check" when billed to insurance. They know roughly what you're talking about.
You are correct that CPT codes give some insight into what was provided, but you are wrong about what codes providers use in this case.
To check myself, I pulled my insurance provider's EOBs for my last two visit to a psychiatrist and my last visit to a psychotherapist. The codes were as follows:
Psychiatrist - CPT 99214 and 90833. Those are "office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity", and "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 30 minutes" respectively.
So I don't think from these you can assume "this person was prescribed meds", necessarily. These are very similar to a standard doctor's visit billing code, or a therapy billing code (as below).
Psychologist - CPT 90837, which is "60 Minute Individual Therapy"
Both of these EOBs indicate the insurance paid the provider for the codes as billed. This is one example, but I'd be surprised to find it wasn't representative (that is, that my providers are not billing in generally accepted ways).
> You can't bill a meds check with no meds.
As you can see above, there isn't necessarily such a thing as a "meds check" CPT code. The codes don't give the kind of information you're imagining.
> And those sessions were probably billed as "intake", "evaluation" or the like. A psychiatrist cannot keep billing intakes and evaluations forever. Talk therapy is coded in its own way, and generally paid at a lower rate.
It is true talk therapy is a separate CPT code; it isn't true that it's always paid at a lower rate. The negotiated rate depends on the insurance company and provider's agreement.
Talk therapy where I am pays 75 dollars for 50 minute session on my insurance.
Someone who has been through med school would not typically lower themself to that rate, nor do I buy the idea that some insurers are inexplicably more generous and pay doctor rates for non doctor work.
Remember, talk therapy does not require as much education, you do not need a phd or md to do it. An MD would not get doctor level payouts doing talk therapy.
It's true an LISW or similar wouldn't make the same rated as a PhD or an MD... but between the same "tier" of education in the provider, rates are surprisingly more comparable.
Insurers aren't more generous - they have negotiated rates. They're never paying 100% of what's charged. Some providers are better at negotiating, or have more leverage, than others.
You've shared a belief that a patient will continue to see a psychiatrist when not being given drugs. Since psychiatrists don't tend to do talk therapy, I will reiterate I don't believe this is correct.
I'm sure there are exceptions- a wealthy person might find a Doctor Frasier Crane type Doctor to do talk therapy- but they would be paying out of pocket. I know the local Ivy League school only takes a special Ivy League insurance offered only to the Ivy league school's students and staff. The wealthy- and their Doctors- don't need to worry about the "rules" set by insurance companies.
I absolutely won't defend his Livejournal comments or any of that other stuff. It's trash and he's wrong.
But with regards to the SSRI article, Siskind says the libido effects are significant and that "[the effects] usually go away a few weeks to months after stopping the medication, but in rare cases they might linger for months or years, and there are a few people who say their sexual side effects never went away. These cases are very unusual and still not well understood."
So he's almost completely agreeing with the posted article. He disagrees on how common these events are but doesn't offer any more evidence than the posted article does, and I think his disagreement is one the current medical establishment shares.
I think his SSRI article therefore remains credible; it is if anything a more mainstream view than the one presented in the posted article. I'd be more than happy to refer people to somebody other than Siskind if some other non-alarmist summary of SSRIs existed that was comparable. I've looked, but haven't found much.
Mostly unrelated to SSRIs, there was an email leak that was much more recent where he also says his anti-reactionary FAQ was made with ulterior motives to promote the "human bio-diversity" head measuring stuff from neoractionism and just attack the feudalism parts or something along those lines:
To be fair to the article - I don't think it claims post-SSRI dysfunction happens to everyone. The sexual side effects during use are well known and do happen to the vast majority of people; I think 100% is an overestimate but 80%+ isn't. Post-discontinuation, the article argues, is more common than reported, but it's not everyone. I agree that's likely - but I still think it's a small proportion of people.
I want to kill myself every second of every day, and it's been that way for 15ish years now.
The only thing, fleeting as it may be, that I find worthy of doing in life is sex, and these ed side effects have kept me from exploring the potential for a world in which I don't to cease to exist or murder in the sake of nihilism.
I'd rather destroy the lives of those around me or others' randomly than live without sex. It's just a function of my utility curve.
Unfortunately and as counter intuitive as it may seem, I'm very cautious of skin to skin diseases such as hsv and hpv, which has kept me from hiring prostitutes, even though the only thing in life I want is exactly that.
I'm sorry you feel that way. It sounds difficult. I believe there are many things that could help you find more pleasure in life and also find more fulfilling sex. I recommend searching for those things, and looking for people who can help you. But I'm actually commenting to point out that sex with a prostitute doesn't have to be risky, despite stereotypes. Most prostitutes are frequently tested for infectious diseases, and most will have no objection if you ask to see a recent clean test. Very very few prostitutes will have unprotected sex. And you could even find a less active prostitute who doesn't have sex with many people. The biggest risk is probably legality, depending on where you're based. But, assuming you have legal access to it, I would recommend seriously considering it. It's a fair exchange of something you have, for something you need that could really help you get what you want out of life. As long as it's between consenting adults, there is no problem with safely exploring this option. One note that I would recommend if you do pursue it is to also pursue personal growth at the same time, because few people find that sex with a prostitute was what they really wanted, and you may find that what you really want in life will take a lot of work to achieve.
The problem I have concerning diseases and prostitutes is that, although many get tested often, almost all testing excludes hsv and hpv unless specifically requested. And since ~12% of the population carry hsv-2, which can shed asymptomatically and be contracted from skin-to-skin groinal contact, it seems that it's an eventuality if I pick up prostitution long term, and then it's for life.
Condoms help, but they're not perfect. I asked on a forums once if prostitutes would be okay if I wore condom shorts such as the following link, and I was told that (1) the hobby was not for me, (2) the probability of contraction given the use of condoms is low enough not to be a consideration, and (3) the item probably wasn't tested under the same standards as condoms so probably isn't as safe (I figure latex material such as this would be a find physical barrier).
I was where you are for about 10 years. Don't give up hope, it can end.
Also have you tried websites for "sugar babies" instead of an actual prostitute. Someone who is willing to get tested, and sleep with you regularly but doesn't have the same risk profile as a prostitute?
For a period of time in the past I ran a small porn production shop wherein I would hire and then get recent test results from models. But TTS, the industry standard, doesn't test for hsv or hpv so I gave up while I was ahead.
I know. It's ridiculous, and I hate it, but that's my mental state. I think I wrote it was counter intuitive in my initial post because, as you point out, it's as rational as pi.
I have sex on a regular basis, and it's not nearly as bad as these side effects make it sound. It's different, sure, but you can definitely have enjoyable sex.
You need to take antidepressants every single day for at least 30 days before you'll notice any effect whatsoever. Every day, without fail. If you haven't tried that yet, I urge you to; it was nothing short of miraculous, and there was no reason for me to live so many years in misery.
That last part isn't true. People report credible effects of positive mood immediately. The issue is you can't necessarily trust these self-reports and it takes roughly 1-2 weeks for someone with a clipboard to start writing down results that correlate with a perceived increase in mood.
Some adverse reactions to SSRIs are so bad people will kill themselves if they go a month. If it doesn't feel right you should just stop taking them.
That last part is my own experience. It was so true for my case that I nearly didn’t discover Prozac at all, because I gave up after the first week. It wasn’t until many years later that I knuckled down with the consistency, since I had nothing to lose.
As it turned out, I had everything to gain.
All of this should be done with the supervision of a doctor.
If you try anything, ask for Wellbutrin first if it is not the first thing prescribed. There are usually not any libido or lethargy issues.
You may have ADHD and may want to get tested for it. I'm looking for a doctor to go to again, but being an adult the ones I've seen so far think I just want drugs. Complications from ADHD look a lot like depression.
This is really interesting. May I ask why you came to the ADHD conclusion in the first place? Was it solely the correlation between depression/anxiety and adhd?
I was surprised to find I exhibit many of these symptoms. Most prominently having stacks of things throughout the office/house which contain various half-worked projects or hobbies or just general information. My shieldmadien constantly complains about the "disaster" and is always shocked when she asks where something is, and I'm able to go straight to the pile of junk which contains exactly what she's looking for.
Other things like time being an elusive concept or going to another room to get something and then getting there and having no idea what I am supposed to be doing are also frequent occurrences. I know where my car keys are, but that's only because I have a very specific plastic tray on the kitchen counter that is supposed to contain them and my wallet. If they disappear from there because I get distracted between walking into the house and emptying my pockets then it's usually a hunt for them.
I tend to bounce between new projects but get obsessively engrossed with them at the start... and then just never complete them.
Not sure if I actually have it, but it is an interesting thought.
> Was it solely the correlation between depression/anxiety and adhd?
Yes, but partially also your existence on HN. Depression/anxiety + well read is almost always some shade of ADHD in my experience (of observing people who get diagnosed by doctors).
Giving up isn't a bad thing. I've given plenty of things up, usually after either realizing I was right or finding someone else had done it.
I don’t think libido or lethargy is the most important consideration. The consideration is whether it eliminates suicidal thoughts. For me, Prozac was the only thing that worked, and this advice would’ve led me astray.
If you want to discount libido that is at least halfway excusable, but that depends on the individual. Lethargy, which almost always comes with libido issues, is more problematic, as it causes weight gain and a corresponding decrease in life expectancy.
It an be hard or impossible to combat. I've had people tell me they discontinued their medication due to weight gain (or libido issues, as in this thread).
ps. Having sex in rubber with prostitute is safer in terms of HPV/HSF infection then with average female in UK without any protection (especially with Y gen) :) So I would not worry about it THAT much.
PSSD seems to be in part mediated by desensitization of 5HTP1A receptors. Psychedelics are known to modulate 5HTP1A and increase plasticity of serotonin neurons. This would logically be another research avenue for psychedelics.
I could not find anything substantial on this specific avenue in a brief literature search, but the mechanism is there, and anecdotally people have reported success.
We need to de-schedule these drugs. At the absolute minimum, we need to get rid of the vile Schd 1 "no medical uses" to allow their research to be more politically/financially palatable.
I posted this here in hope more people would be aware of the long term risks involved with SSRI, which are often not discussed from the doctors. These symptoms might only appear after the withdrawal.
Some manufacturers and healthcare organisations are being to label this as a potential side effect. You can find a one line warning on NHS website now.
People take the drug are usually desperate and at their most vulnerable periods in life. It’s very risky to make life-changing decisions, more so without complete knowledge.
Doctors usually won’t even listen to cases of PSSD by simply attributing the SD as remission of depression. But there’re some recent studies on how SSRI could change neutral receptors in a non-reversible way, which could be the potential mechanism.
Anecdata: an ex experienced this on SSRIs. Was brutal on her and tough for me. A friend had the same issue.
Antidepressants are an awfully tough thing to get right. Whenever my friends talk to me about them I recommend therapy and all the other things before starting ssris or the other families of brain drugs.
I’ve had significant problems with my anti-psychotic before my psychiatrist and I found a proper mix. Given I frequently deal with hypersexuality, there was no way I’d stay on medication long term if that wasn’t fixed.
For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.
I've experienced the sexual side effects. For me they lessened over time (going from mostly not being able to achieve climax to that rarely happening) and taking a lower dose helps. For those that are not at risk of seizures they can take bupropion as well to decrease the dose of the other SSRI further.
But honestly sex is mostly in the brain and not finishing every time is only a drag if you think that it is. Personally I find it liberating, sex becomes a fun intimate pass time without an end goal. And certainly the benefits to my depression and anxiety out weigh the negatives for me.
In my early 20s (male) I was prescribed (read: pushed) citalopram by my family doctor. I took it for about a year. I'm in my early 30s now and sometimes STILL suffer from the inability to reach orgasm. I stopped taking the medication and when I realized it was in fact the medication interfering with my love life, and unfortunately realized too late. I've read alot about this after the fact and am surprised this reached HN. Nothing really to add to this conversation but its reassuring to know I'm not alone.
Ugh. Yes. Not meaning to be crude here and I’m incredibly sympathetic to the men I date, but as a woman in her late 30s it’s hard to find a man my age who doesn’t have problems getting / keeping it up. Most of them link back to antidepressant use.
What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
What about modern society drives the need for such widespread use of antidepressants?
Honestly, the "about" is that we've developed medicines that aren't nearly as horrible as the medicines of yesteryear. Prozac wasn't marketed until the 80's, and a lot of other things have been marketed since then. Marketing is key too - it is really hard to take this stuff if you don't know something is available. And misery has been with us for quite some time.
Is that something we should be willing to give up?
Well, no. Giving up antidepressants means that people suffer more. We could work on reducing the general population's suffering and anxiety. We aren't 100% sure on how to do this, it seems, but we know things like easily affordable health care and a safety net helps out lots.
It hasn’t always been this way, has it?
Actually, yes. And no. I'm not convinced that housewives that used to take vallium in the 70's were taking it because they were happy, for example. We didn't always think to write about this stuff - doubly so when going on about it could get you in a non-modern mental hospital. The 'no' is simply because we can do something about it now. I like to think we are more compassionate overall now, but I have no real reason to think this.
I don't see how that is relevant here. I'm guessing relieving financial stress is really effective in some too.
So what?
It doesn't help all patients, which means that we just can't cure everyone with exercise. Hence, we'd be worse off without them as some folks would suffer more.
It's relevant because there are a variety of therapies available. No single treatment will work for all patients. Medication is sometimes appropriate but it isn't always the best option.
Feeling inadequate is integral to the cherchez-la-femme experience. But it's probably better to be humiliated in night clubs (where eg. women sometimes will pretend not to even see you) than in apps; ego defense mechanisms have less of a chance there. Also: actually kissing tells you a lot that detailed self-reported profiles will never do -- the "chemistry" thing is real, sometimes two people find someone cute and stylish but the kissing doesn't work.
Dating apps are awful, but were a lot better once I challenged my standards (and lowered them a bit; I’m not the young hottie I used to be and that was a hard realization).
> What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
It's completely possible that there's something messed up in modern society that causes depression, or in medicine that diagnoses depression and/or prescribes antidepressants, but the null hypothesis would be that before modern times, people were... just depressed. And then more recently that they'd try treating it with cocaine/meth/etc. Or that they'd fail to treat it, and some percentage of those people would commit suicide, and the remainder would never admit that there was anything wrong, both of which mean the outcome you observe wouldn't happen.
Again, this isn't to say there isn't a more interesting answer, just that you have to at least consider the possibility that it's not something about modern society.
We know that exercise is an effective antidepressant for some people. In pre-modern times people were generally more physically active so I suspect that prevented a lot of depression symptoms.
Depression is relative. Today on social media, people come away with the false conclusion that they are meant to feel euphoric most of the time.
I don't believe in 'feeling happy', yet every magazine promises me i'll be happy if I just do X. Instagram says if I just follow <blah>, my life will become infinitely better. It's all a joke. I never feel happy, but I am not depressed. And more importantly, I have no interest in constant happiness... how boring. Most days I just feel meh. Sometimes I feel hungry.
> What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
GPs have very limited amounts of time for individual patients. Therapists, counsellors and psychiatrists are expensive and have mixed results, and require a significant time investment from the patient and the professional. It may be a long time before any kind of talk therapy has results. For many people who go into a doctor's office complaining of depression symptoms, it will go away within a reasonable timeframe. In many countries, there are waiting lists for any kind of further treatment.
The whole situation adds up to handing out SSRIs as a first line treatment when anyone comes to a GP reporting depressive symptoms; it's cheap, it buys time, it gives the patient a feeling that they're doing something to work on their issue, and gives them time to sign up for further support and get through their waiting list. As far as the GP knows, in most cases, side effects are rare. For many people coming in with mild depressive symptoms, there is some temporary life factor that will go away within the first course of treatment, and with it the symptoms, and that is a "success" for the SSRI stats.
Of course, anyone who's been on SSRIs of various types for any longer length of time knows that's bullshit, and they're quite serious substances with prolonged side effects and withdrawals. I really hope the situation changes.
Trouble in that department is also heavily impacted by men just generally being more sedentary, having poorer diets, and due to those reasons and more, having lower testosterone. Also, consuming pornography in much greater amounts than previously available to people is known to cause serious problems here.
Yes, changing diets, better sleep and giving up porn works wonder in my case. I'm in my mid 30s and never had any sexual dysfunction, but relatively small changes cause major changes in my perceived feelings of "potency", if you will.
Fatty meats, cholesterol heavy foods (butter, eggs), vitamin D have the biggest effect on me, still less than just simply giving up porn.
> What about modern society drives the need for such widespread use of antidepressants?
There's little space for compassion and sociability. Most people in the West spend 8 hours a day working through an endlessly growing backlog of demands, all the while justifying each hour to clients and managers, then go home to drink and watch TV or scroll through news feeds. Our brains are not suited to constantly worrying over the demands of others while being so disengaged from social face to face contact.
"There's little space for compassion and sociability"
I would argue there is more space now than there used to be.
I mean, women were basically property at one point, with changing degrees of freedom. You might not get out of the house much, depending.
Folks working as servants around 1900 basically had to do what their employers said, even if that meant you simply weren't allowed to have a romantic partner.
We kept slaves, and unfortunately, some folks still do.
We are probably lucky to spend only 8 hours a day on things, and I'm really happy that housework doesn't take up a lot of time now. Doing housework or working long hours doesn't grant you much space for compassion nor sociability.
The television and feeds are hobbies and entertainment. The folks in the past did similar stuff, and they had their own outcries - books, bicycles, women's ankles, and so on.
Drinking has been with us for literally Millenia. The amount of drunkards has varied alongside whatever it is we feel is "too much" - in other words, drinking daily wouldn't be strange if that is in the culture, but it is possible that same culture would frown on daily drunkenness.
> I mean, women were basically property at one point, with changing degrees of freedom. You might not get out of the house much, depending.
Can we please stop just repeating cliches that are not even obviously true? While certain countries certainly had these notions, this is not a universal.
And even in cultures with strong 'female ownership', the picture you're painting is incredibly wrong. While women may be considered 'basically' property, they would constantly be socializing with one another. They would be out of their house often with other women and their children. The appearance of 'ownership' would only be from the vantage point of men.
For example, looking at Middle Eastern society, it's completely false to say women don't get out of the house. Women have entire portions of the house to themselves, where they and their female friends can get together, talk, interact, and gossip without any interference from men, including their own husband.
Today we are way more atomized. Many people work, watch TV, and sleep. That's sad. We used to spend most of our day with friends and family. Even the slaves would.
It's not about society, it's about having the option now.
I have severe anxiety and I always just accepted it. After taking 75mg/day of Effexor, I don't have that anxiety anymore and I can function like a normal human. I'm in my mid-30s and I can have sex 3-4x/day easily and it still functions like when I was 15.
I wouldn't blame it all on anti-depressants, since sexual issues for 35+ year old men are common even without them. Blaming anti-depressants is convenient though since no one wants to blame it on genetics/health.
I tied the knot in my early 30s, but friends who chose to remain free agents (even having had opportunities to marry someone great) report that the market thins out more and more as time goes by. And these are men, with easier access to a younger pool.
I wouldn’t say women have it much different — I end up dating a lot of significantly younger men. It is harder to have much in common outside of physical attraction with someone too far from your age group though.
My wife is actually five years older than me. But we met on a night club and made out before talking too much and it stuck. I think we developed a crush on each other in the ensuing daytime dates, came to admire each other and recognize common values. But we had kissed first and tested the chemistry.
People overthink dating and mating. We'd all probably be reasonably happy on arranged marriages. With apologies for the non-inclusive language of an old song, "woman needs man and man must have his mate, on that you can rely as time goes by".
5 years isn’t that much difference and you still share some cultural overlap. I’ve dated people who are closer to 15 years younger and it was hard to have more than a physical relationship because our personalities were formed in such different contexts.
I am a straight man, so have no experience with other men obviously, but this is fascinating. How can it be that so many of us are on antidepressants? Something is surely wrong as you've said right?
There may also be selection effects as men in their late 30s may not have 'paired up' so to speak due to depression. But still, I'm curious if anyone has stats on how many people are on these drugs.
About 15-20%. But that’s just the antidepressants; sexual dysfunction can also be caused by blood pressure medication, epilepsy meds, etc. Anecdotally I would say regular sexual dysfunction among men over 35 is probably closer to 50%.
I don’t know how this compares to past eras though.
I was prescribed cognitive behavioral therapy (CBT) and Prozac. The CBT did far more for me. I dumped the Prozac after a few months. I have bad days and good days, but I know how to get through the bad ones now. I know what prompts them and even when its hard to think positively I still know that I won't think things are as bad tomorrow.
YMMV! A lot!
As I get older I feel healthier when I move, touch people, give love and get love.
In the US, we _do not prioritize health_, physical nor mental. We're surrounded by shit food. We're "insured" basic baseline function, and improvement often has to come out of our own time, energy, and money. If you're in a relaxed white collar environment, its easy to duck out for an hour of therapy. If you're on the clock, it's almost impossible. This is the bigger issue.
Again, some ppl DO need SSRIs or they will harm themselves or others. But always pair with some form of talk therapy and get some daily exercise.
Takes me a little longer on Zoloft. My psychiatrist and I agreed this is more of a good thing than a bad thing. The crippling anxiety I had without it was much worse for my libido.
That being said, I wish we understood these drugs better, because I know the side effects and efficacy vary in the extreme. I know for some people it's like trying to put out a fire with gasoline.
Continued anecdata: when I forget to get my refill, the withdrawal is terrible. Dizziness, malaise, and "brain zaps". One of these days I'm going to have to wean off of it carefully before I try psychedelics.
I'm not a doctor, but I'd caution against trying psychedelics at all if you had crippling anxiety before.
I didn't realize just how bad my anxiety could get until after I did Psilocybin. It wasn't the root cause of my anxiety, of course, but it sure as hell exacerbated it to the point of being pretty debilitating.
I'm now on 25mg of Sertraline, which has all but wiped out my anxiety.
This is interesting. I'm a founder of an app[1] that deals with this ballpark of issue, by providing (among other things) couples with sensate focus therapy, which is a form of sex therapy that has an extremely strong evidence base, and is a pretty standard go-to for libido issues.
We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques are proven.
Can one sue a psychiatrist who prescribed me drugs not telling me about any side effects despite me not having any disease? The psychiatrist just concluded that if I have somatic problems and trouble sleeping I must be mental, turns it wasn't that. No one ever told me about any side effects (it won't hurt your liver I heard, you will remain cured even after stopping the treatment). I repeatedly told him I see no difference, and he interpreted unrelated life changes as results of the drugs. Or perhaps I could sue the company who produced it?
I wonder when we're going to find out better ways to alter the body without causing deleterious entropy. Surely pills and shots are not a solution for everything and are only present because of their easy testability. We need better methods and aggressive creative problem solving and the funding to incentive it.
I did not realize even the short term affects where that prevalent. Terrified of the long term ones now. It definitely happened to me on citalopram. And now on escitalipram. I have been experimenting with adding DHEA and ginseng from my doc and I think its helping a bit.
One thing I find super interesting is how that side effect is pretty inconsistent even in the same person. I’m currently on Wellbutrin/Zyban/Bupropion as a smoking cessation aid and am not having that side effect this time. But last time I was on it for the same reason… oooooohhhhh boy, yeah, it’s a good thing that I had a partner who was good with that!
It’s possible some of the variation is from the specific manufacturer or manufacturing process. In the case of Wellbutrin XL, generic brands have even been recalled due to not being bioequivalent (https://www.medicinenet.com/script/main/art.asp?articlekey=1...)
I have been told by a doctor that effects appear inconsistent across brands or places of manufacture, even with non-recalled generics. You should always consult with your own medical professionals about your medication, but you can often ask for a different generic at the pharmacy.
That’s because Wellbrutin is an NDRI (norepinephrine–dopamine reuptake inhibitor). It’s a stimulant.
It’s actually a third-line medication for ADHD and is sometimes used with other medications to counteract the sexual side-effects of other medications.
You shouldn't take any form of medication unless it's necessary to save your life. Period. Doctors are still mostly quacks, except in some exceptional circumstances
This is absolute nonsense, there are literally millions if not billions of people living happier and better lives due to medications that they don't need to save their lives.
Yes. I have been taking sertraline for over a decade and it has literally saved my life. I was able to become the person I always wanted to be without social anxiety overtaking my life at every corner.
Please don't take any advice from anyone on HN, including me. This community often attracts armchair anecdoctors. Go and speak to a doctor.
Many many summers and a thousand years ago, I went to a pdoc to complain of anxiety issues. I left (after a good hour+ of talking) with a bipolar 2 diagnosis. The diagnosis was correct: at low doses, lamotrigine/Lamictal behaves like an antidepressant (and you have to taper in slowly to prevent bad reactions) and I flipped the fuck out in euphoric mania. I shortly after went on lithium and never regretted it. I started having dreams that seemed to resolve my deeper "psychoanalytical" issues. It really fixed me up.
This has been like 15 years ago. The more I learn, the more it seems I was the textbook case doctors never expect to meet. People are not generally aware that dysphoric mania is a thing. A good diagnosis can change your life.
Anecdotally, yeah. It's worth it. To be frank (I'll comment more on this elsewhere) I think the risk of permanent sexual dysfunction or any other permanent effect is dramatically overblown by articles like this one. The short-term and while-you're-taking-it side effects are real, but for me and many others well worth it.
Everyone in my family has some sort of anxiety issue. Citalopram (with the help of therapy and lifestyle changes) helped me overcome severe anxiety, helped my brother stop throwing up whenever he got in a too-high-pressure situation, and gave my sister the willpower to move out of my parents' house and get a job.
They're good drugs with frustrating downsides. That's life. I'd still recommend them.
Yes. I've been on/off (mostly on) them for around 20 years. It started when I was young and a girl broke my heart. I just couldn't get out of my "funk". I started taking Zoloft and it gave me a life again. I probably have social anxiety and I am def. more comfortable in public and around people I don't know when I'm on an SSRI. I am not as negative and cynical and have hope for the future. I don't want to take them, wish I didn't have too but even with consistent exercise, therapy etc. it just wasn't enough without the medical help.
They can't sleep, can't focus.
Like they are rolling on their bed all the time but no real sleep.
Then on the next day when they have the interview their cognition is exhausted and tired.
Solution: CBD helped them sleep better like in 40 min.
Situation 2. Meeting or having a situation that they will be anxious. (meeting, new job,etc).
CBD before makes the "negative voices" stop.
I talking CBD only.
You will not feel high or anything.
Indeed you will forgot that you use it but then you will not be anxious.
Meaning -> it does not give a "kick" that you feel. suddenly you are relaxed and "forgot" about being anxious.
I was a person that thought the medicinal effects were "exagerated" so the ""hipppies"" could use it. But then once I saw it working I changed my prejudice.
My experience with CBD is that it will knock you out and give you a deep sleep on day 1, but the more you use it the harder it is to sleep without it. Almost like the payday loans of falling asleep.
People need to know that if you have Post SSRI sexual dysfunction, your body usually learns to work around it.
Went I started SSRI's I didn't orgasm for 3 months, but learned how again. Also if you tell your doctor about the sexual dysfunction they will prescribe you Viagra, which I did not need but absolutely love using and overall sex + Viagra is way more fun than before I started SSRI's.
I must be a weird outlier. While I can agree with the article's opening ("Close to 100% of people who take antidepressants experience some form of sexual side effects") I can't, at least from personal experience, subscribe to the main message.
As my wife can attest, when I was on SSRIs, I was hornier than usual.
I'm diagnosed with MDD. I was prescribed an SSRI and was not made aware or informed of the sexual side effects. Thankfully after quitting them my libido has restored but to the other extreme where I'm constantly horny.
For someone that suffers from premature ejaculation, these medications are extremely helpful. The trick is to get the right dose that improves your sexual endurance but doesn't prevent orgasm.
I am from a generation that when SSRI became available, it was a marvelous drug.
Prescribed to teenagers freely and plentiful.
Now on my peers of friends, we have many people who don't have any libido.
The hardest-hit group was Women as they go to therapy more[1].
It is so huge we have Forums like "dead bedroom."
Once a friend that took SSRI told me how she felt about sex:
"I am looking forward to when my husband reaches his 40s, so he does not bother me about sex anymore."
"Brushing my teeth is more useful and fun than sex."
I am not talking about sex partners that are not "competent" or good.
It is like you never felt hungry or willing to eat. But then you *have* to eat, and when you are tasting the food, it is like cardboard * every time*
The concerning part is that our PharmaCo does this every ten years. (Thalidomide, SSRIs, etc.)
So can we believe the mRNA vacuum is really safe?
So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really.
Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;)
As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.