Post-SSRI sexual dysfunction
rxisk.org
rxisk.org
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.
This is not medical advice, only anecdotal interest, but, have known many to leave SSRI for well-timed CBD oil.
Wonder if issues requiring an SNRI are "similar" enough?
Wishing you well!
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.
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.
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.
I'm not sure what the mechanism behind venlafaxine's blunting effect on LSD is.
Also, it does limit, if not entirely mask, the effects of some common recreational dopamine reuptake inhibitors.
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.
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)
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.
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 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.
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 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.)
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.
[1] https://exrx.net/Testing/WeightLifting/StrengthStandards. Bear in mind these are single rep maximum effort, which an untrained person isn't likely to properly do.
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.
> 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
this a great conversation with Weller that i seem to return to about once a year: https://charleseisenstein.org/podcasts/new-and-ancient-story...
I don't think I've ever seen someone so eloquently paint the picture of the world I see.
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.
Sort of. As I understand it, SSRIs have poor efficacy for mild depression, but have better efficacy against severe depression.
> CBT are useful interventions that can be easily monitored by physicians with modern technology.
The 'difficulty' with CBT, or indeed any other therapy, is it's expensive. And our health care system (at least in the UK) is quite underfunded.
You really don’t have a clue why people reach for these drugs.
> 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.
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.
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.
And make sure you have a therapist too.
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.
Either way, hope you are doing OK/OK enough.
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.
Tell that to your heart doctor when you're 70.
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.
https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
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.
Please be careful.
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.
(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.")
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.
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.
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.
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).
I... don't think so
https://www.health.harvard.edu/heart-health/research-were-wa...
https://www.sciencedaily.com/releases/2016/10/161007085247.h...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885279/
https://www.sciencedaily.com/releases/2008/01/080108102225.h...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394769/
> There are now tons of research coming out about how cereals (wheat and corn specially) are basically the culprit of a lot of diseases
Care to share more on what you are referring to?
https://www.hsph.harvard.edu/nutritionsource/what-should-you...
- 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.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.
Pharmacological treatments allow doctors to help those people.
Recently learned about it, and based on my own measurements, seems I have it to some extent.
Every time i measure it at home its 110s/70.
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?
Google "Product name prescribing information"
What does this mean?
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.
^ has information on why 'normal' isn't a good range for everyone.
> The Art of Manliness participates in affiliate marketing programs
Seems like a terrible resource. Much better would be blood work at your PCP (and a possible referral to an endocrinologist).
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.
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.
My point in bringing this up is why accept SSRIs if they have more side effects and are less efficacious than heroin?
> SSRIs aren't addictive [1]
There are also a large number of side effects and risks associated with heroin; it's not just constipation as you say. [2]
[1] https://www.mayoclinic.org/diseases-conditions/depression/in....
True, people occasionally OD on prescription medication, but it's usually as a rebound after having the prescription withdrawn and then finding more drugs.
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.
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.
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.
Could you expand on this? Is this the "exploding head syndrome" where you have an incredibly "loud" hallucinatory experience just as you fall asleep?
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.
[1] https://www.medicalnewstoday.com/articles/brain-zaps#how-the...
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.
You have to take pills more often (3x a day vs 1 a day) and only one potential benefit over SSRI which is less likelihood of sexual dysfunction.
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.
Here is a write up from Lorien Psych (the day job of Scott Alexander at Slate Star Codex) that I think is evenhanded: https://lorienpsych.com/2020/10/25/ssris/
Alexander has his issues, but this is an area where he's actually an expert and his approach to the topic helped me a lot.
As for me, the benefits of a relatively low dose of an SSRI have really outweighed the risks so far.
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.
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 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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
https://www.quora.com/Why-don-t-psychiatrists-do-talk-therap...
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.
He has a major conflict on this topic in particular though.
Livejournal-era Scott (squid314) expressed eugenicist views on the mentally ill (paying schizophrenics to get sterilized): https://www.twitter.com/ArsonAtDennys/status/136101934712109...
So I would not trust his claimed views whatsoever on the libido effects of other psychiatric medication and would look for other sources.
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.
https://twitter.com/ArsonAtDennys/status/1362153191102677001
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.
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).
https://m.aliexpress.com/item/1005001595057592.html?spm=a2g0...
I'm still contemplating it but am having trouble digesting the sti risk. The legal risk doesn't bother me.
Edit: auto-correct
Not insulting you, I know how weird and contradictory humans can be. It's just interesting.
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.
Disclaimer: I'm just a Christian who cares.
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.
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.
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).
I did a quick search and came across a few articles such as the following one: https://totallyadd.com/23-signs-you-do-not-have-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.
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.
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.
As it turned out, I had everything to gain.
All of this should be done with the supervision of a doctor.
That why it is at the same level as breathing, eating and shitting in:
- https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs
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.
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.
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.
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.
For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.
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.
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?
Fatty meats, cholesterol heavy foods (butter, eggs), vitamin D have the biggest effect on me, still less than just simply giving up porn.
[citation needed]
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.
As a man in his 30s growing up I witnessed a shift in attitudes from "just man up" to "seek help", so there's that.
If anything I would suggest humanity to give up dating apps. They're essentially making people feel inadequate and pay for the dubious privilege.
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.
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.
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.
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.
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-...
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 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.
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-...
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.
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".
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.
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.
I don’t know how this compares to past eras though.
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.
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 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.
We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques are proven.
More reading: https://en.wikipedia.org/wiki/Anti-psychiatry https://www.goodreads.com/book/show/6943460-the-emperor-s-ne...
Not a doctor, by the way.
https://web.archive.org/web/20210911150504/https://rxisk.org...
https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
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.
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.
I don't think we understand nearly enough about these systems, though I'd argue that anti-depressants are still a big net positive.
Please don't take any advice from anyone on HN, including me. This community often attracts armchair anecdoctors. Go and speak to a doctor.
Good luck.
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.
But please consider alternatives as CBD or a healthier routine.
Situation 1. Interview next day.
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.
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.
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.
As my wife can attest, when I was on SSRIs, I was hornier than usual.
Such as the first sentence: “Close to 100% of people who take antidepressants experience some form of sexual side effects.”
Says who?
There are certain studies referenced but when other claims like the first sentence are made, I’d like to see where they got that conclusion.
Talking about the higher representations of the other person's body, why proximity / touch causes all these mental discharges.
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?
[1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27
My wife took birth control for a day or two in her twenties before we married, had the symptom, and threw the pills away.
It's very sad. Women's sex drives are as strong as men's, and much stronger when ovulating.