Comment by Jaruzel | Hacker News Reader

Comment by Jaruzel | Hacker News Reader

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.

Does it mean they don't also inhibit LSD effects like Venlafaxin does?

LSD activates 5HT2A. Mirtazapine is the only medication I posted about that blocks 5HT2A.

I'm not sure what the mechanism behind venlafaxine's blunting effect on LSD is.

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.

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.

Yeah, both of those medications are criminally expensive.

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.

Ah, I haven't been on venlafaxine before so I wouldn't be able to comment. Sorry. Only escitalopram and vortioxetine

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.

Well said, that man. :)

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)

My GP told me that having a strong sex drive is normal for men in their 50s, so I suspect you might be experiencing the meds...

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!

this... when it comes to sex, we all need to have an understanding partner. you are very lucky to have such a person in your life.

Is this the only drug/treatment you've attempted to combat the dark well with?

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!

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.

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.

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?

Vortioxetine is associated with fewer sexual side effects, and it works for me!

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.

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