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Discussion in 'Psychiatry' started by Anasazi23, Jul 31, 2006.
Have you ever added Wellbutrin to another antidepressant to alleviate sexual dysfunction?
need a new category for "have heard of it, look forward to trying it in my outpt practice, but haven't done it yet."
And "only worked when I eventually discontinued the previous offender".
Not one of my patients has noted sexual dysfunction to the point where they wanted to stop their current antidepressant.
But then again I'm only in my 3rd year, and I've only done inpatient so far except for 1 month.
If switching to wellbutrin-you got to consider that SSRIs do treat anxiety. The majority of depressed patients have some type of anxiety component worth treating.
Wellbutrin can work, but beware of the anxiety. Also use the SR version...lower starting dose. I have seen trazadone work in some as well, but nothing like good old viagra et al. Will get the power up, and for some reason seems to decrease time to climax....increased time is usually the SSRI culprit.
Totally personal, but I think I've had some sexual dysfunction related to SSRI usage. If your patients aren't reporting it, it's possible they don't feel comfortable discussing it -- I know I didn't bring it up for ages. I did switch to Wellbutrin only (have never taken them combined), and it was about the most miserable experience in my life. I started doing things like waking up at 3 in the morning, not eating and getting way out of control anxiety about everything, which is actually exactly what being depressed was like for me minus the crying. I had no clue Wellbutrin was bad for anxiety, which I guess is the problem with relying on a pcp for your mental health care. Not like I have a choice about that, though.
Anyway, perhaps I should talk to someone about trying the combo since I have like six months of Wellbutrin sitting around.
The question was regarding ADDING wellbutrin to an existing SSRI.
It's not that Wellbutrin is bad for anxiety...more that it doesn't have an efficacy in treating anxiety.
No big difference between the SR and XL formulations. I prefer the XL. Once a day dosing is better if you're confident of the pt's seizure history.
Goody...start Wellbutrin and then get back to us on how it worked. Keep the SSRI on board.
(just kidding. SDN is not a good place to conduct clinical trials)
I disagree with you on the anxiety part, but you probably know more that me . The only reason I said SR is better is because it comes in 100 mg as opposed to 150, so you can start lower.
Well, there's not a tremendous difference between the SR and XL formulations. The SR was a response to the need to divide the doses when it became apparent that it could lower the seizure threshold. And the XL was the response for the need for QD dosing.
I've had a lot of patients on Wellbutrin, and only rarely do I hear a spontaneous complaint of worsening anxiety. Of course, it's entirely possible to have some worsening anxiety if that's a major complaint.
It likely has something to do with the increase in dopamine action, which could be interpreted as anxiety. This is the same reason it's relatively contraindicated in psychotic spectrum disorders.
Hmm...I always thought that the XL was a "response" to the SR becoming generic!
heh....you jaded sob you...
[yoda]"When nine hundred years old YOU reach, think so idealistic about pharmaceuticals YOU will not, hmm?" [/yoda]
I'm there already. I just like calling other people jaded, since I get that comment in reference to myself all the time.
i.e. I've about written off the Journal of Clinical Psychiatry at this stage. Nothing but drug-sponsored Drug A vs. Drug B in disease X.
I think you meant to reply to me, but since appeared to be asking for anecdotal treatment info, I thought I'd share my anecdotal patient info. I'm guessing both are about as clinically valid.
Anyone hear anything about Viagra for women who are experiencing decreased libido on SSRIs/or others like Effexor/Cymbalta?
That's got to be the funniest thing I've read in weeks.
How about a slightly different question: has anyone prescribed something that treats the sexual dysfunction caused by SSRIs?
I've heard of adding WB, never tried it myself because I've heard so many people say it didn't work for them. Besides, I've seen good results with cyproheptidine, which is cheaper, seems to work well, is prn, etc. Just another thought...
So far we have an n=12.
With exactly half claiming Wellbutrin added to an SSRI helps sexual dysfunction, while the remaining 4 claim it didn't help.
A remaining 4 state that they look forward to using it in the future.
Any other comments?
Anyone else try it since the topic was brought up?
It is supposed to be standard practice to ask in a subtle and comfortable manner since most patients will not discuss sexual dysfunction on their own.
I have though had a few patients who "enjoyed" the newfound sexual "dysfunction" their SSRI gave them. In some men, SSRIs can increase the time it takes to reach orgasm--allowing them to last longer in bed. Some of them come back quite happy with this unintended side effect. Unfortunately in other men it can lead to anorgasmia.
Hmm, I guess I'll get a closer glimpse at standard practice if I ever see a psychiatrist (or when I do my rotations ). I've tried a couple of times but have never been able to find a doctor who is taking new patients -- and yes I had decent insurance. So, like lots of people suffering from the more "minor" mental illnesses (you know, non-psychotics), I have to rely on my primary care physician for treatment. I guess it would be nice if we had more psychiatrists out there.
It seems like with most discussions of sexual issues, most of the focus is on male sexuality and not female sexuality here, too. My guess is that women are going to be more reluctant to discuss this stuff with you. Also, women generally don't have problems with having orgasms too quickly, so alas, I doubt any of us experience positive sexual side effects from ssris. Eh, but we're not supposed to enjoy sex anyway -- that would be slutty.
I was going to make the same point about the gender bias, but I tend to attribute some of it to an awful lot of male doctors assuming that anorgasmia in women has more to do with psychological issues than physical. (One male psychiatrist actually told me that the sexual dysfunction caused by SSRIs only affected a small number of men, and didn't apply to women at all. I couldn't get my chin off the ground long enough to explain the facts of life to him. I did wonder if maybe his wife was on an SSRI and telling him sex was better than ever...)
But then, I'm old and cynical and not terribly nice...