And "only worked when I eventually discontinued the previous offender".fiatslug said:need a new category for "have heard of it, look forward to trying it in my outpt practice, but haven't done it yet."
The question was regarding ADDING wellbutrin to an existing SSRI.psisci said: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.
Goody...start Wellbutrin and then get back to us on how it worked. Keep the SSRI on board.whopper said:Not yet.
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.
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.psisci said: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.
Hmm...I always thought that the XL was a "response" to the SR becoming generic!Anasazi23 said: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'm there already. I just like calling other people jaded, since I get that comment in reference to myself all the time.OldPsychDoc said:[yoda]"When nine hundred years old YOU reach, think so idealistic about pharmaceuticals YOU will not, hmm?" [/yoda]
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.Anasazi23 said: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)
That's got to be the funniest thing I've read in weeks.Anasazi23 said:I'm there already. I just like calling other people jaded, since I get that comment in reference to myself all the time.
exlawgrrl said: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.
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.whopper said: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.
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...)exlawgrrl said: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.