The Bupropion Dilemma - Input is appreciated

[PSSD_Throwaway28]

Hi guys,

I've been on this forum for a few months now, so I will spare you a long intro and point you to my post history.

Although my sexual functioning has somewhat improved in the past five months (which I partially credit to L-Citrulline) these improvements has not been very consistent. In particular, I still have pretty bad eregenous and tactile genital numbness. I have okay libido, I can get erections (in fact my erections are much more consistent/harder than Pre-PSSD somehow), and I can have mildly/moderately pleasurable sex with an okay orgasm (though often quite a bit weaker than before), but until I'm pretty aroused and into the act, my genitals don't feel much. That is, until a few weeks ago, when I had the longest window I've experienced: for roughly two weeks, genital sensation gradually improved until it felt like it was approaching my Pre-PSSD state. This wasn't just a sexual thing, even responsiveness to temperature was noticeably better (I tested with mildly hot water). Unfortunately, these improvements subsided, and I was back to my baseline. Around the same time, I finally got through to my doctor about the reality of these symptoms, though he remains in denial about PSSD. He suggested that I wait another month since I have experienced sporadic improvements, but honestly after a year and a half the condition was really wearing on me, so I got him to prescribe me bupropion (150 mg XL) to see if that would push me towards further improvements.

So, here is the dilemma:

I started the Bupropion this past Sunday, and within two days the improvements to genital sensation returned! Both somatic and eregenous sensitivity was significantly improved (though again, not really to pre-PSSD state yet). However, as of last night my genital region is feeling slightly agitated (not aroused) even when I have no contact with them, and there were some noticeable tissue discoloration for about half an hour after I had an erection (I've experienced this before, but this instance seemed more pronounced). Maybe this is a sign that the nerves are waking up and trying to heal after being dormant most of the time, but it could also be a sign that something is going wrong. But other than this and the usual mild symptoms (harder to sleep, slight restlessness, increased libido) I am tolerating the drug very well so far, so part of me is tempted to continue with the one month course to see if the improvements in sensitivity remain since this is by far my most bothersome symptom. On the other hand, I know Bupropion does interact with the 5-HTA1 receptor and so, depending on which theory of PSSD you adopt, there is always the chance that these improvements will give way to permanent worsening. This would be quite devastating, since although my sexual functioning certainly isn't very good right now at all, it's much, much better than nothing. I do however recognize that, if we go by accounts on the forum, it is quite rare for Bupropion to make things permanently worse, and I am on a relatively low dose.

Anyway, what do people think, stick with it for the month (which should theoretically be low risk), or discontinue and see if I continue to get natural improvements to genital sensation overtime (does not seem all that likely after 1.5 years but the prolonged window did give me renewed hope)?

[Markc1113]

I think I would stay on it. I had great improvement on it but honesty only after a few weeks of nothing and then when I tapered to every other day to start getting off of it I had pre Pssd improvements.. lasted a month after stopping it. I tried a few months ago to take it again. The first day my erection quality was worse but then the next day again had huge improvement after not taking a second dose. So it does something.. if I don’t get any improvement soon I’m going to try it or buspirone again as I’ve had windows on both

[sovietxrobot]

Bupropion has virtually no interaction with 5HT. I have never heard of discoloration so I cant speak to that. In general you cant draw any conclusions from a given psychotropic med until 4-6 weeks. Most likely the agitation will fade away, but some will some of the positive effects.

If yours is a typical case of PSSD (developed after abrupt withdrawal) then I don't think 'further damage' is likely. Its the withdrawal event that is the culprit, not the medication per se.

[Markc1113]

Bupropion has virtually no interaction with 5HT. I have never heard of discoloration so I cant speak to that. In general you cant draw any conclusions from a given psychotropic med until 4-6 weeks. Most likely the agitation will fade away, but some will some of the positive effects.

If yours is a typical case of PSSD (developed after abrupt withdrawal) then I don't think 'further damage' is likely. Its the withdrawal event that is the culprit, not the medication per se.

I agree with that, which is why I’m actually considering reinstatement. I had no issues while on the drug until quitting cold turkey.. it’s still scary but could lead to improvement

[Gameclay]

Has bupropion had a positive impact on your mental state? Just wondering because I'm thinking of trying it for my clinical depression (and pssd too)

[Jaxx]

Bupropion has virtually no interaction with 5HT.

Dont agree it is that simple, eg
https://pubmed.ncbi.nlm.nih.gov/18708076/

[sovietxrobot]

Bupropion has virtually no interaction with 5HT.

Dont agree it is that simple, eg
https://pubmed.ncbi.nlm.nih.gov/18708076/

Neuropharmocology is never simple. I was only able to find two papers that posit a link between bupropion and 5HT signaling, including the one you posted. Both are by the same group, have major methodological flaws (tiny sample size, erroneous statistics), and are 10 years old. I remain unconvinced.

[JP1985]

Hi guys,

I've been on this forum for a few months now, so I will spare you a long intro and point you to my post history.

Although my sexual functioning has somewhat improved in the past five months (which I partially credit to L-Citrulline) these improvements has not been very consistent. In particular, I still have pretty bad eregenous and tactile genital numbness. I have okay libido, I can get erections (in fact my erections are much more consistent/harder than Pre-PSSD somehow), and I can have mildly/moderately pleasurable sex with an okay orgasm (though often quite a bit weaker than before), but until I'm pretty aroused and into the act, my genitals don't feel much. That is, until a few weeks ago, when I had the longest window I've experienced: for roughly two weeks, genital sensation gradually improved until it felt like it was approaching my Pre-PSSD state. This wasn't just a sexual thing, even responsiveness to temperature was noticeably better (I tested with mildly hot water). Unfortunately, these improvements subsided, and I was back to my baseline. Around the same time, I finally got through to my doctor about the reality of these symptoms, though he remains in denial about PSSD. He suggested that I wait another month since I have experienced sporadic improvements, but honestly after a year and a half the condition was really wearing on me, so I got him to prescribe me bupropion (150 mg XL) to see if that would push me towards further improvements.

So, here is the dilemma:

I started the Bupropion this past Sunday, and within two days the improvements to genital sensation returned! Both somatic and eregenous sensitivity was significantly improved (though again, not really to pre-PSSD state yet). However, as of last night my genital region is feeling slightly agitated (not aroused) even when I have no contact with them, and there were some noticeable tissue discoloration for about half an hour after I had an erection (I've experienced this before, but this instance seemed more pronounced). Maybe this is a sign that the nerves are waking up and trying to heal after being dormant most of the time, but it could also be a sign that something is going wrong. But other than this and the usual mild symptoms (harder to sleep, slight restlessness, increased libido) I am tolerating the drug very well so far, so part of me is tempted to continue with the one month course to see if the improvements in sensitivity remain since this is by far my most bothersome symptom. On the other hand, I know Bupropion does interact with the 5-HTA1 receptor and so, depending on which theory of PSSD you adopt, there is always the chance that these improvements will give way to permanent worsening. This would be quite devastating, since although my sexual functioning certainly isn't very good right now at all, it's much, much better than nothing. I do however recognize that, if we go by accounts on the forum, it is quite rare for Bupropion to make things permanently worse, and I am on a relatively low dose.

Anyway, what do people think, stick with it for the month (which should theoretically be low risk), or discontinue and see if I continue to get natural improvements to genital sensation overtime (does not seem all that likely after 1.5 years but the prolonged window did give me renewed hope)?

Hey mate, what did you end up doing? Did you carry on taking it? How are you getting on?

[arahant]

Has bupropion had a positive impact on your mental state? Just wondering because I'm thinking of trying it for my clinical depression (and pssd too)

For clinical depression, Buproprion is way better than any SSRI around. Just be careful with dosage and jaw clenching, usually in doses >= 300 mg.
Maybe recovering the clinical depression is a necessary step before any wondering about sexual disfunction.
People with depression also had low libido, anhedonia, totally unrelated to any medication.