Escitalopram Induced, looking for some advice.

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zipdaflip
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Escitalopram Induced, looking for some advice.

Unread post by zipdaflip »

Hi all,

I have been treated with Citalopram 20mg from 2008 - 2010 starting at an age of 17, after that Escitalopram 10mg from 2010 - 2012. Gradually during the last 2/3 years of treatment I developed PSSD symptoms; Low libido, Partly Erectile Dysfunction, can't maintain an erection during sex without Cialis. I have been struggling with this for 8 years now, most part of my adolescent life and came to the conclusion I want to give this a real try to end it, or at least improve it. Other symptoms I have are similair to Major Depression Disorder, but include emotional blunting, anhedonia overall I am not functioning and depression and general anxiety disorder make it really hard to preserve relationships and live life in general.
Psychiatrist is not willing to take this seriously so I'm trying to fix it myself now. This forum has a lot of information and I've spend a lot of hours researching what would be the best approach for someone with my symptoms. I noticed there are some individuals on this forum with medical knowledge or a similar path and if you have the idea you could contribute to my search please comment.

I have tried so far without any effect:

Buspirone; Gave me irregular heartbeat, had to quit after two weeks.
Sint Johns Wort; Not a significant difference.
Edovis; I bought all supplements individually and it gave some relief of symptoms.
+ all kinds of herbs, ginseng, ashwaganda, etc. ; Not a significant difference.
Inositol 12gr: No effect.

I am trying right now:

Bupropion/Wellbutrin 300mg XL; I felt completely cured 100% during the first week and one week after upping dose. Still has a positive effect on libido, I would say about 25%. Also it helps for motivation in general, I would recommend this over any SSRI.
3gr L-citrullis + Folic acid; Helps quite a bit with stronger erections, I've read that a lot of people have a mutation which prevent them to transform L-citrulline to L-arginine, Folic Acid helps with that. I've also read this NO pathway influence can reduce bupropion effectiveness, so I'm a bit in doubt on this.
Maca powder; Helps somewhat with Libido.
Exercise; I try to exercise almost daily to exclude any other possible cause. I'm a physical healthy man (29), not smoking. Eating a healthy diet.

Plan of action:

Adding Mirtazapine 30mg; A lot of stuff has been said over receptor desensitization 5HT1A, I have no idea what the mechanism behind this all is. But I'm willing to try anyway.
I've already test Testosterone Levels, nothing out of the ordinairy. I am going for another blood test for all sex hormones, vitamin deficienty, gut microbe, etc.
If Mirtazapine isn't doing it, I'm considering going back on a SSRI, with the idea behind it my brain became dependent on it.
Because stress and anxiety can play a big role in this too, and I haven't found a way yet to test which is the cause, I am trying to battle depression and anxiety by medication and further therapy too.

Thanks for reading and I'd love to hear some input.
Jaxx
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Re: Escitalopram Induced, looking for some advice.

Unread post by Jaxx »

Hey man, sorry to hear your story but welcome. Mirtazapine and going back to ssri are not without risk, as it made some people worse too. But i understand you want to try things, most of us do. Unfortunately there is no silver bullet and we can hope that trial and error brings us forward.
I tried mirta myself and it didnt do much for me, but i dont have depression nor anxiety so we probably cant compare cases too much. I am a bit surprised you feel better on bupropion, considering your anxiety.
Have you tried or considered maoi’s?
zipdaflip
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Re: Escitalopram Induced, looking for some advice.

Unread post by zipdaflip »

Hi thanks for ur reply. I am aware of the risk, but indeed I would like to try out different options. I haven't considered a MAOI, bupropion as a first line treatment in ssri induced sexual dysfunction was an easy choice, also less risk involved. Do u think it will benefit pssd or mainly anxiety and depression?
sovietxrobot
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Re: Escitalopram Induced, looking for some advice.

Unread post by sovietxrobot »

you have done your homework. I also developed PSSD from escitalopram, but I had to go back on because my depression and anxiety were unbearable. It helped with that but had 0 impact on PSSD symptoms

Your experience on Wellbutrin is pretty common, to myself as well. I add dopa mucuna which resolved my anhedonia symptoms, but take with caution- its pretty similar to levodopa. It shouldn't be sold over the counter honestly; be careful in tapering off and consistent dosing.

mirtazipine and trazodone are both good options. SSRI sexual side effects stem from stimulation of 5ht2a/2c, at least in part, so antagonists should help in theory. you can take subclinical doses of these to get the blockade effect without all the drowsiness. Trazodone hasn't been the slam-dunk I hoped it would be. It restored a depth of feeling- I feel a lot more attraction, more affection/closeness, but actual desire is still lagging.
lordfar
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Re: Escitalopram Induced, looking for some advice.

Unread post by lordfar »

sovietxrobot wrote: Thu Jul 09, 2020 10:48 am you have done your homework. I also developed PSSD from escitalopram, but I had to go back on because my depression and anxiety were unbearable. It helped with that but had 0 impact on PSSD symptoms

Your experience on Wellbutrin is pretty common, to myself as well. I add dopa mucuna which resolved my anhedonia symptoms, but take with caution- its pretty similar to levodopa. It shouldn't be sold over the counter honestly; be careful in tapering off and consistent dosing.

mirtazipine and trazodone are both good options. SSRI sexual side effects stem from stimulation of 5ht2a/2c, at least in part, so antagonists should help in theory. you can take subclinical doses of these to get the blockade effect without all the drowsiness. Trazodone hasn't been the slam-dunk I hoped it would be. It restored a depth of feeling- I feel a lot more attraction, more affection/closeness, but actual desire is still lagging.

Hello. I have been taking Busprione for about a month now, slowly increasing my dose and I have noticed improvements in my libido and erection quality (I still don't get morning erections though). I also have been supplementing with L Arginine and taking 6g of BCCAs a day, as well as working out regularly. All of this has lead to improvements in myself. Does Buspirone act similarly to mirtazipine on 5ht, is that why I felt improvement? Even though my libido has seemingly improved, I still suffer from OCD and anxiety which is hindering me from seeing people and making me scared to try sexual experiences. Can I take mirtazpine + buspirone?
zipdaflip
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Re: Escitalopram Induced, looking for some advice.

Unread post by zipdaflip »

I will def try dopa mucana when Mirtazapine has leveled out, possibly life changing input, thanks a lot. I'm going for a high dose of Mirtazapine, it has less sedation effects and hopefully more therapeutic effects.
sovietxrobot
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Re: Escitalopram Induced, looking for some advice.

Unread post by sovietxrobot »

lordfar wrote: Thu Jul 09, 2020 11:02 am Hello. I have been taking Busprione for about a month now, slowly increasing my dose and I have noticed improvements in my libido and erection quality (I still don't get morning erections though). I also have been supplementing with L Arginine and taking 6g of BCCAs a day, as well as working out regularly. All of this has lead to improvements in myself. Does Buspirone act similarly to mirtazipine on 5ht, is that why I felt improvement? Even though my libido has seemingly improved, I still suffer from OCD and anxiety which is hindering me from seeing people and making me scared to try sexual experiences. Can I take mirtazpine + buspirone?
Buspirone and mirtazipine do not work similarly. Buspirone is a 5ht1 agonist, while mirtazipine is a 5ht2a/2c, alpha2, and h1 antagonist. I would expect them to have complementary effects. I take bupsirone + trazodone.

you can take l-citruline along with l-arginine, there is some research showing that the combination works better than either alone.
sovietxrobot
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Re: Escitalopram Induced, looking for some advice.

Unread post by sovietxrobot »

zipdaflip wrote: Thu Jul 09, 2020 2:46 pm I will def try dopa mucana when Mirtazapine has leveled out, possibly life changing input, thanks a lot. I'm going for a high dose of Mirtazapine, it has less sedation effects and hopefully more therapeutic effects.
Youre welcome. Please let me know how mirtazipine works out, I am considering switching to that myself.
zipdaflip
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Re: Escitalopram Induced, looking for some advice.

Unread post by zipdaflip »

Youre welcome. Please let me know how mirtazipine works out, I am considering switching to that myself.
I tried it only a couple of days, 7.5mg and 15mg. Couldnt stand the side effects. Also I read a reply of meso on a topic by radar I believe, in which he states mirtazapine wasn't the way to go. I have almost the same medication background as him. Close to zero libido the days on mirtazapine, probably cause of its antihistamine effects, which are worse during initiation.

Currently:
- damiana, tribulus, maca, l-citrulline, folic acid, muira, vit D3 B12
- CBD oil
- Wellbutrin 300mg

Also exercising and no porn.
I have mixed positive results. As I stated in my original post I think SSRI use has affected me, but its a combination with depression/anxiety. Im having my bloodwork done and taking a DNA test to check CYP2D6. Ill probably downgrade the wellbutrin because Im slowly goin mad without proper sleep, and maybe try reinstating ssri, also to get my life back on track.
defmyst
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Re: Escitalopram Induced, looking for some advice.

Unread post by defmyst »

zipdaflip wrote: Wed Jul 29, 2020 10:42 pm
Youre welcome. Please let me know how mirtazipine works out, I am considering switching to that myself.
I tried it only a couple of days, 7.5mg and 15mg. Couldnt stand the side effects. Also I read a reply of meso on a topic by radar I believe, in which he states mirtazapine wasn't the way to go. I have almost the same medication background as him. Close to zero libido the days on mirtazapine, probably cause of its antihistamine effects, which are worse during initiation.

Currently:
- damiana, tribulus, maca, l-citrulline, folic acid, muira, vit D3 B12
- CBD oil
- Wellbutrin 300mg

Also exercising and no porn.
I have mixed positive results. As I stated in my original post I think SSRI use has affected me, but its a combination with depression/anxiety. Im having my bloodwork done and taking a DNA test to check CYP2D6. Ill probably downgrade the wellbutrin because Im slowly goin mad without proper sleep, and maybe try reinstating ssri, also to get my life back on track.
Can you elaborate on that DNA test and what you suspect? What is cyp2d6? I recently restarted wellbutrin, but I think it made things worse for me in terms of sensation. Wellbutrin never helped me while I was on Effexor and it doesn't seem to help me now either. I think I will just discontinue it and be done with it.
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