PSSD after Celexa/Lexapro/Remeron/MDMA

[paramahamsa]

Hi all,

I am new to this forum, although I've been a long time lurker across the various PSSD forums. I thought it might help if I start contributing, since I haven't heard of a case like mine.


My history:

- daily, heavy cannabis use since 2009

Jan. 2011: saw doctor for anxiety, tried Celexa for a week but had negative reaction (agitation, mood swings)
Feb. 2011: doctor said I should try Lexapro, similar negative reaction, stopped after a few weeks

Oct. 2011: new doctor at addiction center put me on Remeron/Mirtazapine + Buspar for cannabis withdrawal (loss of appetite, insomnia, etc.) HOWEVER, I continued to use cannabis daily.

Oct. 2011 to Aug. 2012: Remeron (30-45mg) + Buspar (I forgot dosage, but didn't take it that much after noticing the cannabis + Remeron combo gave enough side effects). Had normal libido and sexual function at this time. The Remeron might have even increased libido. I remember masturbating frequently.

Aug. 2012: decided to stop taking Remeron because of following symptoms: increased pressure in head, pulsatile tinnitus, tingling in hands, especially ring and pinky fingers on right hand, and fear that cannabis use while taking Remeron was unhealthy. Literally overnight after stopping the Remeron, I experienced total loss of libido and erectile dysfunction. This was the first time in my life I had sexual dysfunction. At 23 years old, I was terrified. Also experienced brain zaps that went on for weeks; they would happen as I fell asleep each night.

Aug. 2012 to July 2013: slowly recovered; libido and erectile dysfunction were almost back to normal. This would soon change, again overnight.

July 2013: went out drinking one night, blacked out and took a pill from a friend who said it was MDMA. Woke up the next morning with genital anesthesia + muted orgasm, and return of the sexual dysfunction experienced after discontinuing Remeron: loss of libido, erectile dysfunction, etc. It is important to note that I am quite experienced with MDMA. I used to take it in large doses when I was younger and have never had sexual dysfunction afterwards. The only thing different this time was the state my brain was in, months after discontinuing the Remeron. My psychiatrist disagrees and thinks the Remeron has nothing to do with it because of the length of time from discontinuing it. He thinks it has to do with whatever pill I took that July night.

I'm leaving out a lot, so if you guys would like me to elaborate on anything let me know. But basically, I am still experiencing the genital anesthesia + muted orgasm, although ED and libido have improved since that July night. None of my sexual function has returned to baseline, though. I've tried almost all the natural remedies suggested, like inositol, horny goat weed, maca, 5-htp, St. John's wort, Magnesium, L-tryptophan, and more. Nothing really helped (though HGW did have some effect sometimes, and I do still take Magnesium). Those supplements affecting serotonin, like 5-htp and L-tryptophan, seemed to make genital anesthesia worse. I stay away from such serotonergic supplements now, as well as caffeine and alcohol which make genital anesthesia worse. I've also recently gone on a carb-restricted diet and noticed a few "windows" when starting out. Other things that led to "windows" of normal function and feeling include: lifting weights, carb re-feeds after abstaining all week, cannabis use after abstaining all week, or just having an above-average good day. Like others have said, there are just some days when function is better without explanation.

I still have hope that with time, and a good diet, and healthy exercise, I will be able to recover and have somewhat normal feeling again. But of course, getting that numb, rubbery feeling down there is always disconcerting. There's no getting used to that. I might have had depression/anxiety before starting the meds, but with this PSSD condition, I am definitely more depressed/anxious than I've ever been. And of course, every psychiatrist or therapist I've seen is quick to blame my sexual dysfunction on depression/anxiety. I understand depression and anxiety, at this point, play a role in making my symptoms worse. But for the symptoms to have shown up literally overnight, it has to be more than just psychological. Have any of you been successful in finding a psychiatrist who has heard of our condition?

P.S.: I showed this study to my psychiatrist, but it didn't help: http://www.ncbi.nlm.nih.gov/pubmed/25483212. What do you guys think of this? Sound like a promising treatment?

I am also looking into CBD (cannabidiol). I read somewhere that a 5-HT1A agonist would help treat PSSD. And then I found this study: http://www.ncbi.nlm.nih.gov/pubmed/16258853

[paramahamsa]

So I've posted my story, and shared some research leads, but still no love from this forum. I think it has something to do with my atypical history, recreational drug use, and stuff. I would just like to point out that, like you guys, I am suffering from genital numbness and ejaculatory anhedonia. These are rare symptoms; they are not typically seen in people who are just depressed or using other drugs. These are seen in people who have taken anti-depressants.

Deisenhammer and Trawoger [36] state that genital anesthesia is probably associated with all antidepressants that enhance serotonergic neurotransmission. Clayton and Montejo [21] point to a possible basis for the symptom, noting that serotonergic medications may decrease genital sensation via diminished nitric oxide function. Nitric oxide is integral to penile and clitoral tumescence.

I understand that reading my story, it doesn't seem like the normal case. But regardless, I am in the same boat as you guys. I just got here in a different way. And it's actually not that different; the drugs that contributed to this were serotonergic in nature. Also important to note that I had prior history of taking Celexa and Lexapro and had negative reactions to both. Just didn't experience the sexual dysfunction until months later.

[Ghost]

Welcome. There is no lack of love.

Let me begin...

1) Your psych is pretty stupid IMO for thinking that Lexapro would be better than Celexa. Celexa is just the racemic mix of R/S enantiomers, while Lexapro is just one of them. I guess there is the argument (which I think is BS) that the R enantiomer causes more side effects (Lexapro is only S I believe), but still, pick another med doc, if your patient has a bad reaction, try a new compound.

2) It's POSSIBLE that you have protracted symptoms from SSRI, but I think it's more likely that Remeron + Buspar + weed that caused this originally. This would make it non-SSRI related. This is why I think it went away with time.

3) I agree with your doctor that what did it now was the pill, but I would guess that it was MDMA, which can cause PSSD like side effects anyways. This on top of a serotogenic system that was still healing could have done it. I'd stop smoking/drinking/ anything for a while and see if you start healing again. I don't know much about MDMA recovery.

You're more than welcome here, but I do think that your story is a bit different than that of some of us here. But I could be wrong, you never know for sure. I'm always open to hear testimony see evidence.

[paramahamsa]

Thanks for the reply, Ghost.

I sent an email to Joseph Ben-Sheetrit re: the PSSD study, and received this response:

Thank you for your contact and interest in the study.

Post-SSRI sexual dysfunction (PSSD) is a form of persistent sexual dysfunction which starts during treatment with antidepressants and continues despite treatment discontinuation for a substantial amount of time.

The sexual dysfunction you described started only after stopping treatment (not during treatment), and got worse after illicit drug use. Both of these situations are very real in my opinion and are worth both clinical and academic attention, yet they do not fit our current definition of PSSD, so I am sorry but we cannot include you in this study.

Please see a health care professional for a full evaluation and treatment.

I wish a full and fast recovery,

Sincerely,

Joseph Ben-Sheetrit, MD

[Maldoror]

I really don't understand this narrow definition of PSSD. And to think I was excited about this study.

[prima]

Hi have you healed or recovered at all from this? Have you tried CBD as you posted the research for it? Thanks if you're still reading this forum.