I don't have PSSD but....

[berserker]

Hello,
I am writing to this forum as I see there is a lot of good informed people on AD nasty side effects.
In the last 9 years I have been taking Anafranil 150 mgs daily for my ocd. The drug has always worked good. In the last 4 years I progressively started to have more fatigue, depression, ED and loss penis sensibility. I thought it was a side effect of the drug. These issues increased in the last months but libido was always there. I went to my psychiatrist and decided to try Mirtazapine starting with 15 mgs. After 10 days my libido completely dropped (no sexual thoughts, no erection) at the same time I discovered I have really low testosterone levels (could be the cause of what's happening above). Now I am on 45 mgs of mirt
So I started to get super anxious about having lost my capacity of having sex and arousal (really important for me). It was like I had a switch off in my brain and I don't know if it's because of adding mirtazapine or because of the low testosterone.
I spent more than one month in complete panic, obsessing over everything and suicidal, thinking I would not be able to have sex anymore and a relationship. Now I think I would like to try to taper Mirtazapine as I am still fresh. I have no idea on what to do. Urologist says that I suffer of hypogonadism and I will probably go on hormone replacement.
I have some questions:
- Lots of PSSD symptoms are similar to hypogonadism ones but I don't see many people trying the hormone replacement route. Should I address low t first?
- Can PSSD be caused by atypical antidepressants like mirtazapine? I don't see many cases
Thanks

[panpun1]

pls share your lab results

[berserker]

pls share your lab results

Testosterone was 6,2 nmol on a range of 9 and 35.
Who has experience with Clomipramine and Mirtazapine? At the moment I am at 150 mgs for clomipramine and 15 for mirtazapine. I am going to taper mirtazapine in 7/10 days. Clomipramine still don't know.
My penis is always turtled like it gets no blood flow. The sexual/libido side of my mind is completely shut off. It was a drop that I experienced in a couple of days. So abrut and shocking. Any suggestion? Thanks

[berserker]

pls share your lab results

I don't have all my lab results here but I have a level of testosterone of 6,2 nmol on a range of 9 and 35.
At the moment I am taking 150 mgs Anafranil and 15 mgs mirtazapine daily. I am looking to taper the mirtazapine in 7/10 days.
The problems that I have are that penis is always turtled and numb to sexual stimulation. I can only reach 40% erections and sperm seem watery. I had some cases of loosing total sexual arousal while on anafranil but probably mirtazapine give the last hit to it as after a couple of weeks I just lost of my sexual fantasies and desires, like I have a hole in my brain.
Any idea or suggestion about this situation? Could be that tapering Anafranil slowly I can save the situation...damn...

[berserker]

Little update. I have been hospitalised as I was suicidal 2 days ago. First hospitalization....really scared about what is happening to my libido/penis.
I am still taking anafranil (that I would like to taper I am going to ask to the doctor) and mirtazapine 15 mgs that I will taper to 0. They added zyprexa because of my ocd, anxiety and insomnia. I have been sleeping 3 hrs for one month and half. Finally today I was able to sleep for full 11 hrs.
How fucked am i?

[Jaxx]

Thats a serious update bro. Although PSSD sucks, alot, taking care of your depression/suicidal thoughts should be your main priority. When i was taking mirta i slept instantly after taking it, shows how we are all wired differently. Sleep is very important for your mood, take that 11hours if you need it!

[berserker]

I will definitely try to chill and take care of myself but it has been a rough ride. I know now what extreme anxiety and being suicidal means. I wish this to no one. I was almost there to pull the plug then I got fear that I could spent my time paralized on a wheelchair and I desisted. My family it's obviously really concerned but they don't understand this 'paranoia' of mine about my libido and dick not working (especially if they are women). I will that thing will get better lowering some of the meds but it will be a long ride as I have been using them for years....

[berserker]

So now I am in a rut. I am on Anafranil and I would like to taper it. On Mirtazapine that I should quit in a few days and Zyprexa because I was suicidal (it helped the last 2 days but not really today). I am also taking lorazepam and still at the hospital. I have to come with a plan for medication....
The problem is what to do now? It's a vicious circle....

[Jaxx]

I assume your doctor would have suggestions for medication? If your current meds arent helping out, switching to another class is often advised, like TCA's or even MAOI's.
In your case it is perhaps not the Mirtazapine alone that is causing the issues, but the combination?

[sylv]

My theory is the SSRIs, when taken for a long term, are first of all creating "the ground for PSSD" by inducing persistent brain changes, probably on microarchitectural - dendritic / axons level. Then you are starting to be susceptible to get PSSD on any occasion, you need just inducing agent which brings PSSD from it's non-active state to active state. This may be SSRI itself, An atypical Antidepressant, a neuroleptic, a mood stabilizer, or even high stress. You suddenly, "out of nowhere" get emotionally blunted, asexual and your genitals, or whole body starts to be anaesthetised.

This may explain why people who have used SSRI extensively before, get PSSD after abrupt withdrawal or when they've switched to an another drug.

I've taken clomipramine myself for 6 months almost without AE, felt some emotional blunting at the end which let me to go cold turkey. The anxiety was coming back, so short after, I started the escitalopram only to get a sudden lobotomy-like emotional blunting and full sexual dysfunction with anaesthesia after just 3 days of use. The symptoms are continuously present to this day, almost 6 years has passed