antidepressants that do not cause sexual dysfunction and apathy

hello to you all

because of depression (Dystymia with reoccurring episodes of MDD) and a specific social anxiety (glossophobia | speech anxiety), I've been taking Sertraline 50mg for 3 weeks now...

I've started with 12,5mg for 3 days, then went up to 25mg for 7 days and finally upped to 50mg. Since I am on 50mg, I am dealing with some very "annoying" side effects:

# no appetite and no hunger (I've lost a few pounds and have become very skinny: 134 pounds @ 5'9, male)
# insomnia (falling asleep is difficult, shallow sleep, waking up a lot in the night... to my surprise I am not sleepy during daytime, but somewhat "stoned" and dazed.
# flat emotions, emotional dullness / blunting, apathy, anhedonia (it's like being a Vulcan or a Borg drone)
# loss of libido / no sex drive: I have no problem getting "him" hard, but there is no joy in it anymore. It's like being prepubescent. Even if Cara Delevingne jumped at me now, I wouldn't want to have sex with her.

I don't like this Sertraline-stuff. It took away everything human from me, everything that it's worth living for. Eating, sleeping, sex and emotions are the basic things of human existence, see Maslow's hierarchy of needs. I'd rather be depressive and anxious than how I am right now...

My next appointment with my psychiatrist is in 3 weeks. I will talk to him about discontinuing Sertraline and trying something else, maybe Mirtazapine? What can you recommend?

Greetings from Germany,
Duckbruck

Promises from doctors about this regarding their drugs dealing are likely to contain misinformation from the drug companies themselves.

The doctors often just repeat, as the drug companies are allowed to buy them lunches, advertise to them, they buy the top doctor professors to teach the benefits of their drugs to students. They surely influence the medical learning books, pay through the universitys, pay the drug regulators and so on and on. So unfortunately as found guilty in trials. You may find your doctor simply prescribing you wellbutrin as something that may actually improve your sex life. In reality there has no been no study to suggest that. There may have been studies that wellbutrin has caused sexual dysfunction, but at a lower rate than some other antidepressants.

thats all doctors and their drug company backers need for them to claim it is good for sex.

I had a really hard time with sertraline, too. I had absolutely no sex drive and when I did have sex it wasn't pleasant (I never orgasmed, sorry if that's TMI haha). It also made me suicidal.
Now I'm on wellbutrin which I have found to be much, much better. My doctor told me that it is one of very few antidepressants that doesn't have any sexual side effects.

This is off the drug companies website. Do be aware they manipulate data.

https://www.gsksource.com/pharma/con...MG.PDF#page=10

Glaxo were fined billions of dollars by the US court of supreme justice:

https://www.justice.gov/opa/pr/glaxo...failure-report

One of the whistleblowers from that trial talks about Wellbutrin. And about how he would get doctors to sell it to patients with the quotes he was telling them to as a GSK sales drug rep. that includes 'Wellbutrin is the happy horny skinny antidepressant' or something.

Start at 7 minutes and 41 seconds in if you feel like

https://youtu.be/y_RJ9QPG70U?t=7m41s

It is better to be armed with knowledge now, than be stuck later, or take a drug you wouldn't want to and have not been informed about what it is.

Wellbutrin clashes with MAOI's (blood thinners) and most commonly causes adverse effects of agitation and insomnia. In the literature. I assume it must be another form of stimulant drug.

See more on this multi-studied study of antidepressant-induced sexual dysfunctions comparing the percentages of the different antidepressant drugs.

"Montjo-Gonzales et al10 reported an overall incidence of 58% in an unblinded study involving 344 clients who had a history of normal sexual function before SSRI treatments. The frequency of sexual side effects was highest for paroxetine (65%), fluvoxamine (59%), sertaline (56%) and fluoxetine (54%). In a multicenter, prospective, Spanish study involving 1022 people, Montejo et al12 reported a 59.1% overall incidence of sexual dysfunction when all antidepressants were considered as a whole. The differences between drugs are summarized in Table 1 and were as follows: incidence of sexual dysfunction with SSRIs and venlafaxine (an SNRI) were high ranging between 58% and 70% – fluoxetine (57.7%), sertaline (62.9%), fluvoxamine (62.3%), venlafaxine (67%), paroxetine (70.7%), and citalopram (72.7%). This compared with a much lower incidence for the newer 5-HT2 blockers (8% nefazodone and 24% mirtazapine). Moclobemide, a reversible MAOI, (3.9%) resulted in the lowest incidence of sexual dysfunction. When differences between men and women were compared, men reported a slightly higher frequency of sexual dysfunction than women (62% and 60%). Clayton et al,13 in an adult outpatient population (4534 women and 1763 men) receiving antidepressant monotherapy, reported rates of sexual dysfunction as follows: mirtazapine and venlafaxine extended release were associated with higher rates (36%–43%), followed by nefazodone (28%), bupropion SR (25%) and bupropion IR (22%)."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/

I've been on Wellbutrin on and off for 20 years. It's the one med that doesn't cause weight gain or sexual side affects for most people. I think with most psych Meds, if you look hard enough you can find all kinds of articles about how terrible this med or that med is. I don't continue to take it because of other side effects. They all have them.

Sorry, it looks like I didn't fully read last message and understand what was being said. My doctors have always informed me completely about Meds that are prescribed. A responsible doctor will do his own research, as well. I have been prescribed medication for off label use that has worked like no other medication has worked for my condition....like adderall for instance with apathy from schizoaffective disorder. I'm less depressed and can get out of bed. So, I am very grateful for the discovery of these off label uses. When you have to take medications that make you gain a ton of weight, adding a medication that can possibly help with this is a huge godsend. The side effects mentioned in that video are very common possible side effects from a lot of different Meds.

I totally agree that we should know as much as we can about any medication that is prescribed for us. I make a point to always look at possible drug interactions before taking something new, since I'm on a lot of medications. There's a drug interaction checker website, where you can type in each of your Meds to look at possible interactions.

Sorry, if I got sidetracked, Duckbruck. Prozac is also good. Been on mirtazapine a long time ago. I think it caused weight gain.

I've had an appointment with my psychiatrist and we agreed on that I will take 50mg of Sertraline for another month or so and if the side effects (mainy insomnia and appetite loss) haven't subsided by then, we will try augmenting it with either Mirtazapine or Trazodone or alternatively try another standalone med...

Did it help you with your depression / SA? And how was it compared to other ADs?

At what dose are you experiencing sexual dysfunction? I just got my sexual function back to normal on bupropion and now I've been changed to desvenlafax ER, 25 mg to start. Since my T thinks I've been repressing erotic feelings, it was nice to have them back. I would hate to have to change back to bupropion, due to other intolerable side effects.

Well that's good to know I was going to say I was always horny on celexa but if you found the one for you then you found the one for you

50mg of Sertraline

What were those side effects?

These are the medications that have not impacted my sex drive:

Wellbutrin
Trazodone
Trintellix (formerly Brintellix)
BuSpar (apparently sometimes combined with an SSRI to counteract the sexual side effects of SSRIs)

Also, none of the antipsychotics/mood stabilizers I tried (off-label for treatment-resistant depression) impacted my sex drive/physical sensation.

Note: I am female.

thank you for your input
Which of these worked best for you?

Trintellix (formerly Brintellix) works best for me.

I take Trazadone for sleep issues specifically.
I take Seroquel as needed when my sleep issues are really out of control or when intrusive thoughts become out of control.

time for an update:

it's been 8 weeks on 50mg of Sertraline.

on the pro side:
# helps with social anxiety and somewhat with depression
# some subtle psychosomatic symptoms have diminished
# diarrhea no longer an issue! Mr. Hankey is hard and cohesive.

cons:
# insomnia | ****ed up sleep cycle
# weight loss. My appetite is nearly back to normal, but I am still loosing weight or at least not gaining any. BMI 19 right now. That is bothering me. I don't want to become underweight.
# heat intolerance (my entire life I've been loving warmth and heat. I was the guy who could sit at the top row in the sauna for 20min @ 100°C (212 °F), but right now I cannot even stand the mild summer.
# exhaustion (walking 2km around the block makes me feel exhausted & breathless. I feel somewhat weak, without power)
# agitation /motoric restlessness seems to be worse than before taking Sertraline
# and the many times mentioned "zombification"
# mild heachache and "pressure" in my neck. Nothing bad, but very annoying in the mid and long term.

I am unsure about the further course of action: Staying on Sertraline as a standalone treatment is not an option, as the side effects are not bearable in the mid to long term. I've been thinking about the popular Sertraline + Nortriptyline combo, but Lundbeck has withdrawn Nortrilen from the German market, so this is no longer a viable option. I've been also thinking about Sertraline + Mirtazapine (heroic combo | Stephen Stahl), but I am not sure if Mirtazapine will counteract & attenuate the side effects of Sertraline!? Although it might be worth a try before discontinuing Sertraline forever...

What other options are there? Well, there are of course TCAs, which might be worth a try as standalone treatment, for example Amitriptyline, Clomipramine, Trimipramine etc.! Considering Gillmans TCA article & "When to consider avoiding SRIs as first choice" I seem to be a prototype for someone who shouldn't be treated with SSRIs but rather try a TCA as first line treatment *lol*

What are your thoughts?