A few things that seem to work a little - Grungehead OP

[Moloch]

Grungehead on Mon Nov 12, 2012 7:29 pm

Hello

This is the doc guy from hisandher health forums..Michael and some of you
might remember me..

Firstly lots of credit and thanks to Sonny for creating this forum..the research u and some other people here have done on this is incredible..im late to arrive but couldnt find anything since the above mentioned forums went quiet..ive tried the yahoo group but im sorry to say it just appears to be so full of self pity and anti psych agenda,i cant stand it..finally found this forum.

A quick intro..im a psych intern a year away from completing my
specialization..was diagnosed with OCD some 11 years back and was started on
Zoloft(sertraline) an SSRI..Within a week i lost my ability to orgasm...Retarded
ejaculation to be precise where it would take me an hour just to come..and that
too only with masturbation..it was impossible with sex.
I was on Sertraline for a good 9 months before i discontinued..the retarded
ejaculation disappeared but something much more horrible happened..i just didnt
feel anything on orgasm at all..i-e Ejaculatory Anhedonia/Anorgasmic
Ejaculation..i havent been able to orgasm since then..i do ejaculate,my
sensitivity is normalish,my libido is a tad low but the real killer is that
there is just no sensation on orgasm at all..its dead.

My OCD worsened a couple of years back and i was put on
Prozac(fluoxetine)..im now on supratheurapeutic doses,normal doses dont do
anything for my obsessions..


My personal experience has 2 drugs that do partially work on me.i still cant
feel anything on orgasm but the whole build up is a lot better when im on them.

1.Buspirone...5HT1a Partial agonist..works at low doses too eg 15 mg/day but
most of my patients show significant improvement on doses exceeding 50 mg
/day..i myself havent been able to exceed 30mg/day because it causes me horrible
light headedness but most patients actually tolerate it well..sensitivity and
build up,both get better.

2.Ropinirole..a dopamine agonist...this has personally helped me a lot..and
interestingly on low doses of 0.5 mg/1 mg per day..higher doses seem to do
nothing which makes no sense but thats the way it works..i've also noticed
Comparable improvement on Cabergoline...Amantadine has been a big disappointment
for me personally though a few patients do report improvement on a regular 100
mg/day dose.

3.Choline/pyridostigmine...same as above.


Things that ive tried and havent worked..Yohimbine,Gaba,Inositol, a couple of other supplements.

[Moloch]

Sonny on Tue Nov 13, 2012 5:14 am

full of self pity and anti psych agenda


Oh yea, a whole lot of that, and run like a fascist dictatorship as well, by the censor-happy tyrant Vornan.

Here it's total freedom, no censorship. I also soundly criticize anything from the "medical Luddite" point of view as I call it. I debunk quackery as well, like homeopathy for example.

I have OCD too, by the way.

I also have the same issue as you originally had with the retarded ejaculation. It was at least that severe. I have managed to mitigate it a great deal though. I call it "stacked mitigation", which is where I use various things to mitigate my symptoms together, getting a little from each.

but
most of my patients show significant improvement on doses exceeding 50 mg
/day..i myself havent been able to exceed 30mg/day because it causes me horrible
light headedness


That is one of the problems with it, the other being that you must take it on an empty stomach, and it has a short half-life. You can take it 15mg at a time, but that will do very little for you as far as sexual, it does help with anxiety though. What you have to do is take 30 to 60mg all at once. That will indeed give you a lightheaded feeling, probably due to the activity on one of the alpha receptors. However it will also allow you to function normally for a short period of time. Long enough to get off at least.

interestingly on low doses of 0.5 mg/1 mg per day..higher doses seem to do
nothing which makes no sense


That is because there is a feedback loop. So going beyond does nothing. Now a Parkinson's patient on the other had has it so much lower, they need higher doses for that effect. Moderate or high doses may possibly have safety concerns in the long term too. However a very low dose like 1mg twice a day is very safe. Caber works for me as well.

Yohimbine will work, but only the good stuff. It has to be of higher quality. The cheap stuff does nothing for me, but the good stuff works. It has some annoying side effects too, just like the buspar.

[Moloch]

Grungehead on Tue Nov 13, 2012 8:23 am

Sonny wrote:
I have OCD too, by the way.



Sorry to hear that..its such a demon...how is your OCD now and what medications are you on for it?..

I have pure O.. ive been on a steady regimen of 40mg escitalopram and 20 mg Fluoxetine for a while now..around 30-40 percent controlled..its recently lost some of that effct and ive added Aripiprazole to the regimen,something that seems to work better than the other atypical antipsychotics in a fair no. of our outdoor patients..been a week on 5mg/day and although no major benefit,i feel calmer.there has ofcourse the sedation and weight gain to deal with,but yah i can handle those as long as it provides some relief on the Obsession front.

I have tried Nmda Antagonists Amantadine,Topiramate and Acetyl Cysteine with no benefit.

That is one of the problems with it, the other being that you must take it on an empty stomach, and it has a short half-life. You can take it 15mg at a time, but that will do very little for you as far as sexual, it does help with anxiety though. What you have to do is take 30 to 60mg all at once. That will indeed give you a lightheaded feeling, probably due to the activity on one of the alpha receptors. However it will also allow you to function normally for a short period of time. Long enough to get off at l[/sub]east.


I agree,though the problem again is that i cant tolerate more than 15mg per single dose..it causes horrible nausea and lightheadedness.

what are other drugs you're taking for your PSSD symptoms?

And importantly have u experienced any exacerbation of OCD while on ropinirole or cabergoline?..that is a hypothetical possibility and they're have been a few documented cases of compulsive behaviour in people on it for RLS or PD.Something that scares me a little..

Currently imbarking on an as needed basis trial of LevoDopa/carbidopa..not taking it regularly cuz i dont wanna mess up my mental state prior to my penultimate exam on the 20th.have u tried that?.

its a pleasure to talk to you..... and again lots of credit for all the research you and a few others have done here..The 5HT 1a down regulation theory is currently popular with a lot of my colleagues too although they are mostly interested in working out Sexual dysfunction while on SSRIS and not PSSD.
Another reason that made me choose Aripiprazole is because of its 5HT2 and 5HT1a antagonism which could potentially cause upregulation of these receptors,though the occupancy of the latter receptor is only 15 to 20 %..there are 2 studies on the internet showing it improves sexual function in people on SSRIS(resistant depression cases ,for which Aripip is very effective)

[Moloch]

Sonny on Wed Nov 14, 2012 6:59 am

In the case of OCD, the cure is worse than the disease, so I'm on nothing. I have a lot of obsessions and intrusive thoughts, and some compulsions too. Huperzine helps a little, but not much. Memantine helped a little but not enough for the cost. Cabergoline and ropinirole don't affect it. It may cause problems for some though.