His and Her Health

Hi everyone! I'm very excited to find this site and these boards.<P>Anyway, I'm a 27 year old woman, married for about one year. I love my hubby more than anything! He's very attractive and very kind and funny. However, I just don't seem to have a libido at all anymore. It's not just low...it's completely GONE!<P>I am taking Effexor XR for depression and anxiety and this medication works really well for me (keeps me from killing myself!) so I will NOT look at different medications for this. I have recently switched from Ortho-Tri-Cyclen to the Nuvaring (oral contraceptive to a hormonal method still, but different). I was hoping this would help my libido. It hasn't.<P>I want to do something to feel sexier, feel more in the mood...but I can't figure out what to do.<P>Other stuff going on...my hubby got laid off in December and still hasn't found anything. This is a source of stress to us, but we communicate very openly about it.<P>Does anyone have any suggestions? Anything at all??<P>Thanks so much!<P>Tracie

<BLOCKQUOTE><font size="1" face="Verdana, Arial">quote:</font><HR><font face="Verdana, Arial" size="2"><BR>I am taking Effexor XR for depression and anxiety and this medication works really well for me (keeps me from killing myself!) so I will NOT look at different medications for this. I have recently switched from Ortho-Tri-Cyclen to the Nuvaring (oral contraceptive to a hormonal method still, but different). I was hoping this would help my libido. It hasn't.<BR></font><HR></BLOCKQUOTE><P>You're probably on the right track with Nuvaring vs an Oral Contraceptive, but I suspect that your issues may very well have to do with the Effexor. <P>About 60% of the people who took it in a recent study found decreased libido to be a problem. (40%, 62% and 42% also had problems with arousal, delayed orgasm and total loss of orgasm. Over all 67% of all users had some form of sexual dysfunction.) (Reference: Montejo AL ea J Clin Psychiatry 2001, 62, suppl 3: 10-21.)<P>A couple of suggestions that you might consider, if you're willing to make any modifications. (Though it appears that you aren't.) Wellbutrin is less prone to cause problems with sexual dysfunction. Several here have talked about SAM-E and 5HTP.<P>Here's a thread about this very subject.<BR><A HREF="www.newshe.com/ubb/Forum1/HTML/000915.html" TARGET=_blank>www.newshe.com/ubb/Forum1/HTML/000915.ht...t;/A><P>One additional thought. Even if you "fix" your low libido problem, you may find problems with lubrication or orgasm or both. <P>Perhaps others will have other suggestions that are outside of changing anti-depressants, but I think that this is the most likely productive path.<P>There are perhaps some other suggestions I might offer too. Let me know.<P>Thanks,<BR>Greg<P>------------------<BR>My profile has my email address and website. Click on the icon at the top of this post that looks like a head with a question mark.<P>Also note, I am *not* a doctor, and this is not intended as medical advice - Please talk to your doctor about your concerns.<BR><p>[This message has been edited by distressed_12345 (edited 03 July 2003).]

It's not a good idea to mess with a medication regimen that keeps a patient from killing herself, especially when ZERO other possible factors that could be affecting her libido have been considered. Finding the right medication, combination of medications and dosages for a particular patient is often not an easy task. When a patient has an acquired sexual dysfunction that is fully explained by the effects of the psychotropic medication, and not better accounted for by another factor or factors, drug-induced sexual dysfunction may be diagnosed. One does not immediately make the leap from antidepressant use to sexual dysfunction to antidepressant-induced sexual dysfunction. Even when all other possible causes are ruled out (this has not been done), and drug-induced sexual dysfunction is diagnosed, the first step is not switching medications. Non-pharmacologic interventions should be introduced first. These are steps to follow before considering a medication switch:<P>1. Wait for spontaneous remission.<BR>Side effects are more severe in the initial weeks of medication, and later abate. Treatment-emergent sexual dysfunction tends to persist.<P>2. Decrease the medication to a lower dose.<BR>Sexual dysfunction tends to be dose-related, so lowering the medication dose may be helpful. Care needs to be taken, though, not to go below the therapeutic threshold.<P>3. Try partial or complete drug holidays.<BR>Luvox, Zoloft, and Paxil-induced sexual dysfunction has been successfully managed by partial or complete drug holidays (decreasing<BR>or holding the SSRI for a weekend). Prozac is not responsive to the drug holiday approach, because of its longer half-life.<P>Antidepressant-induced sexual dysfunction has gone from being underreported to overreported. Sexual dysfunction was not adequately measured in previous clinical trials. On the flip side, many recent studies do not include placebo controls. Without placebo controls it is impossible to know the real drug effect.<P>In my opinion Tracie should pursue other avenues to explain her low libido.<p>[This message has been edited by Owner (edited 04 July 2003).]

I do agree that you should look at possible other causes of your low-libido before making any major life changes. That said, if your low libido didn't start until after you started Effexor, you may want to consider it as the most likely candidate.<P>There is an article on this site dealing with managing these types of SSRI side effects: <A HREF="www.newshe.com/articles/SSRIsLBand.shtml" TARGET=_blank>www.newshe.com/articles/SSRIsLBand.shtml</A><P>

I still must disagree it would be the most likely candidate. She's had significant life changes in the span of one year. And, from the article you linked,<P>"A core symptom of depression is anhedonia, which is defined as markedly diminished interest or pleasure in all, or almost all activities. Anhedonia includes loss of libido. In one study, it was found that 70% of depressed patients had a loss of sexual interest while not on medication, and they reported that the severity of this loss of interest was worse than the other symptoms of depression."<P>When comparing the incidence of sexual dysfunctions with different antidepressants, keep in mind that different antidepressants are used to treat different types of patients. Effexor is more commonly prescribed for patients with SEVERE depression. Patients with severe depression are more likely to have loss of libido, whether on medication or not.<p>[This message has been edited by Owner (edited 04 July 2003).]

Owner,<P>Please re-read my reply to the woman who began this thread. It says she *should* explore other causes for her low-libido, and that *if* she didn't have low libido until AFTER she started taking the medication for her depression, THEN she *may want to consider* the Effexor as a primary cause. I never said the medication was, or wasn't, the primary cause. Simply that it warranted consideration in certain circumstances. <P>If her libido was low because of depression,and not the medication, then it should have been low BEFORE she was put on Effexor. If her libido wasn't low before that, the medication could be the cause. As could the life-changes, or some combination thereof. Nothing in my post suggested otherwise.<P>I know a good bit about depression meds, including that they are used in a variety of ways to treat a variety of things in a variety of severities. I don't know her medical or psychological history; and, even if I did, I always suggest consulting your doctor before changing any depression medication regimine. Hence, I didn't recommend a course of action, but simply referred her to an article with possible suggestions and ideas for working to manage potential sexual side effects of depression medications (specifically SSRIs).<P>Please don't put words into my mouth--there's been enough of that around here lately.

Wow!<P>What a range of responses. To clear things up...I have always known that Effexor might cause some sexual side effects, but was under the understanding that it was less of a problem than other anti-depressants.<P>My depression is linked to both a genetic predisposition and also some life events. I know that I will probably never go off meds completely, my mother has been on them for years. Actually, the thought of going off scares me quite a bit!<P>However, I just had to INCREASE my dosage, and noticed a slight surge in my libido (brief increase), but it's back to it's original point. <P>I've had a low libido most of my life...I get into a relationship and it just dies. In the beginning it's all sparks and romance, and then...it's just there.<P>I was just hoping that someone might have some tips/suggestions that didn't have anything to do with medication...such as exercise, toys...stuff that has helped them. I am on my third day of quitting smoking, so I'm hoping this will help.<P>Maybe some tips for having a conversation with my hubby would help. I know that the medication might me a trigger, but I also think that taking our relationship for granted...and all those other things might be a cause, too.<P>Thanks so much!!!! I'm checking out those sites recommened in posts!<P>Tracie<BR>

Tracie,<P>That's what I thought you meant from your first message, so I was a bit taken aback by the immediate rush to blame medications. I have many suggestions you could try. I will get back to you later with some when I have more time!

(cracking knuckles) Tips and suggestions not having anything to do with medication? That's right up my alley. First there's my orgasmic diet, spelled out in detail on my website (listed in my profile), with a heavy emphasis on PC muscle exercise.<P>Being on antidepressants, your orgasms are probably slowed down, so I would recommend a very powerful plug-in-the-wall vibrator. There's the old standard, the Hitachi Magic Wand, or my personal favorite, cannot be beat, the Eroscillator.<P>But a vibrator ain't gonna bring back that spark and romance. Dark chocolate might help a bit. Tantra is pretty nifty. But what you really need in my opinion, if you are on antidepressant drugs, is a high level of dopamine during sex to counteract the artificially high serotonin levels. I don't usually recommend this, already having credibility problems here, but an easy way to get dopamine levels up is through spanking. I'm not saying you have to try full-fledged BDSM and be tied up and all that (unless you want to), just maybe have your husband spank your bottom with a house slipper for twenty minutes and see how you feel, if he's open to it. Not too hard, just enough to sting. That should be enough to trigger a dopamine response.<P>Of course there's counselling too, and more psychological approaches which would probably be beneficial, I'm sure others here will post suggestions.<p>[This message has been edited by zaneblue (edited 07 July 2003).]

Zane,<P>you rock. I mean it.

WOW! The things I learn here. <BR>Again Zane, I do enjoy reading your posts!

Full marks for resourcefulness, Zane!!!<P>Re. the spanking: such a contradiction between the sheer indignity of it and the measured and restrained tones pertaining to other threads on the board!!!!!!!!!<P>OK. Now who's first going to try it?

Oh, I tried it (in the interests of science) and my dopamine response is so hair-trigger now from being on my diet, I was actually slurring my words by the end of it. I don't think most women would have that sort of extreme response, especially from such light levels of pain, but it should help things along a bit. I don't think it's a coincidence that there has been such a huge rise in women interested in painful submissive sex when you consider the rise in caffeine intake and antidepressant usage. Women need more extreme sensation as a result, in my opinion.<P>Thanks everyone for the kind words.

Such a huge rise in painful submissive sex? My God.<P>This is ridiculous.

Thanks so much for the suggestions!!! I'm going to look at the diet and see what I can incorporate. Does it have to be followed to the letter or is some leeway allowed (and I'll still get results?)<P>Tracie<BR>