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Post-SSRI sexual dysfunction

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Re: Post-SSRI sexual dysfunction

#201

Post by ivraatiems »

staticman2 wrote: post #105
ivraatiems wrote: post #87

Earlier quoted context omitted.

> You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug. The insurance company doesn't know what you are discussing in your sessions and isn't going to let you see or not see a specialist just based on whether they prescribe you meds. That's not how it works - or not how it should be working if your insurer is…

"tell the doctor you're going off the drug, confirm you went off the drug, the doctor asks if you want to try another drug, you say no, and then you stop talking to the doctor." This is completely consistent with the patient never telling the doctor that, to their surprise, after waiting months the SSRI side effects never go away. I feel like you are arguing against my choice of phrase but not the substance of what I…

> This is completely consistent with the patient never telling the doctor that, to their surprise, after waiting months the SSRI side effects never go away.

That's true, that could certainly happen. I'm more skeptical about the rate at which it happens -- but also, if it is happening, presumably a patient will eventually go back to someone in the medical system and mention it. Whether they connect the dots is a question, but one which can be studied.

> I made a pretty small claim, that your psychiatrist may (not did have, may have) had patients with a condition they didn't discuss with her, that only became known to the patient after treatment had concluded. If you think a minor claim like that requires "surveys" or data, believe what you want, I don't know what to tell you.

The claim that my psychiatrist might have done something or not isn't the claim I want data for. The claim I want data for is "I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for."

That's not an anecdote, that's a pretty bold claim.

> The article this thread links to indicates there is no cure, so any patient who has done research would know discussing it with a psychiatrist would be useless.

I don't think people think about things that way necessarily. I wouldn't read an article and conclude I shouldn't talk to my doctor because the article suggests the doctor can't help, because I don't necessarily put that much faith in a single article. And doctors will frequently ask these sorts of questions, so even if I had read the article, I don't think I'd lie about it to them.

In general, I think you are making a number of assumptions about how people - doctors, insurers, pharma companies, and patients - behave that aren't necessarily borne out in reality. If your assumptions are all correct, your conclusions are reasonable, but I am not sure they're correct.

Re: Post-SSRI sexual dysfunction

#202

Post by txsoftwaredev »

symlinkk wrote: post #43

Has anyone taken SSRIs and actually thought it was worth it? I have severe social anxiety and I’m trying to decide if I should try medication or not.

Yes. I've been on/off (mostly on) them for around 20 years. It started when I was young and a girl broke my heart. I just couldn't get out of my "funk". I started taking Zoloft and it gave me a life again. I probably have social anxiety and I am def. more comfortable in public and around people I don't know when I'm on an SSRI. I am not as negative and cynical and have hope for the future. I don't want to take them, wish I didn't have too but even with consistent exercise, therapy etc. it just wasn't enough without the medical help.

Re: Post-SSRI sexual dysfunction

#203

Post by silexia »

matheusmoreira wrote: post #62
300bps wrote: post #32

Earlier quoted context omitted.

When I was in my mid-20s my doctor wanted me to take blood pressure medication because when I went to her office in the morning I had blood pressure of 150/110. I told her I wanted to see what I could do on my own first. I cut out salt and caffeine, increased potassium and exercised every day. I went back in two months and my blood pressure was 120/80. She took it four times because she didn't believe it. I think the…

Lifestyle changes are the best treatment there is. Shame they can't make a pill out of it. Statistically most people fail to maintain lifestyle changes over the long term. Especially dietary changes. Pharmacological treatments allow doctors to help those people.

I have never had a doctor recommend lifestyle treatments to me. They don't make any money on those. I have osteoarthritis in my hip and multiple doctors recommended an immediate hip replacement. I did a ton of research and ended up on the anti-inflammatory index diet in combination with changing exercises from running and golf that put high impacts on my hip to cycling which does not. All of my pain was gone in three months and has stayed gone for the last two years.

Re: Post-SSRI sexual dysfunction

#204

Post by staticman2 »

ivraatiems wrote: post #201
staticman2 wrote: post #105

Earlier quoted context omitted.

"tell the doctor you're going off the drug, confirm you went off the drug, the doctor asks if you want to try another drug, you say no, and then you stop talking to the doctor." This is completely consistent with the patient never telling the doctor that, to their surprise, after waiting months the SSRI side effects never go away. I feel like you are arguing against my choice of phrase but not the substance of what I…

> This is completely consistent with the patient never telling the doctor that, to their surprise, after waiting months the SSRI side effects never go away. That's true, that could certainly happen. I'm more skeptical about the rate at which it happens -- but also, if it is happening, presumably a patient will eventually go back to someone in the medical system and mention it. Whether they connect the dots is a quest…

Well, you might look for data on how many patients discontinue any sort of treatment for starters. "Patient compliance" would be a starter for such a search.

I get the impression that you have an "attachment" style relationship with your doctors, I don't mean that as an insult, I think that leads you to think that other people are interacting with them like you are, and would not possibly discontinue their long term interactions with the doctor even after deciding to go off drugs. Obviously not everyone is like you.

Re: Post-SSRI sexual dysfunction

#205

Post by staticman2 »

ivraatiems wrote: post #198
batrachos wrote: post #114

Earlier quoted context omitted.

> The insurance company doesn't know what you are discussing in your sessions That's not true. From what I understand, sessions are coded e.g. "Intake" or "Meds check" when billed to insurance. They know roughly what you're talking about. > and isn't going to let you see or not see a specialist just based on whether they prescribe you meds. You can't bill a meds check with no meds. > That's not how it works - or not…

> That's not true. From what I understand, sessions are coded e.g. "Intake" or "Meds check" when billed to insurance. They know roughly what you're talking about. You are correct that CPT codes give some insight into what was provided, but you are wrong about what codes providers use in this case. To check myself, I pulled my insurance provider's EOBs for my last two visit to a psychiatrist and my last visit to a psy…

Talk therapy where I am pays 75 dollars for 50 minute session on my insurance.

Someone who has been through med school would not typically lower themself to that rate, nor do I buy the idea that some insurers are inexplicably more generous and pay doctor rates for non doctor work.

Remember, talk therapy does not require as much education, you do not need a phd or md to do it. An MD would not get doctor level payouts doing talk therapy.

Re: Post-SSRI sexual dysfunction

#206

Post by orra »

n8cpdx wrote: post #113

As someone dating in their 20s, it is getting hard to find people who aren’t having SSRI-related dysfunction. Recently met an older (early 30s guy) and it was seriously cool having a sexual experience that didn’t end with “don’t bother I’m just not going to finish no matter how long we go.” They really seem to be handing out these serious, almost-impossible-to-withdraw medications like candy on Halloween. They don’t…

> SSRIs, which have poor efficacy

Sort of. As I understand it, SSRIs have poor efficacy for mild depression, but have better efficacy against severe depression.

> CBT are useful interventions that can be easily monitored by physicians with modern technology.

The 'difficulty' with CBT, or indeed any other therapy, is it's expensive. And our health care system (at least in the UK) is quite underfunded.

Re: Post-SSRI sexual dysfunction

#207

Post by rytcio »

wayoutthere wrote: post #9

Ugh. Yes. Not meaning to be crude here and I’m incredibly sympathetic to the men I date, but as a woman in her late 30s it’s hard to find a man my age who doesn’t have problems getting / keeping it up. Most of them link back to antidepressant use. What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has…

Porn also causes issues in that department.

Re: Post-SSRI sexual dysfunction

#208

Post by heavyset_go »

Jaruzel wrote: post #22

My personal anecdote: I'm on Venlafaxine which is an SNRI (also cited in the article), and I definitely suffer some of those side-effects. It sucks. At times it makes me want to shy away from sex completely. Other times I think I'm doing OK, only to find out I can't finish, or I finish weakly with no adrenalin rush. So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or k…

There are two medications on the market that have FDA approval for the claim that they have lower incidences of sexual side effects than other similar medications.

One is vortioxetine and the other is vilazodone. In addition to acting as SSRIs, they have high affinities for 5HT1A autoreceptors, activation of which disinhibits the release of neurotransmitters. SSRI sexual side effects are hypothesized to be the result of 5HT2C activation, which inhibits the release of neurotransmitters. The idea is that 5HT1A activation might help with the effects of 5HT2C activation.

There's also bupropion, an NDRI, and mirtazapine, which blocks 5HT2C. Buspirone acts as a 5HT1A activator, as well. They might help with those side effects.

Re: Post-SSRI sexual dysfunction

#209

Post by User23 »

_ktx2 wrote: post #193
FFRefresh wrote: post #118

Earlier quoted context omitted.

I do wonder if there's a culture-wide bug/meme with regards to mental health (and beyond) that makes it hard to push for lifestyle changes at scale. I think one such meme is around agency, with the underlying meme being that humans have no control over their circumstances or mental state. They have anxiety or they have depression. It's part of their identity, and these seem to be thought of as immutable diseases. And…

I was on SSRIs for a time until my thoughts became so irreversibly cloudy that I weened off and stopped. After that I coincidentally stopped drinking, my weight dropped, and now I've stopped using weed for the most part. My anxiety doesn't go away, even if I go ride my bike for hours. The things that give me anxiety are largely social. How people think of me at work, my appearance, what women think of me, and how the…

> I was on SSRIs for a time until my thoughts became so irreversibly cloudy that I weened off and stopped. After that I coincidentally stopped drinking, my weight dropped, and now I've stopped using weed for the most part. My anxiety doesn't go away, even if I go ride my bike for hours.

You may want to try a primarily anaerobic exercise like lifting weights to supplement your cardio. Your mileage may vary, but I personally get a huge endorphin rush from a heavy[1] deadlift. It's so powerful that it takes an effort to not start hugging other people at the gym.

> I've noticed relying on my friends to vent just sours relationships. As much as people gloat about support systems, it's mainly a farce. People will only tolerate hearing so much of your internal dissonance, concerns, and stressors. People want to enjoy you, for the most part. Maybe a partner will be there for you, but not likely in my experience (though, I'm unmarried, so take what I say with a grain of salt.)

More than anything else, people remember how you make them feel. If you're always dumping your negative issues on them, even if they like you, subconsciously they'll learn to associate you with feeling bad and avoid you.

A much better approach is to show an interest in your friends and try to sympathize with what's going well in their lives. And I mean really sympathize. Let yourself feel happiness on their behalf. Encourage them to keep it up. Then they will learn that being around you makes them feel good. Once you build up a good feelings battery in the relationship, you can draw down from it a bit when you're feeling down.

Dating is a different ball of wax. If you're having trouble with basic friendships then it's probably best to establish some healthy habits there first.

[1] https://exrx.net/Testing/WeightLifting/StrengthStandards. Bear in mind these are single rep maximum effort, which an untrained person isn't likely to properly do.

Re: Post-SSRI sexual dysfunction

#210

Post by User23 »

vettedvat wrote: post #200
iammisc wrote: post #182

Earlier quoted context omitted.

> So why are depressive disorders so prevalent there Because there's no such thing as 'depressive disorder'. We expect people to be happy, and when they're not, we call them diseased. Nothing is wrong with them. Also, Ethiopia is in the midst of a civil war isn't it?

False, we expect people to be depressed when depressing things happen, this is normal and called "situational depression," you've confused it with a disorder. Depression has been a problem in Ethiopia for much longer than the conflict in Tigray, despite the abundance of "community, shared culture, shared religion." Looks like it takes more than that...

> "community, shared culture, shared religion."

I don't pretend to be an expert on Ethiopia, but I was under the impression that it's a multi-ethnic state of different tribes who don't necessarily share those things with each other.

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