# The I Cant Cum While on Steroids Thread - Delayed Ejaculation



## sfstud33

This is one of the biggest jokes of being on steroids. You want it all the time, but for some of us we just can't get to the promised land. In my case i can go for an hour and not get there. Im sick of it. An hour in the morning and an hour in the evening and my backside and lower back ache! It may be a good bun workout but its not getting me off.

To help out others who may be in the same situation i've decided to post a bunch of things i've tried because i did find something that eventually worked. And i didn't have to upgrade my wife (she's pretty damn hot already).

There are a lot of posts on the net about delayed ejaculation and some of them suggest a variety of different options. Here is what i tried and the result - Remember - your mileage may vary so i encourage you to try the options to see what works for you - and to post any new ideas and results that you have.

1. L-HISTADINE - Took this every day for a month - No Effect. A Histidine dificiency is not my problem.

2. ACETYL-L-CARNITINE - Another amino Acid. Tried it for a month - no effect. 

3. ALPHA LIPOIC ACID - Been on 30 days - no impact.

4. CHOLINE - Been on 30 days - No impact

5. PROVIRON - Made me insanely horny but didn't help me get there. Still, this ones a keeper.

6. CABERGOLINE - Originally using a research version with one 0.5mg dose Monday and Thursday. Read a lot about how Cabergoline restored normal functioning in men and figured i would try increasing my dose. So i doubled up on the pills on Monday and Thursday. Immediately i noticed a difference, and last night all i can say is i finally got to the promised land! This is after three months of being completely unable.

7. YOHIMBINE - Comes in two versions the scrapings of bark directly off the tree, and a purified HCI version. Tried both. Zippo on the load shooting front. 


If you have any other ideas, then feel free to post them. I'd hate for other guys to go through this problem and not at least have some options to try.


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## 63Vette

The ladies are all saying.... "so what's the problem"? Lol

I will watch  thread with great interest but if there is something better than caber out there... I sure as hell don't know about it...

By all means if anyone has a solution HELP us!

Respect,
Vette


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## Times Roman

You may want to include a list of things NOT to do as well.

I've heard over and over how blokes will look at porn MORE on cycle than off.  This desensitizes (looking at porn) as well.


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## Shane1974

Here's what's funny. While I was on, I came no problem. Now week 3 into PCT, and I can't cum for shit. No erection problems.


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## sfstud33

BTW, you know if you are suffering from delayed ejaculation according to the following metric -

If you cant get there after five minutes of vigorous thrusting.

So if that applies to you, then you should look for options to help.


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## Times Roman

*Effects of acute prolactin manipulation on sexual drive and function in males*

http://joe.endocrinology-journals.org/content/179/3/357

Abstract

The neuroendocrine response to sexual activity in humans is characterized by a pronounced orgasm-dependent increase of plasma levels of prolactin. In contrast to the well-known inhibitory effects of chronic hyperprolactinemia on sexual drive and function, the impact of acute prolactin alterations on human sexual physiology is unknown. Therefore, this study was designed to investigate the effects of acute manipulation of plasma prolactin on sexual behavior.Ten healthy males participated in a single-blind, placebo-controlled, balanced cross-over design. Prolactin levels were pharmacologically increased to high levels (protirelin, 50 micro g i.v.) or reduced to low physiological concentrations (*cabergoline, 0.5 mg p.o*.). Sexual arousal and orgasm were then induced by an erotic film and masturbation. In addition to continuous neuroendocrine and cardiovascular recordings, the quality and intensity of the acute sexual drive, arousal, orgasm and refractory period were assessed by extensive psychometric measures.Administration of cabergoline decreased prolactin levels and significantly enhanced all parameters of sexual drive (P<0.05), function (P<0.01) and positive perception of the refractory period (P<0.01). Administration of protirelin increased prolactin concentrations and produced small, but not significant reductions of sexual parameters. The sexual effects observed from cabergoline were completely abrogated by coadministration of protirelin. Although different pharmacological sites of action of prolactin-altering drugs have to be considered, these data demonstrate that acute changes in prolactin plasma levels may be one factor modulating sexual drive and function. Therefore, besides a neuroendocrine reproductive reflex, a post-orgasmic prolactin increase may represent one factor modulating central nervous system centers controlling sexual drive and behavior. These findings may offer a new pharmacological approach for the treatment of sexual disorders.


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## coltmc4545

This is what causes it for me...

When I'm on cycle, I'm horny a lot more so I masterbate more which causes desensitization. So, my solution is stop jacking off so much. Solved my problem, was free, and freed up some time.

Had this exact problem last night actually. I'm just cruising but I've been horny a lot lately so I'm been jerkin the gerkin more. We started going at it last night and she came twice and it was a no go for me. Soooooo, looks like I'll stop jackin off so much again for awhile. Caber really just makes me horny. I can tell when that shit hits my system because I could watch golden girls and instantly get a hard on.


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## PillarofBalance

How many of you have faked getting off because you were exhausted???  I have. On several occasions.


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## Times Roman

PillarofBalance said:


> How many of you have faked getting off because you were exhausted???  I have. On several occasions.



ha ha ha!

there have been times.....

but it looks a little suspicious when your woman begins to wonder....

...."where's the load?"


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## Times Roman

question....

....anyone try prami, and what was your experience in this department?


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## sfstud33

Times Roman said:


> ha ha ha!
> 
> there have been times.....
> 
> but it looks a little suspicious when your woman begins to wonder....
> 
> ...."where's the load?"



Yea, exactly - my wife isn't going to be fooled with a fake orgasm - she knows if ive gotten a load out or not. And if i try to fake an orgasm then she's going to wonder what else im faking. Not worth it.


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## ken Sass

i cum harder, shoots farther, and i am as horny as a rabbit


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## Georgia

Orgasms without cum? Sounds amazing to me. No mess and you can finally leave it in without a condom or birth control! WOOO!


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## dboldouggie

When I'm on gear it takes me a good hour or so but I bust. I dont see that as a problem my girl loves when I'm on gear.


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## Popeye

Two words to help solve the problem of "Where's the load?".......

*The     "Houdini".*

Now...You have to be hittin' it from the back...

But when you're pounding away and have had enough......pull out.......and spit on her back.

Problem Solved!!


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## Christosterone

PillarofBalance said:


> How many of you have faked getting off because you were exhausted???  I have. On several occasions.



Shit I have, it sucks when they ask for facial and you're faking...but after awhile of laying pipe, the girl loosens up and it doesn't feel as tight, I blame it on them and tell them to do kegels


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## ccpro

I've faked it many times,...throw some saliva on her back or keep some warm yogurt handy...lol.  I don't know that my wife will ever "ask" for a facial, that would probably make doing it less fun!  Everytime we're done my wife asks if I'm ok cause I'm breathing so heavy.  Damn bitch I just knocked the bottom out...and yes it takes a while.  Refraining from beating off definatley helps as does stincking you finger in your girls ass...make ya blow everytime!!!!


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## wideback

Caber Dude, On week 8 of test cyp- 750/week- tren-e 400mg/E4Days was ,like you , having to go an hr. or so, my cardio sessions. started mpresearch"s caber, 1/2 mg 2 a week. The next day I had a I must fuck NOW moments, wow what a session , busted twice . and I"m 51 yrs. old!! And wasnt "placebo effect" cuz I forgot I had taken it.


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## Yaya

When i shoot a load while on cycle it looks like a bunch of salmon on the floor flopping around with.whole milk splashed all over them..


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## grind4it

That's some funny shit. 





Yaya said:


> When i shoot a load while on cycle it looks like a bunch of salmon on the floor flopping around with.whole milk splashed all over them..



Just a side note; if my wife asked for a facial. I would cum SOFT. No need to
Fake that shit.


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## TR90125

delcapone said:


> Caber Dude, On week 8 of test cyp- 750/week- tren-e 400mg/E4Days was ,like you , having to go an hr. or so, my cardio sessions. started mpresearch"s caber, 1/2 mg 2 a week. The next day I had a I must fuck NOW moments, wow what a session , busted twice . and I"m 51 yrs. old!! And wasnt "placebo effect" cuz I forgot I had taken it.



Caber has not had that effect on me.  Seems to improve erectile quality and reduce refractory in that I can get wood again faster but can't get the second nut for a while.


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## AlphaD

grind4it said:


> That's some funny shit.
> 
> Just a side note; if my wife asked for a facial. I would cum SOFT. No need to
> Fake that shit.



Ain't that the truth!


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## ccpro

I've noticed if I stop jerking off 2-3 times a day I'm able to cum when the wife wants to get busy!!!....just sayin!


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## gymrat827

PillarofBalance said:


> How many of you have faked getting off because you were exhausted???  I have. On several occasions.



ahhh more than 25 over the yrs ...........lol

none of the chicks ever figured it out.


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## gymrat827

hcg, caber and DAA are my golden tickets.  im still under 30 tho so its a bit different.


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## ccpro

I just had to fake it.....no nut here!


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## ccpro

Plus I thought I wad going to have a heart attack!


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## BigFella

Old bastard checking in: Never had a problem . . . except when I was young, coming too soon - but more frequently.


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## musclebird

Popeye said:


> Two words to help solve the problem of "Where's the load?".......
> 
> *The     "Houdini".*
> 
> Now...You have to be hittin' it from the back...
> 
> But when you're pounding away and have had enough......pull out.......and spit on her back.
> 
> Problem Solved!!



X2 lmfao

If your only running test and your having libido problems wouldn't that mean your estrogen levels are to high or to low? maybe try tweaking your AI, allot of guys during P.C.T can get it up but have trouble getting to the climax so maybe your levels need to be adjusted, or fake orgasm... haha and if you get caught and she questions then next time blue ball your self with a little porn before you meet up with the lady teach her a lesson to be careful what she asks for


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## sfstud33

Thought i would check in and let you know progress.

I saw a urologist (for something unrelated) and told him about my problem. There are three drugs that are typically prescribed for this problem - particularly if you are taking SSRI anti depressants (which im not). 

Its not only SSRI anti depressants that affect serotonin levels in the brain. Steroids may change your serotonin levels. Have you ever had the feeling of beeing very happy and mellow while on? Thats me. Im on now. I know if i come off cycle i'll be able to close the deal - but im still 2 months away from finishing. So...

The drug i got from my doctor was Cyproheptadine - an old fashioned anti histamine that also lowers serotonin levels. And it works! Deal closed and payload delivered.

Only problem with Cyproheptadine is i took 4mg and felt like sleeping all the next day. So i may need to cut the tablet in half to see if its more manageable. You take it an hour before jumping into bed. Its a pain to have to plan things out, but if you wanna bust one off naturally during sex then its well worthwhile.

Here are the three drugs that i've found so far that are reported to work. I've only tried cyproheptadine so far.....

Amantadine (Parkinson's)
Buspirone (antianxiety)
Cyproheptadine (allergy)

By the way, these are all prescription drugs....


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## B14

Not being able to finish sounds like a prolactin issue..at least it was for me. prami at.25 for a cple days  bump it up to .5 for a cple dys and see if that does it...within a week I was finishing 2x's within a few hrs.

Edit: I was running test and deca..if your only running test I don't know if this fits into the equation. just my 0.02 cents


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## sfstud33

B14 said:


> Not being able to finish sounds like a prolactin issue..at least it was for me. prami at.25 for a cple days  bump it up to .5 for a cple dys and see if that does it...within a week I was finishing 2x's within a few hrs.



Taking cabergoline on Mondays and Thursdays for prolactin control as im doing tren at the moment. You think i should switch to prami?


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## DF

sfstud33 said:


> Taking cabergoline on Mondays and Thursdays for prolactin control as im doing tren at the moment. You think i should switch to prami?



Some guys can't handle prami.  That shit can make you sick as a dog.  On a side note does your wife talk dirty in bed?  That shit gets me to bust one in seconds....lol


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## B14

sfstud33 said:


> Taking cabergoline on Mondays and Thursdays for prolactin control as im doing tren at the moment. You think i should switch to prami?



It worked for me..prami is cheaper, has more "pros" or benefits than caber..if its available I would give it a shot. if you need a good source pm me..good luck brother!!


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## gymrat827

B14 said:


> It worked for me..prami is cheaper, has more "pros" or benefits than caber..if its available I would give it a shot. if you need a good source pm me..good luck brother!!



i took one dose of prami before bed.  I take sleeping pills as I am an insomanic, but the prami put me to bed like 5 min post.  Woke up 2hrs later disoriented, out of it and feeling sick as hell.

It didnt go away.  I ended up calling in sick to work at 645am cuz i knew i wouldnt make it.  was up all night, wouldnt wish it upon anyone who i didnt want dead.

Threw it out once i stopped puking and dry heaving.  fuk prami


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## NbleSavage

Dfeaton said:


> Some guys can't handle prami.  That shit can make you sick as a dog.  On a side note does your wife talk dirty in bed?  That shit gets me to bust one in seconds....lol



Dirty talking wives, no can defense.


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## djt248

Had a similar issue and had to tell my wife about it. Hard to fake your nut when you haven't used a Coney Island white fish in years. She bought some fucking cock ring that vibrates. Did the trick I must say. Only draw back was that it pushed all the blood to the head of my junk and hurt a little. Other than that good times!!


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## graniteman

Christosterone said:


> Shit I have, it sucks when they ask for facial and you're faking...but after awhile of laying pipe, the girl loosens up and it doesn't feel as tight, I blame it on them and tell them to do kegels



^^WTF?!! you're a lucky sumbitch. If my wife or even  ex girlfriends ever 'asked' for a facial I would probably bust a nut right there...Immediately


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## Leotis

Here's what _NOT_ to do- Paxil. 

Do not take Paxil (paroxetine) in any way, shape, or form. You will wear the skin off before you bust one...if you EVER do.


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## Leotis

Annnnnnnd I just noticed this thread was over 2 yrs old. 

Sorry for the necropost!


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## Rip

Gingko Biloba too


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## Rip

Leotis said:


> Here's what _NOT_ to do- Paxil.
> 
> Do not take Paxil (paroxetine) in any way, shape, or form. You will wear the skin off before you bust one...if you EVER do.



Yeah, Paxil is an SSRI antidepressant. 
The drugs in that class tend to cause anorgasmia as one of the most common side-effects. 
Cyproheptadine, Buspar, Bupropion, Gingko Biloba, and a few others are supposed to help counteract that side-effect. 
Check out this article:

Treatment of Antidepressant-Induced Sexual Dysfunction
Michael J. Gitlin, MD
Medscape Psychiatry & Mental Health eJournal. 1998;3(3) 
Sexual dysfunction is a common side effect of SSRIs, occurring in more than 30% of patients.

Sexual side effects have emerged as a major clinical concern with many of the newer antidepressants. Approximately 30% to 40% of patients on serotonergic antidepressants experience sexual dysfunction. Clinical trials of techniques to minimize or treat these side effects have been hampered by a lack of systematic inquiry on sexual dysfunction in antidepressant-treated patients. General strategies and specific drug antidotes to treat antidepressant-induced sexual side effects are discussed. These include such drugs as cyproheptadine, yohimbine, amantadine, buspirone, stimulants, and gingko biloba.

Side effects associated with psychotropic medications are associated with noncompliance that can potentially reduce clinical response to treatment. Selective serotonin reuptake inhibitors (SSRIs) have emerged as the dominant treatment for depression and other psychiatric disorders. However, sexual dysfunction is a major side effect of this group of psychotropic medications. Unfortunately, despite the astounding popularity of SSRIs in the US during the past 10 years, information on the prevalence and treatment of SSRI-induced sexual dysfunction is scant. This article reviews what is known about sexual side effects of antidepressants and strategies to treat them, relying heavily on the anecdotal data and case series that form the bulk of the published literature.

Depressed patients can manifest sexual dysfunction due to a variety of causes. Clinicians should consider all possible causes before attributing sexual dysfunction to a prescribed antidepressant (Table I).[1,2] Etiologies can be grouped into 3 categories: (1) part of the presenting psychiatric disorder; (2) comorbid physical or psychiatric disorders; and (3) drug-induced from medical treatments.

Psychiatric disorders themselves are associated with sexual dysfunction. Depression is assumed to be linked with alterations in sexual functioning, although the evidence for this assertion is less consistent than expected.[3] Only a handful of experimental studies on sexuality in depressed individuals have been published, and all these have evaluated only men.[3-9] These studies show that diminished sexual satisfaction, as opposed to decreased sexual interest or erectile dysfunction, is the most consistent finding in depressed outpatient men.[3] This complaint of decreased satisfaction is probably related to the diminished ability of many patients with depression to enjoy most pleasurable activities.

Sexual dysfunction can occur as a primary condition from either a medical disorder or from a poor relationship with the partner. Unfortunately, the rate of primary sexual dysfunction in a normative population is still in doubt, although the rate of DSM-IV hypoactive sexual desire is estimated at 20%.[10,11] Rates of decreased libido in earlier studies of depressed patients have been estimated as high as 77%.[12]

Given the number of possible causes of sexual dysfunction, clinicians should ask about sexual function prior to prescribing antidepressants to any patient. A minimal set of screening questions should include the 3 major areas of sexual function: interest (or libido), arousal (erectile function in men, lubrication and feelings of arousal in women), and orgasm.

A number of medications besides psychotropics can cause sexual dysfunction, including some antihypertensives and muscle relaxants. Antidepressants cause sexual side effects in all 3 phases of the normal sexual response cycle, including decreased libido, erectile dysfunction (in men), and delayed time to orgasm or anorgasmia in men and women. In open case series of patients treated with SSRIs, orgasmic dysfunction is the most common sexual dysfunction, followed by decreased libido; arousal difficulties represent the least common form.[13]

Painful ejaculation was reported in as many as 20% of men in 2 case series of men taking tricyclic antidepressants (TCAs).[14,15] As yet, this side effect has not been reported to occur in association with the newer antidepressants such as SSRIs, bupropion, nefazodone, and mirtazapine.

Paradoxically, antidepressants (especially those with serotonergic effects such as SSRIs, monoamine oxidase inhibitors [MAOIs], and trazodone) have also been reported, albeit infrequently, to cause occasional increased sexuality. Case reports describe enhanced libido, spontaneous orgasm without sexual stimulation, and spontaneous orgasm with yawning.[16-20]

All antidepressants are associated with potential sexual side effects. However, it is difficult to estimate the percentage of patients experiencing these side effects with any single antidepressant. This is because of the variability in methodology between studies when ascertaining sexual side effects and because of a paucity of studies specifically evaluating the rate of sexual side effects. When patients in a recent study were asked about sexual dysfunction, the rate of these complaints from SSRIs was 55%, compared with only 2% to 7% when sexual side effects were voluntarily reported.[21]

Despite these methodological difficulties, patients taking the highly serotonergic antidepressants -- SSRIs, clomipramine, and venlafaxine -- seem to show the highest rates of sexual dysfunction, varying from 2% to 92%.[15,22] The best estimate is that 30% to 40% of patients on serotonergic antidepressants will have some sexual dysfunction. In descending order, MAOIs seem to be associated with the next highest rate of sexual dysfunction, followed by TCAs. Rates of sexual side effects seem to be consistently lowest with nefazodone, bupropion, and mirtazapine. Rates of sexual dysfunction within a given drug class are probably equal when equivalent dosages are compared.[13,23-25]

Effective treatment of antidepressant-induced sexual dysfunction has advanced little since it was first recognized as a significant problem within the last decade.[26] No double-blind treatment study has yet been published, although one with predominantly negative results has been presented.[27] The absence of a systematic study precludes development of a clinically validated treatment algorithm, since comparison of suggested treatments has not been researched. Despite this limitation, treatment of antidepressant-induced sexual dysfunction can be divided into general strategies and antidotes (Table II).[2]

General strategies for treating antidepressant-induced sexual side effects include decreasing the dose, waiting, switching, and transient discontinuation.

Clinical experience suggests that side effects are generally dose-related, making dose reduction a reasonable first strategy to consider.[23,24] The relative paucity of nonsexual side effects seen with SSRIs makes it likely that at least some patients are on higher doses than necessary for antidepressant efficacy. SSRIs typically show a flat dose-response curve in the treatment of depression, meaning that increasing the doses above the typical doses administered is not associated with greater efficacy.[28] The hope is that the dose threshold for efficacy is lower than the dose threshold for sexual side effects, thereby precipitating fewer side effects while preserving efficacy.[28]

The length of time needed for side effects to diminish after dose reduction depends on the half-life of the antidepressant. With fluoxetine's long half-life, a few weeks at the lower dose may be needed to evaluate the regression of side effects. One study demonstrated that 14 days after discontinuing fluoxetine, only 13% of patients with sexual side effects had recovered orgasmic function.[29] For the other serotonergic agents, a period of a few days (for venlafaxine and paroxetine) to a week (for sertraline and fluvoxamine) is probably sufficient to evaluate the success of dose reduction in diminishing sexual side effects.[30]

This strategy of waiting for the patient to adjust to the medication is based on the observation that other drug-induced side effects, such as nausea and excessive stimulation, diminish after several days to weeks of treatment.[31] A few case reports and case series have noted resolution of sexual dysfunction secondary to administration of TCAs or SSRIs.[23,24,32,33] Although accommodation to these side effects may occur, clinical experience demonstrates that the patient usually experiences partial rather than absolute improvement, and it can take many months of treatment, not days to weeks, before improvements are noted.[20] For example, anorgasmia may diminish to delayed orgasm but rarely to full baseline orgasmic function.

Switching to a different antidepressant is a logical and effective strategy when the first prescribed medication produces a higher rate of sexual dysfunction than the alternative. This has been clearly demonstrated in studies in which patients have switched from an SSRI to bupropion or nefazodone.[23,24,29,34]

In the few studies examining this strategy,[31,35] there is no evidence of a depressive relapse when patients are switched across antidepressant classes. However, reemergence of depressive symptoms is always a risk with this strategy. Switching within a medication class is theoretically less risky for inducing relapse, but its efficacy as a strategy for reversing sexual side effects is less clear. Case reports have demonstrated successful switches from one TCA to another.[35,36] Within the SSRI class, no systematic data exist, but anecdotes about successful switches have been reported.[23,24] A study by Ashton and colleagues[13] noted that sexual dysfunction with one SSRI did not necessarily predict dysfunction with another; however, no data were provided.

The most controversial general strategy involves temporary discontinuation of medication. This technique requires either discontinuing the antidepressant for 1 or 2 days or dramatically lowering the dose for several days.[24,37,38] In the largest study examining this strategy, half the patients taking a short half-life SSRI showed clear improvement in sexual functioning after a 2-day discontinuation, whereas patients taking fluoxetine (with its long half-life) showed no improvement.[37] Other cases have been described in which even a 1-day discontinuation of fluoxetine resulted in diminished sexual side effects.[23] One case report described the successful use of a partial drug holiday with fluvoxamine to treat anorgasmia: Fluvoxamine was lowered from 300mg daily to 100mg daily for 2 days, and the patient had complete resolution of anorgasmia.[38] However, then increasing the daily dose to 200mg rather than restoring it to 300mg resulted in the re-emergence of depression.

The strategy of transient medication discontinuation to treat side effects is controversial because of the potential effects on mood, compliance issues, and withdrawal symptoms. In a study by Rothschild,[37] discontinuation of medication was associated with a mild increase in the scores for 2 of 20 patients on the Hamilton Rating Scale for Depression. Some patients may view this strategy as an indication that compliance with antidepressants is not to be attended to seriously. Lastly, transient discontinuation of a short half-life serotonergic medication (especially paroxetine or venlafaxine) confers the risk of inducing an unpleasant withdrawal syndrome characterized by dizziness, light-headedness, insomnia, fatigue, anxiety, nausea, and sensory disturbances.[39-41]

A variety of antidotes have been reported to treat SSRI-induced sexual dysfunction effectively; however, virtually all the data on these agents are derived from open case reports and case series. Insofar as sexual function improvement may be responsive to placebo effects, it is impossible to estimate the true efficacy of these antidotes.[27]

Most of these antidotes either have serotonin-blocking properties (especially 5HT-2 antagonistic effects) or augment catecholamine activity, especially that of dopamine. The antiserotonergic antidotes are cyproheptadine, buspirone, nefazodone, and mianserin. Medications enhancing dopaminergic tone include amantadine, bupropion, and stimulants, with yohimbine showing noradrenergic effects. Among the reported antidotes, the only 2 without antiserotonergic effects or catecholaminergic activity are gingko biloba and urecholine.

Cyproheptadine is an antihistamine with antiserotonergic properties that has been reported for over a decade to reverse antidepressant-induced sexual dysfunction. Only case reports and case series attest to its efficacy.[13,42-44] Effective doses range from 2mg to 16mg. In the most recent and largest case series, 12 of 25 patients described improvement in sexual function when treated with cyproheptadine (mean dose, 8.6mg).[13] Anorgasmia is the sexual side effect most often reported to be alleviated by cyproheptadine. Cyproheptadine is effective when taken either on an as-needed basis (typically, 1 to 2 hours before intercourse) or on a regular basis.

However, cyproheptadine's utility is often limited by its potential side effects. Excessive sedation and the reversal of the therapeutic effect of the antidepressant are major problems that limit its usefulness. Effectively treated depression and bulimic symptoms have been reported to reemerge soon after cyproheptadine was started.[42,45-48] This reversal of therapeutic effects is itself reversible upon discontinuation.

Buspirone is a serotonin-IA partial agonist typically prescribed to treat persistent anxiety. One case series reported that buspirone reversed both decreased sexual interest and orgasmic dysfunction caused by SSRIs.[49] Most patients using buspirone to treat sexual dysfunction take it daily. The dosage is the same as that used for anxiety (15mg to 60mg daily). The mechanism of action of buspirone in treating sexual dysfunction may be reduction of serotonergic tone via stimulation of presynaptic autoreceptors or the alpha-2 antagonist effects of one of buspirone's major metabolites, 1-pyrimidinylpiperazine.

Nefazodone and mianserin are antidepressants with strong postsynaptic blocking properties. In one case report, nefazodone 150mg taken 1 hour prior to sexual activity completely reversed sertraline-induced anorgasmia.[50] Mianserin, an antidepressant with 5HT-2 and alpha-2 adrenergic antagonist properties, is available in many countries but not in the US. It has been reported to reverse serotonin reuptake inhibitor-induced sexual dysfunction in 9 of 15 patients.[51] Mirtazapine is similar in its biological activity to mianserin and might also be effective in reversing sexual side effects. No case reports or case series have yet been published attesting to this, although clinicians have described such an effect. The putative capacity of mianserin and mirtazapine to reverse sexual side effects can be attributed either to their serotonergic activity or presynaptic alpha-2 activity.

Amantadine, a dopamine agonist, is used both as an antiviral agent and as a treatment for Parkinson's disease. It has been shown in a number of small case series to reverse anorgasmia.[13,52-54] Reported effective doses have ranged between 100mg to 400mg taken either on a daily or as-needed basis. In the most recent case series, 8 (42%) out of 19 patients with SSRI-induced sexual dysfunction improved with amantadine 200mg daily.[13] Given dopamine's consistent effect as a neurotransmitter involved in sexual arousal, a number of other dopamine agonists have been explored as treatments for sexual side effects.[2,55,56]

Bupropion is another commonly touted antidote for SSRI-induced sexual dysfunction.[57,58] It is assumed that the mechanism of action by which bupropion reverses sexual side effects is its weak dopamine agonism. The evidence for bupropion's efficacy is scant, except for unpublished, anecdotal reports, one case report,[57] and a case series[58] in which 31 (66%) of 47 patients showed improvement when bupropion was added to the regimen along with the serotonergic antidepressant. Most patients (18/31) with a successful outcome responded to as-needed use of bupropion 75mg to 150mg. Libido, arousal, and orgasmic difficulties were all effectively reversed. Fifteen percent of treated patients stopped taking bupropion because of its stimulation side effects. It is unclear whether bupropion doses need to be somewhat lower than usual when added to fluoxetine or paroxetine, to compensate for pharmacokinetic interactions resulting in increased bupropion levels.[59]

Stimulants, such as methylphenidate, D-amphetamine, and pemoline, are reported to reverse a variety of sexual side effects caused by SSRIs or MAOIs.[60-62] Low doses of 10mg-25mg of methylphenidate or D-amphetamine have been effective. One should add stimulants to an MAOI with extreme caution because of the risk of a hypertensive episode. However, use of an MAOI/stimulant combination has been shown to be safe in a case series.[63] SSRI/stimulant combinations show no similar risks.

Yohimbine is available with or without a prescription (and with unclear purity) in health food stores. It is an alkaloid from the bark of Corynanthe yohimbi (family, Rubiaceae) and has been used for decades to reverse erectile dysfunction.[64-66] Its efficacy in treating sexual dysfunction may be associated with its ability to block presynaptic alpha-2 adrenergic sites, leading to enhanced adrenergic tone.[65] A variety of sexual side effects have been reported to be alleviated by yohimbine in doses ranging from 2.7mg to 16.2mg daily, prescribed either on a regular 5.4mg 3 times daily basis or on an as-needed basis with single doses up to 16.2mg.[13,67-69] In the largest case series, 17 (81%) of 21 patients showed improvement of sexual side effects when treated with yohimbine (mean dose, 16.2mg).[12]

Typical side effects associated with yohimbine include anxiety, nausea, flushing, urinary urgency, and sweating. Yohimbine has been the subject of the only double-blind, placebo-controlled study to evaluate treatment of sexual dysfunction occurring as a drug side effect.[27] Unfortunately, the placebo effect was marked, showing a minimal drug-placebo difference with yohimbine given at a dose of 5.4mg 3 times daily. Yohimbine is also available in lower potency without a prescription. The purity, potency, and safety of these preparations, however, are unknown.

Bethanechol is a cholinergic agonist that has occasionally been useful in reversing sexual dysfunction associated with TCAs and MAOIs.[70-73] Typical doses are 10mg to 20mg as needed or 30mg to 100mg daily in a divided dose. Potential side effects with bethanechol include diarrhea, cramps, and diaphoresis. No reports have evaluated or suggested the efficacy of bethanechol for treating SSRI-induced sexual side effects.

Gingko biloba is an herbal extract reported to reverse a variety of sexual dysfunctions associated with antidepressants. Information about gingko's ability in this regard is derived from the experience of 1 clinician presenting a large case series.[74] The response rate was greater than 80%, with doses ranging from 60mg twice daily to 120mg twice daily (mean daily dose, 207mg). Reported side effects include gastrointestinal upset, lightheadedness, and stimulation effects. Because gingko may inhibit platelet-activating factor, caution should be used in considering its use by any patient with a bleeding diathesis. The mechanism by which gingko might alleviate sexual dysfunction is unknown.

Treating sexual dysfunction associated with antidepressant medication is an important but relatively unexplored issue in psychopharmacology. A thoughtful diagnostic evaluation, including examination of the possibility that some sexual difficulties attributed to the antidepressant may have another etiology, is mandatory. Should the sexual dysfunction be reasonably attributed to the antidepressant, both general and antidote treatments should be considered using an individualized approach.

References

Gitlin MJ: Psychotropic medications and their effects on sexual dysfunction: Diagnosis, biology and treatment approaches. J Clin Psychiatry 55:406-413, 1994.

Gitlin MJ: Sexual side effects of psychotropic medications, in Dunner DL, Rosenbaum JF (eds): Psychiatric Clin North Am Annual Drug Ther 4:61-90, 1997.

Nofzinger EA, Thase ME, Reynolds CF, et al: Sexual function in depressed men: Assessment by self-report, behavioral and nocturnal penile tumescence measures before and after treatment with cognitive behavior therapy. Arch Gen Psychiatry 40:24-30, 1993.

Howell JR, Reynolds CF, Thase ME, et al: Assessment of sexual function, interest and activity in depressed men. J Affect Disord 13:61-66, 1987.

Roose SP, Glassman AH, Walsh BT, et al: Reversible loss of nocturnal penile tumescence during depression: A preliminary report. Neuropsychobiology 8:284-288, 1982.

Thase ME, Nofzinger E, Reynolds CF, et al: Effect of antidepressant treatment on sexual function in depressed men. Psychopharmacol Bull 30:83, 1994.

Thase M, Reynolds CF, Glanz LM, et al: Nocturnal penile tumescence in depressed men. Am J Psychiatry 144:89-92, 1987.

Thase ME, Reynolds CF, Jennings JR, et al: Nocturnal penile tumescence is diminished in depressed men. Biol Psychiatry 24:33-46, 1988.

Thase ME, Reynolds CF, Jennings R, et al: Diminished nocturnal tumescence in depression: A replication study. Biol Psychiatry 31:1136-1142, 1992.

Nathan S: The epidemiology of the DSM-III psychosexual dysfunctions. J Sex Marital Ther 12:267-281, 1986.

Sadock VA: Normal human sexuality and sexual dysfunctions, in Kaplan HI, Sadock BJ (eds): Comprehensive Textbook of Psychiatry, ed 6. Baltimore, Williams & Wilkins, 1995, pp 1295-1321.

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Ashton AK, Hamer R, Rosen R: Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: A large-scale retrospective study of 596 psychiatric outpatients. J Sex Marital Ther 23(3):165-175, 1997.

Balon R, Yeragani VK, Pohl R, et al: Sexual dysfunction during antidepressant treatment. J Clin Psychiatry 54:209-212, 1993.

Monteiro WO, Noshirvani HF, Marks IM, et al: Anorgasmia from clomipramine in obsessive-compulsive disorder: A controlled trial. Br J Psychiatry 151:107-112, 1987.

Gartrell N: Increased libido in women receiving trazodone. Am J Psychiatry 143:781-782, 1986.

Modell JG: Repeated observations of yawning, clitoral engorgement, and orgasm associated with fluoxetine administration. J Clin Psychopharmacol 9:63-65, 1989. Letter.

Smith DM, Levitte SS: Association of fluoxetine and return of sexual potency in three elderly men. J Clin Psychiatry 54:317-319, 1993.

Sullivan G: Increased libido in three men treated with trazodone. J Clin Psychiatry 49:202-203, 1988.

Ellison JM: Exercise-induced orgasms associated with fluoxetine treatment of depression. J Clin Psychiatry 57:12 596-597, 1996.

Montejo AL, Llorca G, Izquierdo JA, et al: Sexual dysfunction with SSRIs: A comparative analysis. New Research Programs and Abstracts of the Annual Meeting of the American Psychiatric Association, New York, 1996, p 266. Abstract NR717.

Physician's Desk Reference. Montvale, NJ, Medical Economics Co., 1995.

Hsu JH, Shen WW: Male sexual side effects associated with antidepressants: A descriptive clinical study of 32 patients. Int J Psychiatry Med 25:191-201, 1995.

Shen WW, Hsu JH: Female sexual side effects associated with selective serotonin reuptake inhibitors: A descriptive clinical study of 33 patients. Int J Psychiatry Med 25:239-248, 1995.

Modell JG, Katholi CR, Modell JD, et al: Comparative sexual side effects of bupropion, fluoxetine, paroxetine and sertraline. Clin Pharmacol Ther 61:476-487, 1997.

Herman JB, Brotman AW, Pollack MH, et al: Fluoxetine-induced sexual dysfunction. J Clin Psychiatry 51:25-27, 1990.

Jacobsen FM: A double-blind placebo-controlled trial of yohimbine for treatment of SRI-induced sexual dysfunction. New Research Program and Abstracts of the Annual Meeting of the American Psychiatric Association, New York, 1996, p 266. Abstract NR716.

Beasley CM, Bosomworth JC, Wernicke JK: Fluoxetine: Relationships among dose, response, adverse events, and plasma concentrations in the treatment of depression. Psychopharmacol Bull 26:18-24, 1990.

Walker PW, Cole JO, Gardner EA, et al: Improvement in fluoxetine-associated sexual dysfunction in patients switched to bupropion. J Clin Psychiatry 54:459-465, 1993.

Herran A, Palacios-Araus L, Vazquez-Barquero JL, et al: Sexual dysfunction associated with serotonin specific reuptake inhibitors. J Clin Psychopharmacol 17(1):67-68, 1997.

Gitlin MJ, Suri R: Management of side-effects of SSRIs and newer antidepressants, in Balon R (ed): Practical Management of Psychotropic Drug Side-Effects. New York, Marcel Dekker. In press.

Reimherr FW, Chouinard G, Cohn CK, et al: Antidepressant efficacy of sertraline: A double-blind, placebo- and amitriptyline-controlled multicenter comparison study in outpatients with major depression. J Clin Psychiatry 51(suppl B):S18-S27, 1990.

Labbate LA, Grimes JB, Hines AH, et al: Sexual dysfunction induced by SRIs. Abstracts of the Annual Meeting of the American Psychiatric Association, San Diego, 1997, pp 15-16. Paper Session # 12.

Ferguson JM, Shrivastava RK, Stahl SM, et al: Effect of double-blind treatment with nefazodone or sertraline on reemergence of sexual dysfunction in depressed patients. New Program and Abstracts of the Annual Meeting of the American Psychiatric Association, New York, 1996, p 164. Abstract NR358.

Sovner R: Anorgasmia associated with imipramine but not desipramine: Case report. J Clin Psychiatry 44:346-346, 1983.

Shen WW: Female orgasmic inhibition by amoxapine. Am J Psychiatry 139:1220-1221, 1982. Letter.

Rothschild AJ: Selective serotonin reuptake inhibitor-induced sexual dysfunction: Efficacy of a drug holiday. Am J Psychiatry 152:1514-1516, 1995.

Nemeth A, Arato M, Treuer T, et al: Treatment of fluvoxamine-induced anorgasmia with a partial drug holiday. Am J Psychiatry 153:1365, 1996.

Balon R: Drug holidays to counter sexual dysfunction. Am J Psychiatry 153:1370-1371, 1996.

Schatzberg AF, Haddad P, Kaplan EM, et al: Serotonin reuptake inhibitor discontinuation syndrome: A hypothetical definition. J Clinical Psychiatry 58(suppl 7):S5-S10, 1997.

Coupland NJ, Bell CJ, Potokar JP: Serotonin reuptake inhibitor withdrawal. J Clin Psychopharmacol 16:356-362, 1996.

Goldbloom DS, Kennedy SH: Adverse interaction of fluoxetine and cyproheptadine in two patients with bulimia nervosa. J Clin Psychiatry 52:261-262, 1991.

McCormick S, Olin J, Brotman AW: Reversal of fluoxetine-induced anorgasmia by cyproheptadine in two patients. J Clin Psychiatry 51:383-384, 1990.

Zajecka J, Fawcett J, Schaff M, et al: The role of serotonin in sexual dysfunction: Fluoxetine-associated orgasm dysfunction. J Clin Psychiatry 52:66-68, 1991.

Feder R: Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients. J Clin Psychiatry 52:163-164, 1991.

Katz RJ, Rosenthal M: Adverse interaction of cyproheptadine with serotonergic antidepressants. J Clin Psychiatry 55:314-315, 1994.

Price J, Grunhaus LJ: Treatment of clomipramine-induced anorgasmia with yohimbine: A case report. J Clin Psychiatry 51:32-33, 1990.

Zubieta JK, Demitrack MA: Depression after cyproheptadine: MAO treatment. Biol Psychiatry 31:1172-1178, 1992. Letter.

Norden MJ: Buspirone treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors. Depression 2:109-112, 1994.

Reynolds RD: Sertraline-induced anorgasmia treated with intermittent nefazodone. J Clin Psychiatry 58:89, 1997.

Aizenberg D, Gur S, Zemishlany Z, et al: Mianserin, a 5-HT2a/2c and alpha 2 antagonist, in the treatment of sexual dysfunction induced by serotonin reuptake inhibitors. Clin Neuropharmacol 20(3):210-214, 1997.

Balogh S, Hendricks SE, Kang J: Treatment of fluoxetine-induced anorgasmia with amantadine. J Clin Psychiatry 53:212-213, 1992. Letter.

Shrivastava RK, Shrivastava S, Overweg N, et al: Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors. J Clin Psychopharmacol 15:83-84, 1993.

Balon R: Intermittent amantadine for fluoxetine-induced anorgasmia. J Sex Marital Ther 22: 290-292, 1996.

Bitran D, Hull EM: Pharmacological analysis of male rat sexual behavior. Neurosci Biobehav Rev 11:365-389, 1987.

Segraves RT: Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry 46:275-284, 1989.

Labbate LA, Pollack MH: Treatment of fluoxetine-induced sexual dysfunction with bupropion: A case report. Ann Clin Psychiatry 6:13-15, 1994.

Ashton AK, Rosen RC: Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction: A retrospective study. J Clin Psychiatry 59:112-115, 1998.

Kraupl TF: Loss of libido in depression. BMJ 1:305, 1972.

Bartlik BD, Kaplan PM, Kocsis JH, et al: Stimulants for SSRIs-induced sexual dysfunction. New Research Program and Abstracts of the Annual Meeting of the American Psychiatric Association, New York, 1996, p 246. Abstract NR644.

Gitlin MJ: Treatment of sexual side effects with dopaminergic agents. J Clin Psychiatry 56:24, 1995.

Bartlik BD, Kaplan PM, Kaplan HS: Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin reuptake inhibitors. J Sex Marital Ther 21:264-271, 1995.

Feighner JP, Herbstein J, Damlouji NF: Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression. J Clin Psychiatry 46:206-209, 1985.

Morales A, Condra M, Owen JA, et al: Is yohimbine effective in the treatment of organic impotence? Results of a controlled trial. J Urol 137:1168-1172, 1987.

Nelson RP: Nonoperative management of impotence. J Urol 139:2-3, 1988.

Reid K, Morales A, Harris C, et al: Double-blind trial of yohimbine in treatment of psychogenic impotence. Lancet 2:421-423, 1987.

Hollander E, McCarley A: Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry 53(6):207-209, 1992.

Jacobsen FM: Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry 53:119-122, 1992.

Price J, Grunhaus LJ: Treatment of clomipramine-induced anorgasmia with yohimbine: A case report. J Clin Psychiatry 51:32-33, 1990.

Gross MD: Reversal by bethanechol of sexual dysfunction caused by anticholinergic antidepressants. Am J Psychiatry 139:1193-1194, 1982.

Sorscher SM, Dilsaver SC: Antidepressant-induced sexual dysfunction in men: Due to cholinergic blockade? J Clin Psychopharmacol 6:53-55, 1986.

Wandzel L, Falicki Z: Reversal by bethanechol of imipramine-induced ejaculatory dysfunction. Am J Psychiatry 144:1243-1244, 1987. Letter.

Yager J: Bethanechol chloride can reverse erectile and ejaculatory dysfunction induced by tricyclic antidepressants and mazindol: Case report. J Clin Psychiatry 47:210-211, 1986.

Cohen AJ: Gingko biloba for drug-induced sexual dysfunction. Abstracts of the Annual Meeting of the American Psychiatric Association, San Diego, Calif., 1997, p 15.


Medscape Psychiatry & Mental Health eJournal. 1998;3(3) © 1998 Medscape


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## Rip

Most of these antidotes either have serotonin-blocking properties (especially 5HT-2 antagonistic effects) or augment catecholamine activity, especially that of dopamine. The antiserotonergic antidotes are cyproheptadine, buspirone, nefazodone, and mianserin. Medications enhancing dopaminergic tone include amantadine, bupropion, and stimulants, with yohimbine showing noradrenergic effects. Among the reported antidotes, the only 2 without antiserotonergic effects or catecholaminergic activity are gingko biloba and urecholine.

Cyproheptadine is an antihistamine with antiserotonergic properties that has been reported for over a decade to reverse antidepressant-induced sexual dysfunction. Only case reports and case series attest to its efficacy.[13,42-44] Effective doses range from 2mg to 16mg. In the most recent and largest case series, 12 of 25 patients described improvement in sexual function when treated with cyproheptadine (mean dose, 8.6mg).[13] Anorgasmia is the sexual side effect most often reported to be alleviated by cyproheptadine. Cyproheptadine is effective when taken either on an as-needed basis (typically, 1 to 2 hours before intercourse) or on a regular basis.

However, cyproheptadine's utility is often limited by its potential side effects. Excessive sedation and the reversal of the therapeutic effect of the antidepressant are major problems that limit its usefulness. Effectively treated depression and bulimic symptoms have been reported to reemerge soon after cyproheptadine was started.[42,45-48] This reversal of therapeutic effects is itself reversible upon discontinuation.

Buspirone is a serotonin-IA partial agonist typically prescribed to treat persistent anxiety. One case series reported that buspirone reversed both decreased sexual interest and orgasmic dysfunction caused by SSRIs.[49] Most patients using buspirone to treat sexual dysfunction take it daily. The dosage is the same as that used for anxiety (15mg to 60mg daily). The mechanism of action of buspirone in treating sexual dysfunction may be reduction of serotonergic tone via stimulation of presynaptic autoreceptors or the alpha-2 antagonist effects of one of buspirone's major metabolites, 1-pyrimidinylpiperazine.

Nefazodone and mianserin are antidepressants with strong postsynaptic blocking properties. In one case report, nefazodone 150mg taken 1 hour prior to sexual activity completely reversed sertraline-induced anorgasmia.[50] Mianserin, an antidepressant with 5HT-2 and alpha-2 adrenergic antagonist properties, is available in many countries but not in the US. It has been reported to reverse serotonin reuptake inhibitor-induced sexual dysfunction in 9 of 15 patients.[51] Mirtazapine is similar in its biological activity to mianserin and might also be effective in reversing sexual side effects. No case reports or case series have yet been published attesting to this, although clinicians have described such an effect. The putative capacity of mianserin and mirtazapine to reverse sexual side effects can be attributed either to their serotonergic activity or presynaptic alpha-2 activity.

Amantadine, a dopamine agonist, is used both as an antiviral agent and as a treatment for Parkinson's disease. It has been shown in a number of small case series to reverse anorgasmia.[13,52-54] Reported effective doses have ranged between 100mg to 400mg taken either on a daily or as-needed basis. In the most recent case series, 8 (42%) out of 19 patients with SSRI-induced sexual dysfunction improved with amantadine 200mg daily.[13] Given dopamine's consistent effect as a neurotransmitter involved in sexual arousal, a number of other dopamine agonists have been explored as treatments for sexual side effects.[2,55,56]

Bupropion is another commonly touted antidote for SSRI-induced sexual dysfunction.[57,58] It is assumed that the mechanism of action by which bupropion reverses sexual side effects is its weak dopamine agonism. The evidence for bupropion's efficacy is scant, except for unpublished, anecdotal reports, one case report,[57] and a case series[58] in which 31 (66%) of 47 patients showed improvement when bupropion was added to the regimen along with the serotonergic antidepressant. Most patients (18/31) with a successful outcome responded to as-needed use of bupropion 75mg to 150mg. Libido, arousal, and orgasmic difficulties were all effectively reversed. Fifteen percent of treated patients stopped taking bupropion because of its stimulation side effects. It is unclear whether bupropion doses need to be somewhat lower than usual when added to fluoxetine or paroxetine, to compensate for pharmacokinetic interactions resulting in increased bupropion levels.[59]

Stimulants, such as methylphenidate, D-amphetamine, and pemoline, are reported to reverse a variety of sexual side effects caused by SSRIs or MAOIs.[60-62] Low doses of 10mg-25mg of methylphenidate or D-amphetamine have been effective. One should add stimulants to an MAOI with extreme caution because of the risk of a hypertensive episode. However, use of an MAOI/stimulant combination has been shown to be safe in a case series.[63] SSRI/stimulant combinations show no similar risks.

Yohimbine is available with or without a prescription (and with unclear purity) in health food stores. It is an alkaloid from the bark of Corynanthe yohimbi (family, Rubiaceae) and has been used for decades to reverse erectile dysfunction.[64-66] Its efficacy in treating sexual dysfunction may be associated with its ability to block presynaptic alpha-2 adrenergic sites, leading to enhanced adrenergic tone.[65] A variety of sexual side effects have been reported to be alleviated by yohimbine in doses ranging from 2.7mg to 16.2mg daily, prescribed either on a regular 5.4mg 3 times daily basis or on an as-needed basis with single doses up to 16.2mg.[13,67-69] In the largest case series, 17 (81%) of 21 patients showed improvement of sexual side effects when treated with yohimbine (mean dose, 16.2mg).[12]

Typical side effects associated with yohimbine include anxiety, nausea, flushing, urinary urgency, and sweating. Yohimbine has been the subject of the only double-blind, placebo-controlled study to evaluate treatment of sexual dysfunction occurring as a drug side effect.[27] Unfortunately, the placebo effect was marked, showing a minimal drug-placebo difference with yohimbine given at a dose of 5.4mg 3 times daily. Yohimbine is also available in lower potency without a prescription. The purity, potency, and safety of these preparations, however, are unknown.

Bethanechol is a cholinergic agonist that has occasionally been useful in reversing sexual dysfunction associated with TCAs and MAOIs.[70-73] Typical doses are 10mg to 20mg as needed or 30mg to 100mg daily in a divided dose. Potential side effects with bethanechol include diarrhea, cramps, and diaphoresis. No reports have evaluated or suggested the efficacy of bethanechol for treating SSRI-induced sexual side effects.

Gingko biloba is an herbal extract reported to reverse a variety of sexual dysfunctions associated with antidepressants. Information about gingko's ability in this regard is derived from the experience of 1 clinician presenting a large case series.[74] The response rate was greater than 80%, with doses ranging from 60mg twice daily to 120mg twice daily (mean daily dose, 207mg). Reported side effects include gastrointestinal upset, lightheadedness, and stimulation effects. Because gingko may inhibit platelet-activating factor, caution should be used in considering its use by any patient with a bleeding diathesis. The mechanism by which gingko might alleviate sexual dysfunction is unknown.

Treating sexual dysfunction associated with antidepressant medication is an important but relatively unexplored issue in psychopharmacology. A thoughtful diagnostic evaluation, including examination of the possibility that some sexual difficulties attributed to the antidepressant may have another etiology, is mandatory. Should the sexual dysfunction be reasonably attributed to the antidepressant, both general and antidote treatments should be considered using an individualized approach.


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## thqmas

Leotis said:


> Annnnnnnd I just noticed this thread was over 2 yrs old.
> 
> Sorry for the necropost!



lol, it's ok, I guess he needed to be resurrected.


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## gymrat827

brought back from the dead.


As long as the issue is the same, no issue discussing the same issue in the same thread.  Theres already lots of good info here.


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## MS1605

Am I the only one on here that actually welcomes this? 

I get more pleasure out of pleasing a girl for hours then I do busting a nut in 15 minutes and being done.


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## PillarofBalance

MS1605 said:


> Am I the only one on here that actually welcomes this?
> 
> I get more pleasure out of pleasing a girl for hours then I do busting a nut in 15 minutes and being done.



Obviously not married.

My ex wife would actually use the words "hurry up" then when finally I would I would get "good get off." 

Current wife is much smarter. She just makes things a little more interesting to make it happen.

Either way we ain't going at it for hours.


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## MS1605

PillarofBalance said:


> Obviously not married.



5 years in april and im 28 YO...


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## PillarofBalance

MS1605 said:


> 5 years in april and im 28 YO...



Must just be my small pp


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## Beedeezy

MS1605 said:


> Am I the only one on here that actually welcomes this?
> 
> I get more pleasure out of pleasing a girl for hours then I do busting a nut in 15 minutes and being done.


Pleasing a girl for *hours*? No thank you, I work out hard enough and start getting hamstring and quad cramps as it is. Eat the puussy right and get her off before you even go in. That way you both leave happy.


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## MS1605

Beedeezy said:


> Pleasing a girl for *hours*? No thank you, I work out hard enough and start getting hamstring and quad cramps as it is. Eat the puussy right and get her off before you even go in. That way you both leave happy.



Hours...

Anything under an hour and Im very not fulfilled.


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## transcend2007

Funny .. this thread goes back to 2012 ... and the original posts are dead on .... masturbating to porn causes delayed orgasm ... on or off cycle ... if you want to enjoy sex 10X as much as you do now ... stop all masturbation for 2 weeks ... your entire perspective will change ... you'll look at woman differently ... you actually want sex far more .. I'm in my 50's and have masturbated to porn  over 5,000 times ... and over the past 3 months I have been trying to quit ... now realizing that a better goal is to manage it (do it way the F less) ... less masturbation cures delayed orgasm ... and create far great drive and enjoyment of sex ... yes you will cum faster .. so as someone said above learn to enjoy eating pussy ... your woman will love you for that .. also learn the leg over missionary sex technique .. even you guys with tiny penises (and everyone else as well) will give your woman a fvching orgasm ...


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## Adrenolin

After Tren'n for a while,  it makes it hard to bust even from jerkin it.. in fact I've had several times where both arms gave out before I got my nut


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## Skullcrusher

I just let her keep sucking.


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