Posted by Ame Sans Vie on March 23, 2004, at 9:42:26
In reply to Dopamine Agonists Mirapex, posted by bertill33 on March 23, 2004, at 3:57:11
> I am 25 have struggled with depression for 5 terrible years. I have been able to get out of major depression but even on meds that do not cause sexual problems I have no sex drive or function at all. It is getting extremly worrisome. I am hearing I should try mirapex or even deprenyl. Who has some good experience with dopamine based drugs. Wellbutrin did nothing for me. What is even worse is I have little motivation or emotional response. But the major depressive symptoms of pain, sadness and misery are treated.
I have had (and continue to have) extremely positive experiences with several dopaminergic drugs. I've never used one to combat drug-induced sexual dysfunction simply because I either was not able to tolerate the meds that typically cause this side effect (i.e. Paxil, Zoloft, Luvox, Celexa, Lexapro, Anafranil, Elavil, Sinequan, Tofranil, Asendin, and Ludiomil [Prozac was fine for me, though]) or they didn't work (i.e. Nardil and Effexor). But I'm very familiar with these drugs' usefulness, or lack thereof, in treating akinesia and anhedonia.
You mentioned Mirapex -- my experience with it was wonderful at first. It definitely provided me with a ton of motivation and a great sense of purpose. But after a couple months or so, I began having the dreaded sleep attacks that King Vultan alluded to in his post. Maybe adding on Provigil or another CNS stimulant would have helped, but I guess I'll never know now -- my medication regimen at the moment is perfect. I took 1.5mg three times daily. You have to titrate your dose upward *very* slowly, unless you want to be lying on your bathroom floor with the most horrible, unrelenting nausea ever for six hours like I did several times when just beginning treatment. From what I understand Requip, which acts very similarly to Mirapex (i.e. it agonizes the same dopamine receptors), is not a whole lot different. And from what I hear, the same usually goes for Dostinex (cabergoline) and Parlodel (bromocriptine), but they aren't typically very useful for increasing motivation as they aren't as selective about which dopamine receptors they target.
Eldepryl (selegiline/deprenyl) *may* provide some benefit... theoretically. But I've never heard of it being used for sexual dysfunction. However, it definitely has the potential to increase motivation. Aside from increased dopamine levels, there may be a minor added bonus regarding one of selegiline's active metabolites -- levoamphetamine. While not nearly as potent as dextroamphetamine, it may provide *some* benefit. It's also metabolized to levomethamphetamine (aka levmetamfetamine, the stuff in Vick's Inhalers) and levodesmethylselegiline. You just need to keep the dose low -- some say don't go above 5mg, some say 10mg, some say 15mg... I think the general consensus is 5-10mg. At that dosage it's selective for inhibition of MAO-B and thus doesn't require the restrictions of a nonselective inhibitor of MAO; higher doses inhibit MAO-types A and B. Also, it's very important to note that if you're taking any antidepressant which increases serotonergic activity (even at MAO-B-selective doses), combination with selegiline may cause potentially fatal serotonin syndrome.
One important drug to consider is Symmetrel (amantadine). It is an antiviral and Parkinson's drug that actually causes *release* of dopamine. This has potential to be extremely helpful.
Sinemet (levodopa/carbidopa) may be worth considering if nothing else works.
The last of the truly dopaminergic drugs would be dextroamphetamine (Dexedrine/Dexedrine Spansules/DextroStat), dextroamphetamine sulfate/amphetamine sulfate/dextroamphetamine saccharate/amphetamine aspartate combo (Adderall/Adderall XR), methamphetamine (Desoxyn), methylphenidate (Ritalin/Ritalin SR/Ritalin LA/Methylin/Metadate SR/Metadate CD/Concerta), magnesium pemoline (Cylert/Cylert Chewable), benzphetamine (Didrex), phendimetrazine (Bontril/Bontril SR), phentermine (Adipex-P/Fastin/Ionamin), and diethylpropion (Tenuate/Tenuate Dospan). These all act on norepinephrine as well (well, maybe not pemoline... I'm still not sure if anyone knows exactly how it works). Also, the amphetamines has a small effect on serotonin and methamphetamine has a larger serotonergic effect. As far as I know, methylphenidate doesn't affect serotonin (at least directly). Quite a few people find these helpful with sexual dysfunction, and many, MANY people find them (especially amphetamine/methamphetamine) extremely motivating and energizing. Of course, your doctor would probably save these as a last resort, considering the high abuse potential of most of them. I currently take 60mg Adderall XR each morning and 7.5mg Desoxyn four times daily. I've also tried dextroamphetamine (DextroStat -- 15mg three times daily and Dexedrine Spansules -- 30mg each morning) as well as methylphenidate (in the form of Ritalin -- 20mg four times daily), but found it incredibly dull, personally. Pemoline is one I haven't tried, primarily because it can cause very serious liver problems, and also because I hear very few reports of success with this drug. It is only categorized under Schedule IV of the CSA though (same as the benzodiazepines, some mixed agonist/antagonist narcotics, long-acting barbiturates, various sedative/hypnotics, phentermine, and diethylpropion), so some doctors may prescribe it more readily -- you just have to have occasional blood work done to test your hepatic function. The rest of the drugs are diet drugs and for some odd reason many psychiatrists won't consider them, but they can be very effective stimulants and are all (according to the DEA, anyway) less likely to be abused than amphetamines or methylphenidate. Benzphetamine and phendimetrazine are Schedule III (along with some barbiturates, narcotic/non-narcotic combination drugs, dronabinol, and random other things); phentermine and diethylpropion are Schedule IV.
BuSpar has been purported to be helpful to some with sexual dysfunction caused by medication, but I haven't heard much from others about its use in this situation. It has a mild dopaminergic effect, but primarily affects serotonin by antagonizing 5-HT1a receptors.
Bethanechol (Urecholine) has also helped some people, though I think it's mainly used when the sexual dysfunction is MAOI-induced.
Cyproheptadine (Periactin) is an antihistamine that temporarily decreases the activity of serotonin -- many people find this helpful to take as-needed before sexual activity when taking serotonin-enhancing drugs. It does carry with it the possibility of temporarily bringing back your original symptoms since it in essence reverses the effect of the antidepressant. Oh, and it can be sedating -- sex is no fun when you're asleep. :-)
Yohimbine is an alpha-1 (and perhaps alpha-2 as well) adrenoreceptor agonist. It used to be prescribed often for impotence. It has a mild stimulant/euphoriant effect as well. You can get yohimbine by prescription, or you can buy standardized yohimbe extract capsules or liquid in health-food stores, GNC, etc. 5.4mg of yohimbine is often an effective dose. Consult your doctor before going out and trying it on your own though.
The last thing I can think of at the moment is gingko biloba. I've heard tell of it being used for this, but I haven't heard firsthand experiences. It's also available at most places you can buy supplements.
Hope this helped some (and sorry for being so long-winded! lol).
~~Michael
poster:Ame Sans Vie
thread:327293
URL: http://www.dr-bob.org/babble/20040319/msgs/327338.html