The other option for treatment of sexual dysfunction includes lowering dose of the anti depressant. This is often a tricky option as most antidepressants have a fine line between effectiveness and no effect. Lowering the dose may reduce sexual dysfunction but may also decrease effectiveness of the drug- most patients are reluctant to try this option.
The other option includes adding another medication to counter the sexual dysfunction or one can switch to another anti depressant with a lower incidence of side effects.
One of the alternative drugs, which has often been prescribed to counter sexual dysfunction is bupropion. Bupropion is an effective anti depressant and does not cause a change in sex drive or weight gain. Bupropion, also sold as Wellbutrin, is an atypical antidepressant that does work well. There are several studies which have shown that bupropion can reverse sexual dysfunction in normal healthy individuals. The improvements were observed in terms of arousal, orgasm, and overall sexual satisfaction. However, it was observed that sexual benefits usually were more prominent at a higher dose (300 mg). A lower dose (150 mg) was not much different compared to placebo
However, at high doses, bupropion often has many side effects including inability to sleep, anxiety, and intense headaches. Most people stop taking the drug because of headaches and mouth dryness.
Another drug recommended to counter the sexual dysfunction is to use selegeline. This anti parkinsonian drug when applied as a patch (6 mg) does work as an antidepressant and has minimal sexual side effects.
Tuesday, April 14, 2009
How can I improve my libido while taking an antidepressant?
A fairly high number of individuals who take anti depressant medications complain that they have decreased libido, lack of sexual desire, failure to achieve an erection or inability to ejaculate. The exact numbers of people who have sexual dysfunction from anti depressant medications is not known, but anecdotal reports suggest that the numbers are high.
The sexual dysfunction that occurs with anti depressants has been known for decades and is somewhat difficult to resolve. Almost every class of anti depressant drugs has been associated with sexual dysfunction and lowered sexual excitement. The sexual dysfunction generally occurs after the patient has been on the drug for a few months. In some cases, the sexual dysfunction improves with time, but in many cases, the problem only gets worse. These sexual side effects while not life threatening, seriously affect an individual’s lifestyle. Often the patients solve the problem by refusing to take their medication. This lack of compliance then leads to worsening of the mental health problem.
So how can this problem be resolved?
When an individual first complains of sexual dysfunction, a wait and see approach may be appropriate because some individuals will improve with time. The wait and see period should not be more than 2-4 months. If the patient has not improved by then, he/she is unlikely to improve.
The sexual dysfunction that occurs with anti depressants has been known for decades and is somewhat difficult to resolve. Almost every class of anti depressant drugs has been associated with sexual dysfunction and lowered sexual excitement. The sexual dysfunction generally occurs after the patient has been on the drug for a few months. In some cases, the sexual dysfunction improves with time, but in many cases, the problem only gets worse. These sexual side effects while not life threatening, seriously affect an individual’s lifestyle. Often the patients solve the problem by refusing to take their medication. This lack of compliance then leads to worsening of the mental health problem.
So how can this problem be resolved?
When an individual first complains of sexual dysfunction, a wait and see approach may be appropriate because some individuals will improve with time. The wait and see period should not be more than 2-4 months. If the patient has not improved by then, he/she is unlikely to improve.
Thursday, April 9, 2009
PICA- eating crap part 2
Once the patient has recovered from surgery, a consultation is made with a psychiatrist to evaluate the individual. Close monitoring of the patient is necessary. Many individuals continue to persist with this bizarre eating habit even after surgery.
While pica is common in childhood and occasionally there may be just one episode, there are developmentally delayed children who do persist with this eating habit. The treatment of pica is behavior management.
Close supervision is required of children known to put things in their mouth. Unfortunately developmentally disturbed children fare well with psychotherapy and many require medications. Healthy adults generally recover spontaneously or with some type of behavior management.
While pica is common in childhood and occasionally there may be just one episode, there are developmentally delayed children who do persist with this eating habit. The treatment of pica is behavior management.
Close supervision is required of children known to put things in their mouth. Unfortunately developmentally disturbed children fare well with psychotherapy and many require medications. Healthy adults generally recover spontaneously or with some type of behavior management.
PICA- eating crap
Pica is an exotic name for a mental disorder which is characterized by persistent eating of non food substances such as hair, paint, paper, soil, pencils, metal pins, etc. However, some individuals may eat foods like raw rice, excess salt or sugar, flour, etc. The disorder is quite common and is estimated to occur in 4-25% of the population. A fascinating observation is that the majority will continue to eat only one these non nutritive items during the course of the disorder. Of course, there are others who will eat multiple items.
Pica is most commonly observed in the 1st-3rd decade of life. It may occur early in children but is often mistaken for just children being foolish. To make a diagnosis of Pica, one must persist with these eating habits for more than one month at an age where such a habit would be considered developmentally unsuitable.
Most individuals who develop Pica are healthy individuals. Pica has often been reported during pregnancy where females suddenly develop a taste for bizarre items. The disorder is also seen in wide variety of mental disturbed individuals, esp. those with dementia and some types of schizophrenia.
The majority of healthy individuals eat the non nutritive substances secretly and often are brought to hospital with symptoms of bowel obstruction. Some children eat plaster from the walls and in the past, lead poisoning was a common emergency admission. A number of individuals require surgery because the foreign material may have either blocked the bowel or caused a perforation in the stomach. At surgery, the diagnosis of pica is usually made by the findings of hair, soil or plastic straws, etc.
Pica is most commonly observed in the 1st-3rd decade of life. It may occur early in children but is often mistaken for just children being foolish. To make a diagnosis of Pica, one must persist with these eating habits for more than one month at an age where such a habit would be considered developmentally unsuitable.
Most individuals who develop Pica are healthy individuals. Pica has often been reported during pregnancy where females suddenly develop a taste for bizarre items. The disorder is also seen in wide variety of mental disturbed individuals, esp. those with dementia and some types of schizophrenia.
The majority of healthy individuals eat the non nutritive substances secretly and often are brought to hospital with symptoms of bowel obstruction. Some children eat plaster from the walls and in the past, lead poisoning was a common emergency admission. A number of individuals require surgery because the foreign material may have either blocked the bowel or caused a perforation in the stomach. At surgery, the diagnosis of pica is usually made by the findings of hair, soil or plastic straws, etc.
Wednesday, April 8, 2009
Emsam; An Anti depressant which is applied as a patch. Part 2
Emsam patch is changed once daily at the same time. The patch does tend to get stick to the skin rather firmly and most people need to apply an adhesive remover or mineral oil to get it off. The new patch should always be rotated a new skin site. Once the patch is applied firm pressure with the palm should be applied for a few seconds to ensure proper contact with skin. Emsam comes in various doses and it is recommended that depressed patients start with the 6mg/24 hr formula. At this does level there are no dietary restrictions. However, if the higher doses of 9 and 12 mg are used every 24 hrs, dietary restrictions do apply.
So does Emsam work?
Several studies have shown that compared to placebo, Emsam is a superior anti depressant. At present Emsam is used to treat clinical depression and has even been found to be useful in patients who have failed to respond to other SSRI and tricyclic anti depressants. The most common side effect is at the application site and is redness caused by the adhesive tape. Other rare side effects include headache, lack of sleep, diarrhea dry mouth, and gastric upset. These side effects occur in less than 5-10 percent of individuals. There are a whole list of drugs which cannot be taken while taking Emsam and the list is no different when one takes the other anti depressants.
Emsam has been on the market for only 2 years to treat depression but the results indicate that it does help some individuals who have failed to respond to other anti depressants. So far it has remained a decent drug with not as many side effects as the tricyclics. Furthermore, weight gain has not been a problem with this agent. How long it will continue to work in depressed patients remains to be seen.
So does Emsam work?
Several studies have shown that compared to placebo, Emsam is a superior anti depressant. At present Emsam is used to treat clinical depression and has even been found to be useful in patients who have failed to respond to other SSRI and tricyclic anti depressants. The most common side effect is at the application site and is redness caused by the adhesive tape. Other rare side effects include headache, lack of sleep, diarrhea dry mouth, and gastric upset. These side effects occur in less than 5-10 percent of individuals. There are a whole list of drugs which cannot be taken while taking Emsam and the list is no different when one takes the other anti depressants.
Emsam has been on the market for only 2 years to treat depression but the results indicate that it does help some individuals who have failed to respond to other anti depressants. So far it has remained a decent drug with not as many side effects as the tricyclics. Furthermore, weight gain has not been a problem with this agent. How long it will continue to work in depressed patients remains to be seen.
Emsam; An Anti depressant which is applied as a patch
Emsam was released a few years ago as transdermal patch for the treatment of depression. Emsam is Selegeline. Selegeline is a monoamine oxidase inhibitor (MAOI) used in the treatment of Parkinson’s disease and has been around for more than a decade. It was observed that many parkinsonian patients who were treated with selegeline had improved mood and spirits. Further work revealed that selegeline did improve mood in patients with depression.
Monoamine oxidase inhibitors have been used to treat depression for more than half a century and are some of the oldest drugs in the pharmacopeia. While the drugs are effective, the major problem with MAOI is that people have severe dietary restrictions otherwise complications can occur. However, with Emsam, the drug is delivered via the skin and the same type of dietary restrictions are not needed (esp at the low dose).
Emsam is slow absorbed through the skin and enters the brain where it works in depressed patients. The biggest advantage of Emsam is that because it does not go via the stomach and avoids the liver, it has a very low risk of inducing problems which were previously seen with older MAOI. The risk of high blood pressure with this formulation is less than 1 percent.
Emsam is usually applied as patch on the skin. When the 6 mg patch is applied every 24 hours there are no dietary restrictions. The drug is slowly absorbed through the skin continuously for 24 hours and this keeps level of Emsam fairly constant thought out the day.
Monoamine oxidase inhibitors have been used to treat depression for more than half a century and are some of the oldest drugs in the pharmacopeia. While the drugs are effective, the major problem with MAOI is that people have severe dietary restrictions otherwise complications can occur. However, with Emsam, the drug is delivered via the skin and the same type of dietary restrictions are not needed (esp at the low dose).
Emsam is slow absorbed through the skin and enters the brain where it works in depressed patients. The biggest advantage of Emsam is that because it does not go via the stomach and avoids the liver, it has a very low risk of inducing problems which were previously seen with older MAOI. The risk of high blood pressure with this formulation is less than 1 percent.
Emsam is usually applied as patch on the skin. When the 6 mg patch is applied every 24 hours there are no dietary restrictions. The drug is slowly absorbed through the skin continuously for 24 hours and this keeps level of Emsam fairly constant thought out the day.
Wednesday, April 1, 2009
IF I have bipolar, can I take antidepressant drugs?
As a rule anti depressants are almost never used to treat bipolar disorder. It is only the rare physician who treats bipolar with an antidepressant. The reason for the hesitancy in treating a bipolar patient who is depressed with a conventional anti depressant is that the drug may rapidly induce a state of mania with potential adverse outcomes, such as extreme paranoia, suicide or psychosis.
Further, not all anti depressants work in the same way and there is always a chance of harming the patient. For the above reasons most psychiatrists have been very hesitant in using the conventional anti depressant in individual with a bipolar disorder. The routine practice has been to use an anti depressant in combination with a mood stabilizer to prevent the sudden onset of mania. Some physicians only use a mood stabilizer alone or combine it with a anti psychotic (neuroleptic) drugs which is approved for use in bipolar depression.
At the moment there is no way of knowing which bipolar individual will react adversely to the anti depressant drugs. Most of the factors which determine the type of reaction are individually based. Individuals who continue to abuse drugs, or have had prior treatment failures with anti depressant, or those who have a rapid cycling form of bipolar disorder or those with a genetic alteration a certain gene (serotonin transporter gene) have a high risk of developing adverse reactions.
So far there are no rigid rules or guidelines as to when an anti depressants can be used in patients with bipolar disorder. In those individuals with bipolar disorder who continue to have prolonged episodes of depression, it is important to discuss this issue with your mental health counselor. One needs to develop a treatment plan to meet individual needs. If an anti depressant is started, one needs very close follow up to ensure that there are no untoward problems during the with mania phase.
Further, not all anti depressants work in the same way and there is always a chance of harming the patient. For the above reasons most psychiatrists have been very hesitant in using the conventional anti depressant in individual with a bipolar disorder. The routine practice has been to use an anti depressant in combination with a mood stabilizer to prevent the sudden onset of mania. Some physicians only use a mood stabilizer alone or combine it with a anti psychotic (neuroleptic) drugs which is approved for use in bipolar depression.
At the moment there is no way of knowing which bipolar individual will react adversely to the anti depressant drugs. Most of the factors which determine the type of reaction are individually based. Individuals who continue to abuse drugs, or have had prior treatment failures with anti depressant, or those who have a rapid cycling form of bipolar disorder or those with a genetic alteration a certain gene (serotonin transporter gene) have a high risk of developing adverse reactions.
So far there are no rigid rules or guidelines as to when an anti depressants can be used in patients with bipolar disorder. In those individuals with bipolar disorder who continue to have prolonged episodes of depression, it is important to discuss this issue with your mental health counselor. One needs to develop a treatment plan to meet individual needs. If an anti depressant is started, one needs very close follow up to ensure that there are no untoward problems during the with mania phase.
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