Hi Doctor: Still Looking For An Adjunct To My SSRI

Posted on Fri, 17 May 2019

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 17 May 2019 Answered on

Last reviewed on

Question : Hi Doctor:

Still looking for an adjunct to my SSRI that will help with sex drive and other side effects, primarily 5ht2 antagonism. I am reconsidering a small dose (10-20) mgs of Nortriptyline as it has increase sex drive and motivation in the past (before I was taking SSRI). Questions:

-will the noradenergic activity continue to be activating? or does that fade and leave you with sedation from the other mechanisms of the drug?

-I am a slow metabolizer of nortriptyline (2d6 mutation). At this dose will I get enough 5ht2c antagonism to boost dopamine and get a sexual benefit?

Thank you

Answered by Dr. Seikhoo Bishnoi (5 hours later)

Brief Answer:
Bupropion can be tried.

Detailed Answer:
Hello thanks for using ask a doctor service

You can keep Bupropion in options if you haven't tried this drug yet. The drug has great potency and is approved adjuvant drug for sexual dysfunction due to SSRIs. The drug will not alter metabolic parameters too.

Nortriptyline theoretically should cause sexual dysfunction mainly in form of delayed ejaculation and slight reduction in sex drive. But if the drug has worked in past in your case then that might be because of improvement of depressive symptoms and thus indirect improvement in sexual parameters.

Taking low dose should help you. The drug is a TCA and its 5HT2c antagonism will not be very high at low dose. But still you can give this drug as try.

Thankyou

Please let me know if you need more clarifications.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (45 hours later)

I really wish buproprion worked for me! I must have tried it 6 or 7 times in different combinations. It always starts out good but within a few days I feel very zoned out, depersonalized, sometimes angry, and tired. It is a very uncomfortable, detached feeling.

I have a theory that drugs that stimulate norepinephrine give similar detached, bored, somewhat sad feeling. Drugs like clonidine and prazosin, however, seem to have the opposite effect. Thanks for all your help.

Answered by Dr. Seikhoo Bishnoi (2 hours later)

Brief Answer:
You can give bupropion a try again

Detailed Answer:
Hello again

You can give Bupropion a try again. This should work for you.

Drugs which stimulate Norepinephrine neurotransmission results in improvement of alertness, attention and reduces drowsiness. Sadness is mainly taken care by Serotonin neurotransmission. Clonidine is alpha adrenaline agonist and helps in reducing anxiety, calms down the individual.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar