Hi Dr. I've Been On Celexa Now For 5 Weeks

Posted on Fri, 10 May 2019

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

Fri, 10 May 2019 Answered on

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Question : Hi Dr.

I've been on Celexa now for 5 weeks I think. The sexual side effects just hit me (no desire, no pleasure) although mood is better than the whole MAOI/tianeptine/Lamictal trials.
Seeing as stimulants help with drive but make me very compulsive, and buproprion zones me out; I was looking for a different way to treat the SSRI sexual dysfunction.

Blocking the 5ht2 receptors with a low dose of nortriptyline or nefazadone is what I'm thinking. The nefazadone might have fewer side effects.

What dose nefazadone would you suggest to start at as an adjunct?

Answered by Dr. Dr. Ashok Kumar Choudhary (10 hours later)

Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for posting again at Healthcaremagic.

It is true that loss of desire is well established side effect of citalopram use and generally appears within four weeks of citalopram use which holds true even in your case. However the side effect is not permanent and multiple options exist to counter this particular side effect.

Every doctor have their own preferences among the available options and I generally prefer dopamine agonists such as pramipexol at low dosages (0.25 to 0.75 mg per day).

Nefazodone is also promising option and can be started at 50 mg per day. For the purpose of adjunct medication the effective dose is generally 100-300 mg per day. The dose can be increased by 50 to 100 mg at a time at the interval of one week.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.

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

Follow up: Dr. Dr. Ashok Kumar Choudhary (2 days later)

THANK you. Do you think the nefazodone will worsen the sedation during the day at this dose? I stopped taking the trazodone at night thinking it was possibly responsible for the sedation and because it felt like it was worsening my mood in the morning.

Answered by Dr. Dr. Ashok Kumar Choudhary (8 hours later)

Brief Answer:
Less likely

Detailed Answer:
Hello,
Thanks for follow up.

Nefazodone have profound sedation as side effect but it appears mostly at the higher dose. In compare to trazodone the chances are less for sedation particularly at low dosages. In my opinion at low dosages chances of sedation is low and a genuine attempt should be made.

I hope this helps you further.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Ashok Kumar Choudhary (13 hours later)

I just picked up my trazodone and will give it a try. Given that I am primarily looking for 5ht2 antagonism (and resulting increase in dopamine and neurepinephrine), does this happen relatively quickly or will it take 2 weeks to notice the difference.

I am also taking small doses of ritalin occasionally but stimulants really increase compulsive behavior and feelings of interpersonal detachment. I assume I should stop trazodone for sleep?

Thank you

Answered by Dr. Dr. Ashok Kumar Choudhary (7 hours later)

Brief Answer:
It takes time

Detailed Answer:
Hello,
Thanks for follow up.

Unlike other actions of nefazodone, 5HT2 antagonism takes time to manifest properly. There is no criteria whether it takes two weeks but it is often believed that proper effect may take 2-6 weeks to manifest and sexual side effect reversal of celexa is not an exception.

Small query- Are you discussing trazodone or nefazodone as we have through discussion about nefazodone and you stated that you picked your nefazododone?

I look forward to answer you further.
Thanks again.

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

Follow up: Dr. Dr. Ashok Kumar Choudhary (17 hours later)

Sorry I mis-spoke. I picked up the nefazodone (serzone) yesterday. Trazodone has been allowing me to sleep through the shaking and racing thoughts, etc. of the celexa (and helped sleep on the MOAIs) As mentioned I think the negative morning feelings and daytime sedation are resulting from the trazodone or mCPP metabolite.

So from what I understand, the Celexa-mitigating properties of the serzone will take some time to evaluate, correct? I imagine sedation and mental fogginess will come before.

Follow up: Dr. Dr. Ashok Kumar Choudhary (7 hours later)

following up....I read my DNA results and I have a mutated 2d6 gene. So I am metabolizing trazodone at a normal rate or faster (with modafinil) and have a higher than normal concentration of mCPP. mCPP releases serotonin and agonizes the 5ht receptors, which I'm trying to antagonize with the nefazodone.

trazodone has consistently let me sleep but sad and agitated in the morning. I'm thinking a different 5ht antagonist might be needed?

Answered by Dr. Dr. Ashok Kumar Choudhary (25 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

It is true that serzone causes sedation and mental fogginess but it is not essential. It is also true that the effects become obvious apparent after passage of some time but again the effects may paper much earlier or later. I mean to say that real life experiences with medications is quite different from textbook descriptions for individual patient and keeping an open eye is answer. It is important to remain cautious but it must not be too cautious to cause psychological distress.

I agree with you that due to 2d6 gene mutation you might have high concentration of mCPP and trying a different alternative could hold answer for the ongoing problems.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj