Hour-Long Stand-Up Orgasm While Shopping

[Harry Edwards]

 From the Health section of the NY Times, a cautionary tale of the 
hidden drawbacks and talents of antidepressants. How is it that women 
have all the fun even when they are depressed?? Although if I had an 
experience like the one described below, I'd be headed for the 
Emergency Room.          twisty dodds


A Pill's Surprises, for Patient and Doctor Alike
  By RICHARD A. FRIEDMAN, M.D.
  
  
-------------- next part --------------
A non-text attachment was scrubbed...
Name: spacer.gif
Type: image/gif
Size: 45 bytes
Desc: not available
Url : http://www.pairlist.net/pipermail/austin-ghetto-list/attachments/20050125/01db2af2/spacer.gif
-------------- next part --------------

Published: January 25, 2005

  
-------------- next part --------------
A non-text attachment was scrubbed...
Name: a.gif
Type: image/gif
Size: 341 bytes
Desc: not available
Url : http://www.pairlist.net/pipermail/austin-ghetto-list/attachments/20050125/01db2af2/a.gif
-------------- next part --------------
s a psychopharmacologist, I know that every patient responds slightly 
differently to medication. But it wasn't until I met Susan that I 
understood just how differently.

  She'd come to see me because she was depressed, and I'd successfully 
treated her with a course of Zoloft, a popular antidepressant. But as 
often happens, Susan's desire for sex had vanished along with her 
depressed mood.

-------------- next part --------------
A non-text attachment was scrubbed...
Name: spacer.gif
Type: image/gif
Size: 45 bytes
Desc: not available
Url : http://www.pairlist.net/pipermail/austin-ghetto-list/attachments/20050125/01db2af2/spacer-0001.gif
-------------- next part --------------
  "I kind of miss it, but I feel really bad for my husband, who's 
getting very frustrated," she said.

  The sexual side effects of antidepressants like Zoloft and Prozac - 
the class of drugs known as selective serotonin reuptake inhibitors, or 
S.S.R.I.'s - are well known. The drugs frequently cause diminished 
libido, erectile dysfunction in men, and delayed orgasm or an inability 
to climax at all in women. The same flooding of the brain with 
serotonin that alleviates depression leads to sexual effects in many 
patients.

  Early on, the rates of sexual side effects from S.S.R.I.'s reported in 
the medical literature were quite low, in the range of 10 percent to 20 
percent. But clinicians knew better. Most of their patients reported 
some sexual effects, and it quickly became clear that the early reports 
were wrong.

The reason for this error was simple. Early clinical trials of the 
drugs did not look for sexual side effects; they just recorded problems 
that patients spontaneously reported. Because most patients are 
reluctant to bring up any sexual side effects on their own, the 
researchers got the false impression that these drugs had little effect 
on sexuality. When the subjects were specifically asked about sexual 
side effects, the rates rose to 40 percent to 50 percent.

  Susan fell into that unlucky percentage, and she asked me if anything 
could be done. There were three possible approaches, I told her. She 
could stop the drug from time to time, a strategy that might 
temporarily restore her sex drive but could cause discontinuation 
symptoms; she could lower the dose of the antidepressant, which might 
provoke a relapse of depression; or we could try to counteract the side 
effects with another medication.

A temporary escape didn't appeal to Susan, so we decided on the third 
approach, an antidote. The question was, Which one? Serotonin-blocking 
drugs like Periactin, an antihistamine, treat sexual side effects, but 
they can also undo the drugs' antidepressant effects. I decided to 
prescribe Wellbutrin, a different class of antidepressant that has 
shown some ability to counteract sexual dysfunction caused by 
S.S.R.I.'s.

Little did I know.

Two weeks later, Susan called from her cellphone to say that the 
antidote was working. While shopping, she said, she spontaneously had 
an orgasm that had lasted on and off for nearly two hours . She was 
more delighted than alarmed, but I was stunned. I have had my share of 
therapeutic surprises, but this was hard to believe.

Was this a medical emergency or unrepeatable fluke that Susan needn't 
worry about? When I saw her the next day in my office, she was calm and 
somewhat amused by my concern. After all, since when is an orgasm a 
cause for alarm?

I was worried, though, that the addition of Wellbutrin had set off an 
episode of mania, an effect that antidepressants can have in up to 5 
percent of patients. In that case, her prolonged orgasm might be a 
symptom of hypersexuality, common in mania. But Susan didn't seem 
either manic or depressed.

It seems that for her, the Wellbutrin just had an extreme sexually 
enhancing effect. Several colleagues told me about patients of theirs 
who had experienced heightened sexual desire on Wellbutrin, but none of 
the reports came close to Susan's. That Wellbutrin can enhance sexual 
pleasure isn't surprising: it increases the activity of dopamine, a key 
neurotransmitter in the brain's reward pathway. In fact, drugs of 
abuse, like cocaine, alcohol and opiates, release dopamine in this 
circuit - and so does sex.

A year has passed without a recurrence of this surprising side effect. 
But Susan is enjoying sex now - clearly more than she did before she 
became depressed. Because this was her first episode of major 
depression, the chance of a recurrence was only about 50 percent, so I 
suggested stopping the antidepressant. She liked that idea, but then 
paused and asked, "Do I have to stop the Wellbutrin, too?"

  We both laughed.