Chapter 2
Sexual side effects can include
low libido
ejaculatory delay: some clients ask for this, by the same token SSRIs are used for premature ejaculation
delayed orgasm
anorgasmia
rare: impotence
rare: priapism (d/c meds)
rare: retrograde ejaculation
PREVENT by starting low - going slow
STRATEGIES
→ titrate slowly/decrease dose
→ wait, wait, wait… it gets better over time
→ “weekend holidays” skip meds for a day or two (educate on potential discontinuation symptoms..)
→ advise pt to skip the dose before sexual activity (eg take it after activity right before sleep)
→ CBD creams help increase genital sensitivity
→ encourage patients to seek inspiration (toys, visuals etc)
TREAT with
→ add Buspar 15-30mg BID especially if there is ongoing anxiety
→ add bupropion 75mg BID if there is NO anxiety and/or there are ongoing depressive symptoms (lack of motivation, lack of energy, lack of focus) or side effects such as emotional blunting/fatigue/weight gain
→ add ciproheptadine 4mg 1-2 hours before intercourse
→ consider Viagra 25-100mg PRN or tadalafil 5mg daily if the problem is ED
→ low libido: saffron has some positive research data
Now Foods 50mg QD
Designs for Health Mood Stasis 1 cap QD
If the augmentation strategy does not help enough, leave 2nd agent (buspirone vs bupropion) on and decrease dose of SSRI to a point of complete cross titration if needed/tolerated