In need of help.

Hi Area,

I've been going through a tough couple of months dealing with persistent sexual dysfunction due to SSRI'S and Quietapine and I hope you can help me.

I've read through hundreds of posts from here and other forums online and am losing hope. I'll give you some background on me in hope that you can help.

I am 34 and have been taking Fluoxitine (Lovan here in Australia) 40mg since 2010 for OCD and Anxiety. During that time my libido had dropped a little and Morning Erections had completely disappeared. However I still functioned.

In late October due to work and relationship related stress I was having problems sleeping and got a prescription for Seroquel (Quietapine) 50mg. This is when most of my problems began. My Erections became weaker followed by complete ED. I soon lost ALL LIBIDO and my Penis is almost completely numb. I now believe this combination of drugs triggered PSSD.

I stopped taking Seroquel on the 1st of Jan 2017 and tapered off Fluoxitine by 15th of Jan. I thought getting of the drugs would help me regain my sexual function but it hasn't. In fact around January 5th I had a complete emotional shutdown for about 3 days. No emotions positive or negative. I haven't been the same since, I feel my empathy has completely disappeared. Even my constant anxiety has now disappeared. I also developed restless legs syndrome which seem to be returning back to normal.

So I'm here asking for your help seeing as how you seem to be one of the only sources on PSSD.

I've tried Ginseng, Ginkgo, Ashwaganda, Tribulus, Maca and there has been absolutely no change so far. I've gone to my General Practitioner, Psychiatrist, Hypnotherapist, A sexual health doctor, Endocrinologist and their only response seems to be that I'm probably depressed and to consider going back on Antidepressants. This doesn't seem right to me. Soon I'll be going to a Urologist and perhaps a Neurologist in hopes of finding a way of fixing this but I've lost almost all faith in doctors.

Can you offer any guidance on my healing Erectile Dysfunction, Morning Erections, Loss of Libido, Genital Numbness, Loss of Emotions.

Inositol? Nystatin? Wellbutrin? Curcumin? SJW? Licorice Root? Mianserin? Anything which can bring me back to the person I was.

Anyway I hope to hear from you (Sorry for the massive post).

Miguel29 wrote:Hi Area,

I've been going through a tough couple of months dealing with persistent sexual dysfunction due to SSRI'S and Quietapine and I hope you can help me.

I've read through hundreds of posts from here and other forums online and am losing hope. I'll give you some background on me in hope that you can help.

I am 34 and have been taking Fluoxitine (Lovan here in Australia) 40mg since 2010 for OCD and Anxiety. During that time my libido had dropped a little and Morning Erections had completely disappeared. However I still functioned.

In late October due to work and relationship related stress I was having problems sleeping and got a prescription for Seroquel (Quietapine) 50mg. This is when most of my problems began. My Erections became weaker followed by complete ED. I soon lost ALL LIBIDO and my Penis is almost completely numb.  I now believe this combination of drugs triggered PSSD.

I stopped taking Seroquel on the 1st of Jan 2017 and tapered off Fluoxitine by 15th of Jan. I thought getting of the drugs would help me regain my sexual function but it hasn't. In fact around January 5th I had a complete emotional shutdown for about 3 days. No emotions positive or negative. I haven't been the same since, I feel my empathy has completely disappeared. Even my constant anxiety has now disappeared. I also developed restless legs syndrome which seem to be returning back to normal.

Very very sorry to hear of your ordeal.

I think there are a couple things going on here.
You said that you experienced a loss or morning wood first, that indicates a Free Testosterone deficiency, and / or a Prolactin excess.

The restless legs syndrome is tied to the motor action of Dopamine, so there's probably something wrong with your dopamine receptors, either hypofunctional (most likely) or hyperfunctional (less likely).

The emotional impairments are likely due to a now desensitized Serotonin autoreceptor terminal (5-HT1A Somatodendritic Autoreceptors).

My advice to you is to get your Total Testosterone (TT) level tested, as well as ESPECIALLY, your Prolactin (PRL) level. Get Free Testosterone (FTT) tested. Get Cortisol/ACTH tested.

SSRI's, like Prozac (Fluoxetine), can deplete neurosteroids with years of use, even though in the short-run they enhance them.
Seroquel likely made your Prolactin levels elevated/high.
You probably are deficient in Vitamin D & Zinc, from Seroquel use, and may have thyroid deficiency as well.

Miguel29 wrote:
I've tried Ginseng, Ginkgo, Ashwaganda, Tribulus, Maca and there has been absolutely no change so far.

How long did you take them for? They all can take several weeks to two-three months to work. They also aren't going to have effects on every single parameter, especially if there is a neurological issue.

Miguel29 wrote:
I've gone to my General Practitioner, Psychiatrist, Hypnotherapist, A sexual health doctor, Endocrinologist and their only response seems to be that I'm probably depressed and to consider going back on Antidepressants. This doesn't seem right to me. Soon I'll be going to a Urologist and perhaps a Neurologist in hopes of finding a way of fixing this but I've lost almost all faith in doctors.

Can you offer any guidance on my healing Erectile Dysfunction, Morning Erections, Loss of Libido, Genital Numbness, Loss of Emotions.

Inositol? Nystatin? Wellbutrin? Curcumin? SJW? Licorice Root? Mianserin? Anything which can bring me back to the person I was.

Anyway I hope to hear from you (Sorry for the massive post).

I would say the best way to go is to get the testing done mentioned on my first paragraph, and then do the following steps...

Supplement with 3 Grams (3000 MG) of D-Aspartic Acid. Take daily. Should help within 2-3 weeks, biggest results after a month or two.
Take Sarcosine powder at 1.5 Grams or 1,500 MG, once or twice daily, this should help libido.
Take one HALF of teaspoon of CEYLON Cinnamon per day, NOT SAIGON OR ANY OTHER KIND OF CINNAMON, ONLY CERTIFIED LOW-COUMARIN CEYLON CINNAMON...this kind is not toxic to the liver. Also supplement with Ibuidlast solution at IRC.BIO; these steps should all help to restore nitric oxide synthase, glutamate and Dopamine activity that may be lacking.

Thanks for your reply Area,

I was hoping this would all be part of the same underlying cause. So it's hard to read that it could be multiple things all going on at once. I've had my testosterone taken 3 times within the last 2 months.

The results were:

23/01/2017: 9 nmol/L
30/01/2017: 7 nmol/L
20/02/2017: 15 nmol/L

Normal levels are supposed to be between 10-33 and my first two tests were definitely under. But after getting more Vitamin D and Zinc they seem to have gone back up into normal range. I will get another test in the next month or so.

My most recent Prolactin levels were at 11 ug/L (I was told anything under 15 was fine)

I'd be interested in knowing what you think based on my results.

I've been taking Ginkgo and Ginseng the longest at about 6 weeks. The rest of the supplement less time. I'll take the steps you advice hopefully they do the trick. Should I be cutting out any of the supplements I've been taking? I understand this is likely to take some time to sort out but seeing little to no improvements is discouraging to say the least.

Thanks for listening.

Miguel29 wrote:Thanks for your reply Area,

I was hoping this would all be part of the same underlying cause. So it's hard to read that it could be multiple things all going on at once. I've had my testosterone taken 3 times within the last 2 months.

The results were:

23/01/2017: 9 nmol/L
30/01/2017: 7 nmol/L
20/02/2017: 15 nmol/L

Normal levels are supposed to be between 10-33 and my first two tests were definitely under. But after getting more Vitamin D and Zinc they seem to have gone back up into normal range. I will get another test in the next month or so.

My most recent Prolactin levels were at 11 ug/L (I was told anything under 15 was fine)

I'd be interested in knowing what you think based on my results.

I've been taking Ginkgo and Ginseng the longest at about 6 weeks. The rest of the supplement less time. I'll take the steps you advice hopefully they do the trick. Should I be cutting out any of the supplements I've been taking? I understand this is likely to take some time to sort out but seeing little to no improvements is discouraging to say the least.

Thanks for listening.

No. Keep taking the supplements you are on, but try to get a blood test for Zinc levels as well - we want to make sure you aren't getting TOO MUCH Zinc either. Too much or too little Zinc can cause neurological issues. Same with Vitamin A & D; deficiency can cause nerve issues, too much (excess) can also cause issues.

Could I ask you Area, what your view is on Anhedonia/Emotional Numbness?

I'm currently under the assumption that my Serotonin levels are too high and Dopamine levels are too low. From what I can gather high levels of Serotonin can cause Emotional Numbness/Anhedonia and low levels of Dopamine seem to have a similar affect (lack of motivation/lack of enjoyment etc..). Perhaps adding Seroquel to Fluoxitine was what had this effect.

Up until a few months ago I had high levels of anxiety/OCD but that's now disappeared, replaced with complete apathy (really the opposite of anxiety). Maybe this is the cause for loss of libido?

If these seems at all plausible does taking Shilajit to lower Serotonin and then Forskolin to repair Dopamine Receptors seem like a viable option for me?

I might also add another point as it now seems relevant:

I've recently begun to regain my erections through masturbatory.  The interesting thing I've noticed though is despite the fact I can now masturbate and ejaculate I experience no orgasm. There's no euphoria or feeling of orgasm just ejaculation. I've never had strong orgasm but now they are completely absent.

It seems like this could fit into anhedodia and lack of libido. In which case should I consider dropping Ginkgo (Agonist) in favor of an Shilajit/ or another Antagonist?

Miguel29 wrote:Could I ask you Area, what your view is on Anhedonia/Emotional Numbness?

I'm currently under the assumption that my Serotonin levels are too high and Dopamine levels are too low. From what I can gather high levels of Serotonin can cause Emotional Numbness/Anhedonia and low levels of Dopamine seem to have a similar affect (lack of motivation/lack of enjoyment etc..). Perhaps adding Seroquel to Fluoxitine was what had this effect.

It sounds like it. Though it could simply be ''desensitized 5-HT1A-autoreceptors'' and / or SERT downregulation causing the Basal (resting) level of Serotonin to be too high...you might have endorphin imbalance as well, check this article/list out. See if it fits you.
https://area1255.blogspot.com/2016/01/symptomssigns-of-high-and-low-endorphin.html

Miguel29 wrote:
Up until a few months ago I had high levels of anxiety/OCD but that's now disappeared, replaced with complete apathy (really the opposite of anxiety). Maybe this is the cause for loss of libido?

Probably, Yes.

Miguel29 wrote:
If these seems at all plausible does taking Shilajit to lower Serotonin and then Forskolin to repair Dopamine Receptors seem like a viable option for me?

Try to look for Tibetan Shilajit Paste; the best form of Shilajit. That should help. Add L-Tyrosine to boost Dopamine.

Oh wow, sounds similar to me except I took celexa. Do ssris like celexa and decrease dopamine and increase seratonin or something. wish u luck, I'm beginning to think it's permanent. I had anhedonia on celexa but went away after stopped taking it the sexual side effects persisted.

I heard someone said changing ssri or stopping abruptly causes this. I also get bruxism. Orgasm is the whole reason I liked sex and now it's like meh this is boring I would rather sneeze or eat a meal. The sex is ok but like it's not great like it should be.

Yup, this does suck. I just hope it's not permanent. The more I look into it the more questions I have...

After looking at "Signs of High And Low Endorphin Levels" article. It certainly does seem like I tick most if not all of the symptoms for High Endorphins. Will get all those hormone levels checked to make sure.

Thanks for that.

Miguel29 wrote:Yup, this does suck. I just hope it's not permanent. The more I look into it the more questions I have...

After looking at "Signs of High And Low Endorphin Levels" article. It certainly does seem like I tick most if not all of the symptoms for High Endorphins. Will get all those hormone levels checked to make sure.

Thanks for that.

No problem!

Could I ask you what your thoughts are on Metergoline as another possible solution to PSSD?

Miguel29 wrote:Could I ask you what your thoughts are on Metergoline as another possible solution to PSSD?

It works for some, but it's a powerful drug, not something that you can just load up on, you'd want to start really low, like 1-2 drops per day, on the skin, then eventually work up to a full dose.

Idea Labs DC sells it for a good price.

I'd check them out for sure.

On another note, PSSDforum.com has some positive experiences, but a lot of people still don't know about the chemical.

Here's the store page to buy it.

http://www.idealabsdc.com/lab/

Thanks Area-1255 for your insights. So I'm guessing you cured your pssd over time through supplements Area-1255? I still struggle with anxiety (does not help the panic of having this). But are there supplements that help specifically with the following - genital numbness or anesthesia. Loss of sensitivity. Anorgasmia (takes ages to cum and the loss of sensitivity doesn't help). Premature ejaculation on ocasion. Orgasms coz I just ejaculate let's be real and get headaches from sex. Or is there more of a one size fits most. Thanks, I feel like ssris killed my sex function. I'm eagerly awaiting the supplements you recommended for addressing pleasure less orgasms. I have a gf and she gets upset that I don't cum early and by that it takes lots of effort on both parts and it's putting a lot of strain on relationship atm so I guess soon I won't have a gf haha

wheatlyos wrote:Thanks Area-1255 for your insights.  So I'm guessing you cured your pssd over time through supplements Area-1255?  I still struggle with anxiety (does not help the panic of having this).  But are there supplements that help specifically with the following - genital numbness or anesthesia.  Loss of sensitivity.  Anorgasmia (takes ages to cum and the loss of sensitivity doesn't help).  Premature ejaculation on ocasion.  Orgasms coz I just ejaculate let's be real and get headaches from sex. Or is there more of a one size fits most.  Thanks, I  feel like ssris killed my sex function.  I'm eagerly awaiting the supplements you recommended for addressing pleasure less orgasms.  I have a gf and she gets upset that I don't cum early and by that it takes lots of effort on both parts and it's putting a lot of strain on relationship atm so I guess soon I won't have a gf haha

She gets upset ''that you don't cum early?'', she doesn't like she cares too much about you mate, just sayin', either that or there's a lack-of-communication here. Like I said, these things take time...you have to have some patience, work out, and strive for your own results.

Hi Area,

I was wondering your advice in regards to supplements and the "Negative Feedback Loop".

I've read come across alot of articles/posts saying how a supplement "worked at first but then the effects wore off". Specifically testosterone supplements, but also for Nitric Oxide, Dopamine and Acetylcholine supplements.

In your experience is it better letting supplements have a cumulative effect or cycling supplements throughout the week? For example: Monday-Icariin, Tuesday-Tongkat Ali, Wednesday-Shilajit etc...

I'd like to get the maximum benefit from these.

Miguel29 wrote:Hi Area,

I was wondering your advice in regards to supplements and the "Negative Feedback Loop".

I've read come across alot of articles/posts saying how a supplement "worked at first but then the effects wore off". Specifically testosterone supplements, but also for Nitric Oxide, Dopamine and Acetylcholine supplements.

In your experience is it better letting supplements have a cumulative effect or cycling supplements throughout the week? For example: Monday-Icariin, Tuesday-Tongkat Ali, Wednesday-Shilajit etc...

I'd like to get the maximum benefit from these.

No, that's Insane.

You can take each supplement daily without an issue, there's no reason to take one one day and another on a different day; they would never build up in your body that way. You'd get Zero benefit.

If you are worried about Tolerance, then take every supplement daily, but take 2 Days off per week, so 5 days on and 2 days off should work.

Any news Miguel?

Hey Area,

Thanks for checking in, I appreciate it. At the moment I'm at a standstill. Symptoms are still where they were a few months ago (Genital Numbness, Zero Libido/No Sexual urges, completely pleasureless ejaculations).

Since I last posted I've gone to an Endocrinologist, 2 Psychiatrists and a Men's Sexual Health Doc. Their advice has been largely contradictory.

It does appear that I have Low Testosterone. My endo and Men's Health Doc both believe depression is the cause behind this. Both strongly urging me to stay away from any kind of Testosterone enhancing supps or TRT. They also believe that raising my Testosterone would not increase my Libido or help treat Pleasureless Orgasm and Genital Anesthesia (this doesn't sound right to me). Psychiatrists on the other hand says there's no proof depression can cause Low T.

The men's health Doc said he's seen cases of PSSD before and that he can reverse it by using Edronax. However I am weary of trying an SNRI. And besides I'm not sure I believe it could truly reverse anything as I've come across no evidence. He did prescribe me 5mg of Cialis daily in order to bring back Morning Erections. Which I have decided to try for 3 months to see if it can actually restore that function.

So right now I'm left with the advice to leave my testosterone levels where they are. Take one of the Antidepressants that has been prescribed (Edronax, Agomelatine or Moclobemide). And Cialis for 3 months. Does any of this sound like a good way to go forward? Are these antidepressants safe? Are they likely to heal PSSD?

Supplements which I have taken so far have had no noticeable impact (Tyrosine, Choline, Maca, Mucuna Pruriens, Shilajit, Icariin 60, B6, D3, Zinc, Boron etc...) I will admit that I haven't tried DAA, Sarcosine or Ibudilast because of what my Endo recommended. Please don't think I don't value your advice on PSSD, it's just so confusing when everyone is telling you something different and also when I've become a little paranoid about what I take.

I was hoping that by giving it some time it would improve naturally. Most cases of recovery seem to happen within a year maybe two. But so far nothing has changed which worries me.

Do you believe it is likely PSSD improves with time? Is a full recovery more likely by taking Antidepressants or supplements like DAA, Sarcosine or Ibudilast? Is being too cautious likely to be my downfall here?

Sorry for the post. Hope you can give me some perspective on these things.

I don't think Edronax would help sexual function per se, because its a norepinephrine selective reuptake inhibitor, it might make orgasm more pleasurable, but would further hinder/weaken erectile function.

As far as Testosterone levels go, no I don't agree that Depression causes low T; its usually low T causes Depression - and that starts the cycle.

So your best bet would to stick with Testosterone boosters. You may find substantial benefit in Forskolin + Shilajit + Tongkat ali. Eat more leafy greens, eat Broccoli stalks and increase meat protein intake.
Additionally,

--> Add a Folate supplement (400 mcg metafolin x3/day).
--> BCAA Supplement
--> Ceretropic Caffeine + NALT.
These are my suggestions for now.

Hi Area, I have a question regarding antidepresssants.

Would you consider Moclobemide as a safe option for someone with PSSD? Could it possibly aggravate sexual/anhedonia symptoms? If not maybe Agomelatine?

Also do you think a Dopamine Agonist might be of use for increasing Libido/decreasing Anhedonia. Pramipexole, Cabergoline or Ropinirole maybe?

Miguel29 wrote:Hi Area, I have a question regarding antidepresssants.

Would you consider Moclobemide as a safe option for someone with PSSD? Could it possibly aggravate sexual/anhedonia symptoms? If not maybe Agomelatine?

It could help, it seems to help Men better than Women. Agomelatine is another option, just make sure you measure it out WITH A SCALE and get from a trusted source.

Ceretropic.com is a good source of Agomelatine.

Miguel29 wrote:Also do you think a Dopamine Agonist might be of use for increasing Libido/decreasing Anhedonia. Pramipexole, Cabergoline or Ropinirole maybe?

They could be, but Cabergoline can produce heart problems with long-term use [1], so I'd use either Ropinirole or more preferably, Lisuride instead. Idea Labs sells that as well. If you do want a traditional dopamine agonist, I'd buy it from Naps; they have the best prices!

Hi Area, I've been reading your articles about NMDA receptors and Glutamate. You say Low Glutamate can cause Anhedonia, lack or anger etc... How likely is this to be related to the Anhedonia PSSD sufferers experience?

Also, this may sound dumb but is Glutamine related to Glutamate. I'm thinking of adding it as part of my excerise supplements but don't want to worsen Anhedonia/emotional blunting. Sorry if that sounded dumb, just wanted to check.

Miguel29 wrote:Hi Area, I've been reading your articles about NMDA receptors and Glutamate. You say Low Glutamate can cause Anhedonia, lack or anger etc... How likely is this to be related to the Anhedonia PSSD sufferers experience?

Also, this may sound dumb but is Glutamine related to Glutamate. I'm thinking of adding it as part of my excerise supplements but don't want to worsen Anhedonia/emotional blunting. Sorry if that sounded dumb, just wanted to check.

Glutamate is VERY related to Anhedonia but it is less of a linear relationship as it is with libido and sexual arousal. For example, activating some glutamate receptors such as NMDA and AMPA may theoretically help with Anhedonia and mglu5 may as well. But on the other hand, activating some glutamate  receptors in the I family may lead to despair in susceptible peoples.

Glutamine is fine, it won't harm you or worsen your symptoms.

I would get a well reviewed brand though, preferably with no/low fillers, a lot of companies add too much extra garbage to their glutamine.

Most folks find that Optimum Nutrition's Glutamine is a good brand.

Glutamine is technically a breakdown product of glutamate, but it exists to help synthesize other proteins and to help increase the effectiveness of blood cells.