My Report and Mistakes

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borisz_30
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My Report and Mistakes

Unread post by borisz_30 »

Hello everyone, I hope all of you are doing good.

I'm 30 years old and I live in Brazil - South america. Well, I'd like to introduce my case and my mistakes, maybe to help, or exchange some information too. And I apologize for any grammar mistake that I might commit, my English skills are pretty rusty.

I've always had some mid-range anxiety. Insomnia led me to a panic attack in April-2018, but as I was not aware of medication, treatments or such, I've kept on dealing with it my way, until august-2019, and on therapy as well. On that time, I was with serious stress and anxiety due to burnout from excess of work, had recently moved to another city and was nearly 5 days without getting to sleep. Then, I decided to go to the doctor and he prescribed me the Escitalopram 10mg (a.k.a. Lexapro), and a benzo (clonazepam) which I would take only for a few months - but I kept on using not frequently, only when I had some trouble to sleep. I always had some fear of medications in general, so this was a really extreme case. I wouldn't try it if I didn't feel (and was advised to) the need.

The 1st month of treatment was a hell-like: so much pressure in the head (same that I feel nowadays, but worse), dry mouth/throat, and the sexual side effects appeared in the first week (delayed orgasm/ejaculation, no pleasure, the effects that everyone tells). Well, it was horrible. But as I had a struggle with social anxiety, I kept on going, as the doctor and some internet stuff promised that "the side effects were temporary and not permanent". And in about 30 days, 35 days, being really diligent with the medication, I started to feel less side effects, could have normal erections, normal ejaculation (no delay or PE), pleasure, and was feeling a bit better of the original problem, could feel more present in the moment, calmer, etc. That gave me the impression that the treatment was good, and that I should not worry about things.

Doctor prescribed me Trazodone (50mg) two months after the beginning of treatment, to help increase my sleep. It indeed increased my sleep, but gave me some side effects like some long erections in the morning and during REM sleep, and apathy in the day. I took it for 45 days and left "cold turkey" coz I started to get afraid of these effects. I think it was my second mistake, maybe I should kept on trazodone, but I was afraid of priapism or permanent damage.

Before this, doctor tried to rise the Escitalopram to 15mg but I didn't respond well to it (I think it was too strong), and this gave me constipation, and worsened my mood and libido, then I decreased to 10mg expecting that the treatment would get back to its trail, but I guess it never was the same. This happened around december / january of 2020, I assume I have taken 15mg for about a month.

Then in 2020, pandemic year came and I kept the treatment with the 10mg, but not as diligent as in the first time. Sometimes I did not take the medication, and as I was working from home, was being able to sleep a lot more than when in the regular work, and changed the time I was taking it (nearly the lunch time). Libido kept very low, but I was still being able to feel some pleasure. Sexual side effects weren't a big deal for me coz I was single and didn't focus on relationships at that time.

I kept Escitalopram for most of the year, still had to deal with constipation, but haven't had much bad mood. I was noticing that the good effects of the medication were not helping as once. I thought that lowering the dosage could help me, and I asked doctor to lower it to 7,5mg (which was half of the 15mg pill), and he agreed. He didn't agree with discontinuation though. So I kept on taking 7,5mg escitalopram for some time, I believe that it was from october till december. I should've returned to doctor, but as I was not feeling so good and really wanted to discontinue the treatment, I didn't, and then in january / 2021 I lowered to 5mg for some days until complete discontinuation (didn't taper properly, just made it my own way).

Hardest part of discontinuing the treatment was the mood, it worsened a lot for some time (got really angry). In March me and my family got Covid-19, it was hard, but when I recovered from covid I was feeling pleasure, erection, almost normally. Libido didn't came back, but that wasn't a big deal. I mean, I could deal with the low libido, if I could feel pleasure with masturbation and such.

Things kept that way for about 5 months (from march to august 2021). No libido, a little depressed, but still could feel pleasure with masturbation, and that's how I was living life. But in september it sadly changed, and I dunno what triggered the worsening of my symptoms.

I was feeling 'ok' in august, had a very good day where I felt aroused and masturbated (like pre ISRS) and I thought that all would be fine again. I even cried one day. But these events were quite isolated and that day was one of the last days I felt pleasure.

At the beginning of september, I started to notice a decrease on my sleeping, libido totally disappeared and sexual pleasure as well. I still can get an erection, sometimes I have morning erection, and I can masturbate but when I ejaculate I feel almost zero pleasure... Maybe 10%? Dunno... That's making it hard to keep on going.

Also, As if this wasn't enough, I've been having tinnitus in my left ear, and I been feeling pressure in the same side of my head, just like when I began with Escitalopram in 2019 (two fucking years ago). Sleep quality had decreased so that I take Zolpidem to help me to sleep (I wasn't taking anything to sleep this year).

Well, this sudden worsening of things is making everything harder for me. I confess I wasn't aware of PSSD, and I started reading about it and it maybe can be one of the triggers, as well as stress at work. But Idk... I remember I was taking L-Triptophan between july and august, so it can also have affected me somehow.

---
Summarizing my current status,
I don't feel sexual pleasure when I masturbate or ejaculate, or even much of sexual will itself. I can get an erection normally but stimulation. I have very little libido, that floats - some days it happens, some days not. I got tinnitus in the left ear, as well as a small pressure in the same side of head (which I consider really boring)

I also got constipation (very annoying, I go to bathroom each two or three days), and some dhermatitis (or acne) in the forehead, which are two extremely bothersome things, but I'm not sure they are linked to PSSD.

I forgot to mention emotional blunting. Sometimes it's hard for me to feel pleasure with things or even sad - think of sad events and things. I can't cry. And can't feel much happy, but I don't feel angry or cringy either. Sometimes I feel kinda indifferent with life - which can't be so normal.

Another thing that upsets me is that my hair seems to be ugly... "dry", and the beard also. I definitely think something is wrong (still, not saying it's properly linked to PSSD).

What am I taking?
I took Peruvian Maca for about 20 days already (no result so far, 4 pills per day), Rhodiola Rosea (it worked for one or two days, giving me a better mood and feeling a bit better, but gave me a little anxiety, so I stopped, although I want to try again), and started taking St. John's Wort two weeks ago (and I have stopped, just to make a test, but had no cons or pros though).

Also I got back to running, but I only feel good when I can reach a really high heart-rate (185~192bpm).

One thing that kind of scares me is that sometimes, when I have deep sleep, I get an erection and I wake up. Or even when I relax a lot in bed and am getting to sleep. But that's not linked to stimulation or mind thing, this is involuntary.

I'm aware I will not get back to the way I was before. I don't care for having an extreme sexual wish, as it can also be bothersome sometimes (I had obsessive thoughts with sex when I was 24, it was not healthier either), but I just wish I could have a better life quality. I have been single (still am) most of my life, due to my nerdy ways, but I don't want my sexual life to end this way. The other effects are also very hard to cope with - this pressure in the head, acne, constipation etc).

I don't care if I need to take some medicine again, even if it's for the rest of my life, but I am really concerned about getting back on Escitalopram and living the same hell again and even worsening things :( . But in the absence of results or improvements, I believe that it will be the way.

I'm open to suggestions. I want to to avoid going to doctor, but as this pressure in the head doesn't seem to leave me, as well as the tinnitus, I may go.

But I want to try another medicine - Zoloft, Bupropion or Buspar are on my list.

As you can notice, my memory is quite good, so if you want to know further information you can ask me.

I'd like you guys some comments on my situation, what should I do first? Is there anything that can be helpful short or mid-term?

I am so sorry that I had done this damage to myself, and the reasons that it happened are not fair either.. Coz my life still sucks, and it's worse than before the treatment. That's maybe a karma thing.

I hope everyone gets well and wish you a recover and may you all find joy and hapiness, thanks a lot for reading and sorry for the long report.
Last edited by borisz_30 on Wed Oct 20, 2021 4:48 pm, edited 1 time in total.
borisz_30
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Re: Report and Mistakes

Unread post by borisz_30 »

Hello everyone,

I would like to share with you guys some of my findings in these times since I wrote my intro and had been trying some stuff and also reading / studying a lot to develop a strategy and deal with my case in a more assertive way.

I have been using forum search quite a lot and it's very rich regarding data and info, which helped me clarify some things. I don't understand much about health science and body functioning like many of you, which makes it sometimes hard to understand some things, but I did my best. And I would like to thank Meso for his very useful FAQ that is available too.

So, I've been trying some changes on my diet, like eating more fruit and salad, and I guess I've managed the constipation and it helps a bit with mood, which is great. I confess that my diet was not as healthy as it should be.

But what I've found more interesting is that I started drinking coffee the last 5 days, and it seemed to help with some things, mainly the head pressure. So it looks like to me that my PSSD is concerning of low regulation of dopamine in the brain.

What leads me to this first conclusion are some thoughts that I've had based on my own perception. I can't write it in a more scientifical way, but is corroborated by some things I will point out.

Looks like the ISRS has levelled my serotonin up to a level that it can't get lower anymore, in a way I don't feel sad, don't feel anxious, but I feel sometimes apathetic and without "Pleasure" in doing things or even the sexual pleasure itself. Pleasure is linked to Dopamine, which seems to be lacking here.

Another thing that corroborates my theory is that I have been taking St. John's Wort, and some days I feel better when I don't take it, or when I take a lower dosage than the suggested in the label (which is 3 capsules / day, and I take two or just a single). And as St John's Wort is recognized for helping with serotonin, I believe that serotonin is okay on baseline.

I guess the caffeine helped my dopamine rise a little bit and that gave me a better feeling of disposition and mood, better than what the supplement did. Head pressure also decreased, and tinnitus decreased a bit as well. So that may be a sign that I am aiming at the correct direction.

But not everything are flowers. I noticed that I have had a decrease on sleep time / quality in response to it (I slept less, but I didn't feel bad) and I noticed that my erection is not the same (looks like it has decreased a bit).

Summing up, my baseline is I have normal erection and low pleasure. When I increase serotonin, I increase head pressure and have almost no pleasure. When I try to increase dopamine, I have less erections, less sleep, but a little more pleasure. That's weird, but seems to be the mechanism here.

My question is: does it make any sense? How to 'regulate' both systems in a way one doesn't screw up another?

And there is the cortisol that may be lifted by the coffee as well... Maybe it's the reason why when I take it, I have less erectile potential.

-----
I want to add some data to my report: When I had the panic attack in 2018, I was prescribed Setraline which I took a single pill during the episode. I remember that on that day I felt cold waves and very hot waves through my body, couldn't get to sleep and that my penis seemed to diminish. Then I didn't take it anymore. The panic attack gone, but I never been the same after that episode. I strongly believe that the Sertraline may have caused the 'one pill' problem to me as well. I never felt really well after that episode of panic attack, and I thought that those waves were a consequence of the attack itself, and didn't link it to any medication until reading about PSSD.

This is so true that I ended up having to take the escitalopram (which I believe didn't cause much harm sexually, but on my mood).

Although, as I remember that the side effects of Escitalopram did improve with some time, I think that maybe if I had struggled a bit more with sertraline, maybe I would have a different kind of response, maybe the side effects would also go away. Anyway, I've been reading that Sertraline is a ISRS that has a dopaminergic response too, and I would be disposed to try it as a "last resort" option if I don't manage the situation through a more natural way - and i've read that it helps people with Tinnitus and head-aches.

I know that reinstatement is widely non-recommended, and I understand that it would be a hit or miss - it can save or bury me for all.
---

Well, I know I write quite a lot, but it's the only way I can organize my thoughts and write a self-report in order to try to find a key or a window to have a better life and maybe achieve some goals I still have.

Thanks for reading, let me know if you can help me somehow.
Last edited by borisz_30 on Wed Oct 20, 2021 5:18 pm, edited 1 time in total.
borisz_30
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Re: Report and Mistakes

Unread post by borisz_30 »

Another doubt that I have:
How bad hair quality and acne in the head can be related to PSSD?
sovietxrobot
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Re: Report and Mistakes

Unread post by sovietxrobot »

in summary it sounds like you had sexual side effects of escitalopram and had PSSD after abrupt discontinuation? Is that right? What about discontinuation from trazodone, did that have an immediate effect?
borisz_30
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Re: Report and Mistakes

Unread post by borisz_30 »

sovietxrobot wrote: Wed Oct 20, 2021 4:43 pm in summary it sounds like you had sexual side effects of escitalopram and had PSSD after abrupt discontinuation? Is that right? What about discontinuation from trazodone, did that have an immediate effect?
Hi friend,

Yes, you're right. When I began with Escitalopram, I felt all the sexual side effects (delay, lack of pleasure, lack of libido, etc), and improved a little most of the time in treating with 10mg - it only worsened by raising dosage to 15mg. And when I discontinued it, I didn't fully recover, so yes I got PSSD from it.

I didn't have much problems with lefting trazodone, as I remember. I didn't affect much on sexual side, but on mood, it made me a little more apathetic. It's hard to track coz I was taking it altogether with Escitalopram, so that I may have had some side effect and didn't link properly. The only bad thing of lefting trazodone is that my sleep seems to be like it was on it - I wake up with a serious dry mouth and sometimes I would have an erection in the REM sleep, probably.
sovietxrobot
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Re: My Report and Mistakes

Unread post by sovietxrobot »

e ola para voce também, amigo.

St. John's wort is serotonergic and in some people behaves similarly to SSRIs- you should carefully taper off this if youre going to come off. Don't make the mistake of thinking that herbal supplements are somehow safer than prescription medication- they are unregulated and not well studied, and some of them can be just as potent as prescription medication. Also you have no idea what the dosage is.

You could try buspar and melatonin. Buspar is pretty mild but it might help you some, and it synergies with melatonin, which will also help your sleep. I also found yohimbine to be helpful as well. This trio gives me a lot of relief independent from other medications, and they are all pretty safe.

It sounds like trazodone wasn't a great fit for you, although its the only thing I've found that could restore genital sensitivity, libido, emotions, and pleasure. You could consider trying that again or something similar like Flibanserin. If you try any of these, its imperative that you stick to a rigid dosing schedule- no more missing doses. And if you want to get off, you need to taper very slowly to reduce the risk of a crash.

I believe in Brazil you have better access to psychiatric care than in the US. Were you able to find a psychiatrist who believes in PSSD and is willing to work with. you?
borisz_30
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Re: My Report and Mistakes

Unread post by borisz_30 »

sovietxrobot wrote: Wed Oct 20, 2021 6:02 pm e ola para voce também, amigo.

St. John's wort is serotonergic and in some people behaves similarly to SSRIs- you should carefully taper off this if youre going to come off. Don't make the mistake of thinking that herbal supplements are somehow safer than prescription medication- they are unregulated and not well studied, and some of them can be just as potent as prescription medication. Also you have no idea what the dosage is.
Olá Robot Friend!! I'm sorry for taking a while to reply, i try to keep my mind clean of everything on weekends, so that's why I only came today.

I will really take into consideration what you've said about St. John's and supplements! I really understand that this can be also deadful for the body.

I decided to lower the dosage to only one capsule / day, to make it easier in case I need to drop off. But, sincerely, haven't been seeing any great effect so far. Maybe a little better mood - still not sure..
You could try buspar and melatonin. Buspar is pretty mild but it might help you some, and it synergies with melatonin, which will also help your sleep. I also found yohimbine to be helpful as well. This trio gives me a lot of relief independent from other medications, and they are all pretty safe.
I was thinkg about Buspar (buspirone, here) , as the doctor even mentioned it when I talked to him about lack of libido, etc (in late 2020).
I was so afraid of taking anything new that I didn't buy Buspirone and thought it would be as harfmul as Trazodone was. :(
It sounds like trazodone wasn't a great fit for you, although its the only thing I've found that could restore genital sensitivity, libido, emotions, and pleasure. You could consider trying that again or something similar like Flibanserin. If you try any of these, its imperative that you stick to a rigid dosing schedule- no more missing doses. And if you want to get off, you need to taper very slowly to reduce the risk of a crash.
Talking about trazodone, I think that not tapeting it and being afraid of priapism was a big mistake. For me, it seems like I still have the same side effects I had while taking it, which is very suspicious, get it? Would it be safe to try to reinstate it in a lower dosage, until get some effect and then try to taper off very slowly?

Where can we find some tappering plans for medications or supplements? Is it a trial / error thing?
I believe in Brazil you have better access to psychiatric care than in the US. Were you able to find a psychiatrist who believes in PSSD and is willing to work with. you?
I'm not really sure of it, althought it's something I'm bound to try. My last psychiatrist was really good, although kind of expensive for me. But I wasn't aware of PSSD when I last consulted him, the least I said was that I was having libido and sexual issues and worries, he even mentioned and prescribed Buspirone, I didn't buy coz I didn't know it. But maybe it would be worth trying.

I just want to get rid of the head pressure and tinnitus, so what I will try to do is to treat these things as a separate matter. Try to strike up a good plan to treat PSSD (anorgasmia, lack of libido, pleasure, etc), and see what may work for constipation, head-pressure, etc.

Thank you for your kind replies, you were surely helpful. But as you can see, I'm pretty new to all this stuff, so I guess that's pretty normal to have a brainstorming when we first touch the roots of PSSD.

Cheers!
borisz_30
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Re: My Report and Mistakes

Unread post by borisz_30 »

Hey there,

So yes, I was reading and possibly I got PSSD from the combination of Escitalopram and Trazodone, but I am really really worried about this second medication.

I was reading that it shall be tappered off very slowly, and I left it cold turkey in 2019 due to the not-wished erections during morning time. I was taking a 50mg dosage, and took it for 25 days (still have the box here an I was counting the pills).

What is scaring me is that these side effects I used to have when taking Trazodone didn't leave me. Looks like the brain somehow misses it, even from a long long time ago. Which I find quite weird and scary at the same time. And I have tinnitus, head pressure, and sleeping is like a rock and even when I relax for a little while in bed trying to sleep, I get a mild erection. And looks like if it keeps happenning, penis may create a fibrosis and lead me to complete impairment.

I can't stop thinking about it. I know many will not trust my theory of withdrawal syndrome from trazodone. I am seriouly thinking about reinstating it at a low dosage, and taper off very very slowly, even with a long term plan. I think I will talk to that doctor to see, but I'm really worried that he won't believe me either :

Edit: I've found some article that backs-up what I feel:
https://nurses.uroweb.org/rare-and-unkn ... erections/
https://www.sciencedirect.com/topics/nu ... l-erection
(my erections are not painful exactly, I remember feeling a bit of pain in the past though)

So now I think I should try an urologist to see what he says about it. And it was induced by these changes in sleep caused by Trazodone, i'm really sure.
nicopickle
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Re: My Report and Mistakes

Unread post by nicopickle »

i have the exact same issue as you from trazodone. i think i know what’s happening. the withdrawal from trazodone caused an overactive adrenal gland. trazodone targets the adrenergic receptors. i’m curious. do you respond to weed or alcohol? it seems that when there is so much cortisol from an overactive adrenal gland to get an euphoric high. i think this relates to the weak orgasm as well.
sovietxrobot
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Re: My Report and Mistakes

Unread post by sovietxrobot »

borisz_30 wrote: Wed Oct 27, 2021 4:28 pm I was reading that it shall be tappered off very slowly, and I left it cold turkey in 2019 due to the not-wished erections during morning time. I was taking a 50mg dosage, and took it for 25 days (still have the box here an I was counting the pills).
Abrupt discontinuation from trazodone could certainly cause PSSD. I think its one of the best drugs to treat PSSD because it is selective for 5HT2A, but this also makes it dangerous. I personally have recovered from a trazodone crash by going on a higher dosage and tapering back down slowly. Your plan is not unreasonable.

Tapering is pretty straightforward, but I think people with PSSD have an extreme sensitivity to withdrawal effects so you need to be quite conservative. You want to decrease your dosage by small increments, every 4 weeks. With trazodone for example, the smallest pill I had was 25mg, so I cut this in quarters and went down 7.5mg everything month.

You can probably go faster than this, the rule of thumb is 10% dose reduction per month, but I have pretty severe PSSD so I'm not taking chances.
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