Paxil Sexual Side Effects Question

[johnps]

I have just started Paxil 3 days ago having it prescribed for frequent panic attacks. I have been started on a 10mg dose each morning and I am also taking .5mg of Xanax which I believe will be temporary until the paxil takes effect and the dosage increased. I have also been prescribed 100mg of Trazodone which I take at night for related sleep problems. So far I have not had any of the sexual side effects but it has only been 3 days on a low dose.

I have heard all the talk about the sexual side effects and it is really scaring me. Does anyone have any experience or advice in this area? Does loss or decrease of libido always occur? If so when will this start. Does the delayed ejaculation also always occur? If so when should I expect these side effects to occur? Right now I don't know which will be worse. Loosing my sex life or having occasional panic attacks which have been pretty bad. Thanks for any advice or help on this.

You could go to askapatient.com, type in Paxil and see how many people ended up with those same problems.

As you can see, most of us are not happy with Paxil. Do yourself a favor and start keeping a journal now, how much you take, what else you take, how you feel, etc. Xanax and a sleep med seems a bit much (to me) since the sleep meds and xanax helped make me moody. I did have problems with delayed orgasms; however, it's in my opinion it would be better to be a man with this problem. Not everyone gets side effects but most of the people I talked to did have a sexual side effect. But with Paxil, Xanax, and a sleep med, you won't even be in the mood for sex, hahaha. I was always still in the mood, not as much yes but still in the mood, and would still have an orgasm. Panic attacks are worse than a delayed orgasm, but the side effects are worse than both. Keep an eye out.

[LossLeader]

Delayed orgasm is ok for men, to begin with. On a low dose it's not so bad.

Unfortunately, after a while - and especially if you up the dose - it will degenerate into impotence. I mean, it might take a few years, but it will happen. And then when you come off the drug you may well find yourself having extremely bad premature ejaculation. Worst of both worlds.

It's like everything else with these drugs - you may get a honeymoon period of anything between a month and three years, but eventually they turn on you. And when you stop taking the drug, things suddenly get a whole lot worse than they were to begin with.

Have a read of a few more threads on this forum and think very carefully about whether you want to start taking Paxil. It's a lot better that you hear this stuff now, when you haven't been taking it very long, than later (even a couple of weeks later) - when it's too late to get off without experiencing some degree of withdrawal.

Also, if your doctor used the phrase "chemical imbalance", or the phrase "non-addictive".... then ignore everything else they say about this drug from now on, and listen to the people who've taken it.

[Delynbetter]

Psychiatry department at University of California-San Francisco has a continuing medical education course where they inform doctors that Paxil should be reserved for anorexics, pedophiles and nymphomaniacs.

I'm thinking the percentage is really high if they're preaching it.

[Kristin]

Johnps- welcome to the site. Have you spent time reading on this site? I urge you to because taking a mind-altering drug can have severe negative consequences. I think people should be well informed to make a decision like this. Most of us were not informed because our doctors were not and still are not informed because the phamaceutical companies have hidden data about the dangerous side affects and potential for addiction.

Many people on this site who are going through withdrawal say that withdrawal anxiety is vastly greater than the anxiety they had before taking the meds and would give anything to go back to their original level of anxiety.

While sex is really important I agree, many here cannot work, parent, leave the house, or even take care of themselves because the withdrawal is so all-consuming for their bodies and minds. So it makes me wonder if you are fully informed about the Paxil you are starting. The word is that Paxil is the most addictive one of the bunch.

This is a great site to learn from and ask questions and get support, welcome.

[Charlie]

Originally Posted by Delynbetter

Psychiatry department at University of California-San Francisco has a continuing medical education course where they inform doctors that Paxil should be reserved for anorexics, pedophiles and nymphomaniacs.

I'm thinking the percentage is really high if they're preaching it.

Depending on which reaction the person gets they could take these people from bad to worse...

[Katesmom]

Frankly, John, the libido issue would likely be the least of your problems. After you take Paxil for a while, you really won't care that much if you are having sex or not. You won't care that you've gained 20 pounds. You won't care that your too tired to do anything. You won't care that you don't have fun anymore, or get sad. You just won't care. Strangely, you'll know that you should care, but you just won't be able to. Paxil is not worth it. Therapy is.

Also, know that xanax is very addictive. It doesn't take long at all to get addicted to benzos. It's scary if your doc is telling you to take it everyday. It should only be taken as needed. It has a really short half-life and is known to cause major rebound anxiety when it wears off, so it's possible that the xanax will actually make you feel worse.

[Delynbetter]

Charlie, so true! Also at the same time they were telling the doctors about this they did NOT bother to mention anything about withdrawal, tapering or talk too much about other side effects that come with the drugs.

[bran23]

I was on paxil for 5 years. My sexual side effects did not start right away but when they didi they really did. Last couple of years I was counting the months between intimacy with my wife. I'm getting off Paxil now. It is not easy but at least I can feel again.

[Homerbcool]

Sex side affects for sure..but here is the real message...stop taking paxil now, find an alternative beofre you get put on this effing paxhell train...speak to your doctor about what yuo have found here, addictive, side affactes including sex problems, gain weight, not to mention it really effs up your brian...emotional problems, or just a complete lack of emotions....get therapy from a Phsycologist, if I could go back, i would withdrawl from the wrold for 30 - 0 days go to a retreat and get better, even if I could not afford it, I would do anything NOt to have taken this crap!!!!

[josephlester]

Yeah, this drug is awful. I've been on it for over five years now. It is almost impossible for me to ejaculate during sex. I can only come if I do it myself, and even then only if I do it with a LOT of friction. My main worry now as I try to get off this drug is that I've developed a mental hang up about sex that won't go away once the meds finally leave my system. In other words, I have such a difficult time ejaculating during sex that I get anxious about it altogether.

[Sugarpeeps]

Good morning to you. You should read some of the threads on here about this very subject; there are some nasty side effects. Also, I have read recently that they have seen that some of the sexual side effects (anorgasmia, premature ejaculation etc) that are brought on by the medications do NOT reverse upon discontinuation of the drug in some people.

[LossLeader]

Got a link for that, Sugarpeeps?

[altostrata]

The rate for adverse sexual side effects with Paxil is around 50%.

However, John, you should know that study after study has shown that Paxil, along with Effexor, is the worst SSRI for side effects and discontinuation syndrome. Some doctors do not prescribe Paxil anymore. Women of childbearing age should not take it because it can damage the baby.

Celexa, Lexapro, and Wellbutrin have better reputations for side effects, including sexual side effects, and discontinuation syndrome. Wellbutrin can enhance sexual response (I found this to be true). Prozac has less discontinuation syndrome than Paxil but the same rate of adverse sexual side effects.

(Trazodone apparently also can be sexually stimulating. However, you can have a paradoxical reaction to trazodone -- it can make you anxious -- if you take it with Paxil. There can be a drug-drug conflict over the liver enzyme P450 cyp 2d6.)

If you are curious about whether SSRIs can damage your sexuality long-term, check out the Yahoo discussion group ssrisex. The news is not good.

Doctors insist that long-term damage from SSRIs, including Paxil, is so rare that it hardly matters. However, this discussion board and many others are populated by people who have had severe discontinuation syndrome and other long-term adverse effects.

Panic attacks can be treated effectively by cognitive behavior therapy (CBT), which has no physical side effects and can give you a feeling of empowerment.

Your chances of adverse sexual side effects with Paxil are 50-50 and experiencing a wicked discontinuation syndrome are better than even. If I were you, I would either try CBT or switch to a less risky SSRI before my brain got wrapped around Paxil.

By the way, I have been recovering from discontinuation syndrome for almost 2 years. Along with other terrible symptoms, it made me anorgasmic.

[Chrysalis]

John,

I echo everything everyone has already said above. In short, get away from Paxhell while there is still time. If I could do it over, I'd try therapy, nutritional support, supplements, exercise, anything but Paxil. Hindsight is 20/20.

I need to add one more thing. Paxil and Trazodone are not really supposed to be prescribed together, according to some sources. I took them together for about 8 of my 9 years on Paxil, not knowing this. Occasionally there would be a warning on the paperwork from the pharmacy, indicating a duplication of therapy, but I didn't know. I haven't died of it, but I'll never know what internal damage might have been enhanced by the combo.

You'll see by my signature that I'm still weaning off the Paxil, and hopefully eventually the Trazodone, too.

Best Wishes!

Margaret

[johnps]

Just thought I would update this thread.

After taking the Paxil for less than a week I decided not to continue with it due to all the bad stuff I heard. The Trazodone did not work at all for insomnia in fact I think it made it worse. Currently I am taking Xanax only when I feel I need to which is maybe twice a week. For my insomnia issues I am taking Lunesta which works great. I also tried Ambien CR which also worked but not quite a well as the Lunesta. I try to limit the sleep meds but have been taking them about 3 nights per week.

Since my first posting my panic attacks are much less frequent. I still have fairly regular anxiety issues but nothing that has driven me to want to take the meds that have more side effects than they are worth.

[benny_man]

It seems PP Has saved a Possible victim!
Shoo''Close call.
Good work PP, I am glad to see you beating this John.

[scotty]

John, look into therapy for the anxiety. I know it was VERY helpful for my son. Good choice.

[Chrysalis]

Good choice not to do the Paxil, John. You dodged a bullet.

Hope things continue to improve for you!

Margaret

[elisa]

I'm glad that you decided not to choose Paxil as your life companion!! These AD's act as elephants in a china shop...

[kathy2731]

Chemical Imbalance...what a crock. I suffered from situational depression. In other words, I know what caused the depression. Iwas really suffering and was desperate for a quick fix. I didn't want to go the therapy route because I wanted this awful sadness to go away FAST. I wasn't used to feeling so heartbroken and sad. I was always an upbeat, glass half full kind of girl. So when I went to my doctor in desperation, he said I was suffering a type of post traumatic stress and I must have a chemical imbalance. He said take paxil and you will feel better in two weeks. Eureka, an answer and more importantly, a quick fix. No fuss, no muss. Paxil worked great. I felt much better. Could handle the sadness much better, but it was still there. Paxil made it more bearable. Five years later, and finally off this stuff for a week, I realized this. How could I have had no chemical imbalance for 48 years, and overnight just because I suffered a heartbreak, all of a sudden my chemicals are all imbalanced? I can't believe I bought that crap. Bottom line, I didn't want to have to put in any work, I wanted to feel better instantlyand what better way then to have a doctor you trust give you a magic pill. Lesson well learned...you don't need to pop a pill everytime you are sad, can't sleep, are overweight, etc. There are no magic cures.

[altostrata]

Originally Posted by johnps

Just thought I would update this thread.

After taking the Paxil for less than a week I decided not to continue with it due to all the bad stuff I heard. The Trazodone did not work at all for insomnia in fact I think it made it worse. Currently I am taking Xanax only when I feel I need to which is maybe twice a week. For my insomnia issues I am taking Lunesta which works great. I also tried Ambien CR which also worked but not quite a well as the Lunesta. I try to limit the sleep meds but have been taking them about 3 nights per week.

Since my first posting my panic attacks are much less frequent. I still have fairly regular anxiety issues but nothing that has driven me to want to take the meds that have more side effects than they are worth.

John, thanks for listening!

You may have had the paradoxical Paxil-trazodone effect of increased anxiety.

Please be careful about taking Xanax, which is definitely addictive, and Lunesta, which may yet prove to be, only occasionally. All of these psychoactive drugs do things to the brain that medicine doesn't understand yet -- and the drug companies don't want to admit.

[altostrata]

J Clin Psychiatry. 2003;64 Suppl 10:11-9.

Antidepressant-related erectile dysfunction: management via avoidance, switching antidepressants, antidotes, and adaptation.

Labbate LA, Croft HA, Oleshansky MA.

Department of Psychiatry and Behavioral Science, Medical University of South Carolina and Veterans Administration Medical Center, Charleston, SC, USA. labbatel@musc.edu

The ideal antidepressant would control depression with no adverse effect on sexual function. Erectile dysfunction and other sexual dysfunction associated with antidepressant medication treatment are problems with many antidepressants and can lead to patient dissatisfaction and decreased compliance with treatment. A computerized MEDLINE search (English language, 1966-2003) was performed using the terms antidepressive agents, erectile dysfunction, and sexual dysfunction. Emphasis was placed on studies with specific sexual function measurements taken before and after treatment and placebo control. Mixed mediator, nonserotonergic antidepressants that block postsynaptic serotonin type 2 receptors (nefazodone, mirtazapine) or that primarily increase dopamine or norepinephrine levels (bupropion) were thought to be good choices for avoiding antidepressant-associated sexual dysfunction or for switching patients in whom antidepressant-associated sexual dysfunction emerged. Comparisons with serotonin reuptake inhibitors (SRIs) have revealed less desire and orgasm dysfunction with nonserotonergic bupropion, less orgasm dysfunction with nefazodone, and superior overall satisfaction with sexual functioning with bupropion or nefazodone. However, most of these studies have design flaws that make evidence-based claims of efficacy difficult to substantiate. Agents proposed for antidote use in antidepressant-associated sexual dysfunction have either not been studied in men or not proved efficacious in randomized placebo-controlled trials. Switching to and augmentation with bupropion or nefazodone have also not clearly shown efficacy in controlled trials and require care and monitoring to avoid SRI discontinuation symptoms and loss of antidepressant efficacy. Few proposed treatment options, apart from avoidance, have proved effective for antidepressant-associated sexual dysfunction, which can have negative consequences on depression management.

[altostrata]

J Sex Marital Ther. 2002 Oct-Dec;28(5):451-61.

Relationship between CYP 2D6 metabolic status and sexual dysfunction in paroxetine treatment.

Zourkova A, Hadasova E.
Department of Psychiatry, Masaryk University, Brno, 63900, Czech Republic. zourek@kralovopolska.cz

This article describes the incidence of sexual dysfunction in 30 patients subjected to long-term treatment by paroxetine in dependence on the P 450 CYP 2D6 isoenzyme metabolic status. Measured on the Arizona Sexual Experience Scale (ASEX; McGahuey, Delgado, & Gelenberg, 1999), the incidence of sexual dysfunction in patients converted to CYP 2D6 poor metabolizers was markedly higher compared with patients who had no history of such conversion, a difference that reached the level of statistical significance. Our article discusses the incidence of sexual dysfunction in connection with reduced CYP 2D6 capacity.

[altostrata]

J Clin Psychopharmacol. 1998 Aug;18(4):274-81.
Comment in:
J Clin Psychopharmacol. 2001 Apr;21(2):241-2.

Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo-controlled study with fluoxetine, fluvoxamine, paroxetine, and sertraline.

Waldinger MD, Hengeveld MW, Zwinderman AH, Olivier B.
Department of Psychiatry and Neurosexology, Leyenburg Hospital, The Hague, The Netherlands.

Depression is a common cause of sexual dysfunction, but also antidepressant medication is often associated with sexual side effects. This article includes two related studies. The first double-blind, placebo-controlled study was conducted in men with lifelong rapid ejaculation and aimed to assess putative differences between the major selective serotonin reuptake inhibitors (SSRIs) (fluoxetine, fluvoxamine, paroxetine, and sertraline) with regard to their ejaculation-delaying effect. Sixty men with an intravaginal ejaculation latency time (IELT) of 1 minute or less were randomly assigned to receive fluoxetine 20 mg/day, fluvoxamine 100 mg/day, paroxetine 20 mg/day, sertraline 50 mg/day, or placebo for 6 weeks. During the 1-month baseline and 6-week treatment periods, the men measured their IELT at home using a stopwatch. The trial was completed by 51 men. During the 6-week treatment period, the geometric mean IELT in the placebo group was constant at approximately 20 seconds. Analysis of variance revealed a between-groups difference in the evolution of IELT delay (p = 0.0004); in the paroxetine, fluoxetine, and sertraline groups there was a gradual increase to about 110 seconds, whereas in the fluvoxamine group, IELT was increased to only approximately 40 seconds. The paroxetine, fluoxetine, and sertraline groups differed significantly (p < 0.001, p < 0.001, p = 0.017, respectively) from placebo but the fluvoxamine group did not (p = 0.3. Compared with baseline, paroxetine exerted the strongest delay in ejaculation, followed by fluoxetine and sertraline. There was no clinically relevant delay in ejaculation with fluvoxamine. In men with lifelong rapid ejaculation, paroxetine delayed ejaculation most strongly, whereas fluvoxamine delayed ejaculation the least. The second double-blind, placebo-controlled study was carried out in men with lifelong rapid ejaculation (IELT < or = 1 minute) and in men with lifelong less-rapid ejaculation (IELT > 1 minute) to investigate whether data about SSRI-induced delayed ejaculation in men with rapid ejaculation may be extrapolated to men with less-rapid ejaculation. After measurement of IELT at home (using a stopwatch) during a 1-month baseline assessment, 32 men with an IELT of 1 minute or less (group 1) or more than 1 minute (group 2) were randomly assigned to receive paroxetine 20 mg/day or placebo for 6 weeks in a double-blind manner. Patients continued to measure their IELTs at home during the 6 weeks of the study. At baseline, 24 patients consistently had IELTs of one minute or less (group 1), and eight patients had IELTs of more than 1 minute (group 2). The geometric mean IELT was 14 seconds in group 1 and 83 seconds in group 2. Twelve patients in group 1 and five in group 2 were randomized to the paroxetine 20 mg/day. The percentage increase in the geometric mean IELT compared with baseline in patients treated with paroxetine was 420% (95% confidence interval [CI], 216-758%) in group 1 and 480% (95% CI, 177-1,118%) in group 2 (p = 0.81). After 6 weeks of treatment with paroxetine, the geometric mean IELT was 92 seconds in group 1 and 602 seconds in group 2 (p < 0.001). Therefore, the paroxetine-induced percentage increase in IELT seems to be independent of the baseline IELT. This suggests that ejaculation-delaying side effects of some SSRIs investigated in men with lifelong rapid ejaculation may be generalized to men with less-rapid ejaculation.