Re: Citalopram side effects

[Guest guest]

If there are no contraindications, you could give her samples of Viagra Levitra or Cialis and see if it helps.Make sure she does not have atrophic vaginitis.Pedro Ballester, M.D.

Warren, OH

[Guest guest]

How old is she? If perimenopausal/menopausal, lack of estrogen may be playing a role in both her mood, attention disorder, and low libido. If she has had oophorectomy, and is past 50, then consider checking testosterone level if she does not respond to adequate estradiol replacement.What was her libido like in the past- has it really changed? Is she really talking about level of interest or ability to arouse and orgasm? Sometimes, I combine Bupropion with an SSRI for various reasons including libido and ADD. If it definitely seems related to her citalopram use, then I would try switching her to escitalopram which has a less impact on libido in my practice experience.What other marital problems does she have? Body

image problems? You are in Florida, yes? Consider referring to a qualified sex therapist.Carla Gibson FNP To: IMP < > Sent: Thursday, July 26, 2012 5:35 PM Subject: Citalopram side effects

I have a female patient with ADDH and depression anxiety.

I have her in adderall stable and with citalopram stable.

she is complaing of lack of libido, she is saying that she has marital problems because she does not have a libido.

I was wondering if somobody from the group have any ideas to help her.

Thanks Adolfo

PS: I do not want to change her meds because she was a train reck when she came to see me.

[Guest guest]

Pedro, I'm curious as to how Viagra would help. Those medications help ED but my understanding is that it improves blood flow not libido/desire. Is there new information? Alfredo,I once went through Epocrates and listed all the SSRI's and how far down the side effect list loss of libido appeared and switched patients to those that had it lower on the side effect list. Not sure how scientific it was but seemed to work for a couple of patients. Unfortunately many patients do have to stop medication due to this side effect. Sometimes Wellbutrin works better but I've had patients complain of sexual side effects on it too. Sometimes it takes a bit of trying different

combinations. Good luck. To: Sent: Thursday, July 26, 2012 7:43 PM Subject: Re: Citalopram side effects

If there are no contraindications, you could give her samples of Viagra Levitra or Cialis and see if it helps.Make sure she does not have atrophic vaginitis.Pedro Ballester, M.D.

Warren, OH

[Guest guest]

It may just anecdotal, urban-medical myth on the effect on the female.That is why I suggested samples, even if it just a placebo effect, it is less expensive than the hormonal options suggested earlier.

I got the impression, Adolfo did not want to change any of the psychiatric medications.What is the factual evidence that hormonal manipulation with testosterone in females woks?

Pedro Ballester, M.D.Warren, OH

[Guest guest]

http://www.tripanswers.org/Answer.aspx?qid=3883 

We searched the NLH Specialist Library for Women’s Health, and TRIP and Medline databases but found very few studies of testosterone therapy to treat perimenopausal or premenopausal loss of libido. The majority of research focuses on testosterone therapy to improve libido in either postmenopausal women or in women who have a surgically induced menopause. We found no trials of testosterone therapy in perimenopausal women; but did locate two trials and a review article in premenopausal women.

A review article by Kalantaridou, published in 2006, notes:

“Testosterone therapy for postmenopausal women and women with surgical menopause, albeit controversial, is becoming more widespread. However, only limited data are available to support its use in premenopausal women. ..Only a few studies investigating the effects of testosterone therapy have been performed thus far in premenopausal women. Long-term trials evaluating safety and effectiveness of testosterone therapy in premenopausal women are lacking. Common adverse effects include hirsutism and acne, which reverse with discontinuation of treatment. The availability of testosterone regimens specifically designed for women is expected to help maintain testosterone levels within the normal range and clarify whether the apparent beneficial effects of testosterone therapy are physiological or pharmacological.” [1]

Goldstat and Briganti et al assessed the effectiveness of a transdermal testosterone patch to improve well-being, mood and sexual function in premenopausal women reporting:

“Premenopausal women with low libido participated in a randomized, placebo-controlled, crossover, efficacy study of testosterone cream (10 mg/day) with two double-blind, 12-week, treatment periods separated by a single-blind, 4-week, washout period. RESULTS: Thirty-four women completed the study per protocol, with 31 women (mean age 39.7 +/- 4.2 years; serum testosterone 1.07 + 0.50 nmol/L) providing complete data. Testosterone therapy resulted in statistically significant improvements in the composite scores of the Psychological General Well-Being Index [+12.9 (95% CI, +4.6 to +21.2), P = 0.003] and the Sabbatsberg Sexual Self-Rating Scale [+15.7 (95% CI, +6.5 to +25.0), P = 0.001] compared with placebo. A mean decrease in the Beck Depression Inventory score approached significance [-2.8 (95% CI, -5.7 to +0.1), P = 0.06]. Mean total testosterone levels during treatment were at the high end of the normal range, and estradiol was unchanged. No adverse effects were reported. CONCLUSIONS: Testosterone therapy improves well-being, mood, and sexual function in premenopausal women with low libido and low testosterone. As a substantial number of women experience diminished sexual interest and well-being during their late reproductive years, further research is warranted to evaluate the benefits and safety of longer-term intervention.” [2]

Of interest, also, may be a pilot study of transdermal testerone gel for hypoactive sexual desire disorder by Chudakov et al:

“…AIM: We hypothesized that a single dose of testosterone given 4-8 hours prior to planned intercourse in women with hypoactive sexual desire disorder (HSDD) might increase desire without side effects associated with chronic use. METHODS: The design was randomized double-blind crossover. Premenstrual women with HSDD received eight packets of gel or identical placebo for use before intercourse twice weekly for 1 month. For a second month, the alternate treatment was given. MAIN OUTCOME MEASURES: Ratings were performed using the patient-rated Arizona Sexual Experiences Scale for females and the clinician-rated Sexual Function Questionnaire (SFQ-V1). RESULTS: Ten patients completed the study. On the five-item self-report Arizona, the item " How easily are you aroused? " was significantly improved on testosterone gel vs. placebo, P = 0.03. There were similar trends on the physician-rated SFQ-V1 " arousal-sensation " cluster. CONCLUSIONS: These preliminary results suggest that testosterone gel given prn before intercourse has effects on sexual arousal, and further research is needed to define dosage and time schedule to optimize this effect and determine its clinical relevance.” [3]

http://www.ncbi.nlm.nih.gov/pubmed/14634409

J Urol. 2003 Dec;170(6 Pt 1):2333-8.

Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder: a double-blind, placebo controlled study.

Berman JR, Berman LA, Toler SM, Gill J, Haughie S; Sildenafil Study Group.

SourceDepartment of Urology, University of California-Los Angeles Medical Center, 90024, USA. JBerman@...

Abstract

PURPOSE:We evaluated the efficacy and safety of sildenafil citrate in spontaneously or surgically postmenopausal women with female sexual arousal disorder (FSAD).

MATERIALS AND METHODS:

Sildenafil (a 50 mg dose adjustable to 100 or 25 mg) was evaluated in a 12-week, double-blind, placebo controlled study in 202 postmenopausal women with FSAD who had protocol specified estradiol and free testosterone concentrations, and/or were receiving estrogen and/or androgen replacement therapy. Patients were excluded if emotional, relationship or historical abuse issues contributed significantly to sexual dysfunction. Primary end points were questions 2 (increased genital sensation during intercourse or stimulation) and 4 (increased satisfaction with intercourse and/or foreplay) from the Female Intervention Efficacy Index (FIEI). Secondary end points were the remaining questions from this index, the Sexual Function Questionnaire and sexual activity event log questions.

RESULTS:

Significant improvements in FIEI questions 2 (p = 0.017) and 4 (p = 0.015) were noted with sildenafil compared with placebo. For women with FSAD without concomitant hypoactive sexual desire disorder (HSDD) sildenafil was associated with significantly greater improvement in 5 of 6 FIEI items compared with placebo (p <0.02). No significant improvements were shown for women with concomitant HSDD. Most adverse events were mild to moderate with headache, flushing, rhinitis, nausea and visual symptoms reported most frequently.

CONCLUSIONS:

Sildenafil was effective and well tolerated in postmenopausal women with FSAD without concomitant HSDD or contributory emotional, relationship or historical abuse issues. All patients had protocol specified estradiol and free testosterone concentrations or were receiving estrogen and/or androgen replacement therapy.

http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?AccessionNumber=12006007067

CRD summaryThis review concluded that there was some evidence to suggest that pharmaceutical interventions to treat female sexual dysfunction improve one or more aspects of sexual function, but it is unclear whether these improvements are clinically meaningful. Given the limited number and quality of the studies, the authors' cautious conclusions are likely to be reliable and their suggestions for further research warranted.

Authors' objectivesTo review randomised controlled trials (RCTs) of pharmaceutical interventions to treat female sexual dysfunction (FSD) in order to optimise the design of future studies.

SearchingPubMed was searched from 1980 to 2005; the search terms were reported. Additional studies were identified from the reference lists of retrieved articles.

Study selectionStudy designs of evaluations included in the review

Randomised controlled trials (RCTs) were eligible for inclusion in the review.Specific interventions included in the review

Studies of pharmaceutical treatments for FSD were eligible for inclusion. The included studies evaluated sildenafil or testosterone/methyltestosterone, with a wide range of doses and regimens used across studies.

Participants included in the reviewStudies of healthy women with FSD were eligible for inclusion. FSD was defined according to the American Psychiatric Association's revised Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or the American Foundation for Urologic Diseases (AFUD) classifications. Hypoactive sexual desire disorder, female sexual arousal disorder, female orgasmic disorder and sexual pain disorders were included. Surgically menopausal women were excluded from the review. The age of women in the included studies ranged from 18 to 78 years.

Outcomes assessed in the reviewEligible studies had to include specific and comprehensive measures of sexual function, either questionnaire or hormone measurements. Behavioural, physiological and psychological outcomes, measured using clinical or laboratory tests, outcome scales and personal diaries, were reported.

How were decisions on the relevance of primary studies made?The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.

Assessment of study qualityThe review was restricted to double-blind RCTs. Study quality was further assessed in relation to statistical power, participant inclusion and exclusion criteria, participant definition, outcomes, outcome measurement methods and treatment duration. The authors did not state how many reviewers performed the assessment.

Data extractionThe authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Changes in sexual behaviour and response were extracted.

Methods of synthesisHow were the studies combined?

The studies were combined in a narrative, grouped according to the methodological criteria being investigated.How were differences between studies investigated?

Differences between the studies were discussed in the text, and study details and results were tabulated.

Results of the review

Eleven RCTs (n=3,056) were included in the review. Three were crossover studies.Quality.Five studies were sufficiently powered to detect a statistically significant difference between the intervention and placebo groups. Many studies used subjective outcomes that were open to bias, and there was no consensus on the types of participants included in the studies.

Effectiveness.Two studies evaluating sildenafil and all seven evaluating testosterone/methyltestosterone showed some improvement in one or more aspect of sexual function with treatment; the other studies showed differences between the intervention and placebo groups.

Of the two sildenafil studies with adequate statistical power, one reported no change in sexual response and the other an increase in genital sensation and satisfaction.

The three testosterone/methyltestosterone trials with adequate statistical power reported increases in satisfying sexual activity and sexual desire, accompanied by a decrease in personal distress, with treatment.

Authors' conclusionsThe majority of included studies showed some improvement in one or more aspects of sexual function. However, it is unclear whether these improvements are clinically meaningful.

CRD commentaryThis review was based on a clear review question. The reviewers only searched PubMed and the reference lists of retrieved publications, and made no attempt to locate unpublished material, therefore publication bias might have affected the findings. It was unclear whether language restrictions were applied during the search, thus there is the potential for language bias. It was unclear to what extent bias and errors might have arisen through the study selection, quality assessment and data extraction processes, as these review methods were not described. The quality of the studies was, however, assessed, this being one of the main aims of the review.

Given the differences between the included studies in terms of their participants and outcomes, the use of a narrative synthesis was appropriate. The authors' findings also took the validity of the studies into account, in particular their statistical power. However, given that effectiveness was not the main focus of this review and the evidence is limited by the number, size and quality of the studies, the authors' cautious conclusions are likely to be reliable and their suggestions for further research warranted.

The lead reviewer is employed by Organon. However, Organon did not fund the study, which was part of the reviewer's thesis.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.Research: The authors recommended that future studies should assess statistically significant improvements that are clinically meaningful. Consensus should also be reached in relation to: what is the minimal important difference in effect size; inclusion and exclusion criteria for defining the FSD population; primary outcome measures; and trial end points which reflect clinically relevant outcomes embedded in a biopsychosocial sexual response model for women.

Pedro Ballester, M.D.Warren, OH

[Guest guest]

I can see it now...the next, best combo drug: testosterone + sidenafil....prn before the old gal's hot date....it'll make millions!  Think we could package it with McConaughey videos, personal lubricant and some filmy lingerie?

 

 

I'm sorry...I think I just went off the deep end.....

Annie

 

It may just anecdotal, urban-medical myth on the effect on the female.

That is why I suggested samples, even if it just a placebo effect, it is less expensive than the hormonal options suggested earlier.

I got the impression, Adolfo did not want to change any of the psychiatric medications.

What is the factual evidence that hormonal manipulation with testosterone in females woks?

Pedro Ballester, M.D.Warren, OH

-- Annie Skaggssville, KY

[Guest guest]

Annie ....all that and then who needs the date??Lol!Connected by DROID on Verizon Wireless Re: Citalopram side effects I can see it now...the next, best combo drug: testosterone + sidenafil....prn before the old gal's hot date....it'll make millions!  Think we could package it with McConaughey videos, personal lubricant and some filmy lingerie?  I'm sorry...I think I just went off the deep end.....Annie  It may just anecdotal, urban-medical myth on the effect on the female. That is why I suggested samples, even if it just a placebo effect, it is less expensive than the hormonal options suggested earlier.I got the impression, Adolfo did not want to change any of the psychiatric medications.What is the factual evidence that hormonal manipulation with testosterone in females woks?Pedro Ballester, M.D.Warren, OH-- Annie Skaggssville, KY

[Guest guest]

BIG smile!!!

 

 

Annie ....all that and then who needs the date??Lol!Connected by DROID on Verizon Wireless

Re: Citalopram side effects

 

I can see it now...the next, best combo drug: testosterone + sidenafil....prn before the old gal's hot date....it'll make millions!  Think we could package it with McConaughey videos, personal lubricant and some filmy lingerie?

 

 

I'm sorry...I think I just went off the deep end.....

Annie

 

It may just anecdotal, urban-medical myth on the effect on the female.

That is why I suggested samples, even if it just a placebo effect, it is less expensive than the hormonal options suggested earlier.

I got the impression, Adolfo did not want to change any of the psychiatric medications.

What is the factual evidence that hormonal manipulation with testosterone in females woks?

Pedro Ballester, M.D.Warren, OH

-- Annie Skaggssville, KY

-- Annie Skaggssville, KY

[Guest guest]

Fascinating  sociologically!! Apparently all of you lurk,  incl Pedro with his usual cool abilities to get searches and data, Annie saving lives hanging  dopamine and   running vents,  and then while no one posts and eveything is very  quiet all of  a sudden   BAm there you all are when the,ah right  topic,  is posted.

 what a crowd.

 

BIG smile!!!

 

 

Annie ....all that and then who needs the date??Lol!Connected by DROID on Verizon Wireless

Re: Citalopram side effects

 

I can see it now...the next, best combo drug: testosterone + sidenafil....prn before the old gal's hot date....it'll make millions!  Think we could package it with McConaughey videos, personal lubricant and some filmy lingerie?

 

 

I'm sorry...I think I just went off the deep end.....

Annie

 

It may just anecdotal, urban-medical myth on the effect on the female.

That is why I suggested samples, even if it just a placebo effect, it is less expensive than the hormonal options suggested earlier.

I got the impression, Adolfo did not want to change any of the psychiatric medications.

What is the factual evidence that hormonal manipulation with testosterone in females woks?

Pedro Ballester, M.D.Warren, OH

-- Annie Skaggssville, KY

-- Annie Skaggssville, KY

--      MD          ph    fax

[Guest guest]

Adolfo,Do you have access to UpToDate? they have some good articles on this topic, and their summaries should include the data that Pedro found.leslie-- Kernisan, MD MPH

Geriatrics

How old is she? If perimenopausal/menopausal, lack of estrogen may be playing a role in both her mood, attention disorder, and low libido.  If she has had oophorectomy, and is past 50, then consider checking testosterone level if she does not respond to adequate estradiol replacement.

What was her libido like in the past- has it really changed? Is she really talking about level of interest or ability to arouse and orgasm? Sometimes, I combine Bupropion with an SSRI for various reasons including libido and ADD.  If it definitely seems related to her citalopram use, then I would try switching her to escitalopram which has a less impact on libido in my practice experience.

What other marital problems does she have? Body

image problems? You are in Florida, yes?  Consider referring to a qualified sex therapist.Carla Gibson FNP

To: IMP < >

Sent: Thursday, July 26, 2012 5:35 PM Subject: Citalopram side effects

 

I have a female patient with ADDH and depression anxiety.

I have her in adderall stable and with citalopram stable.

she is complaing of lack of libido, she is saying that she has marital problems because she does not have a libido.

I was wondering if somobody from the group have any ideas to help her.

Thanks Adolfo

PS: I do not want to change her meds because she was a train reck when she came to see me.

[Guest guest]

LOL, I enjoyed hearing from folks I'd met at previous camps too! To: Sent: Friday, July 27, 2012 9:15 AM Subject: Re: Citalopram side effects

Fascinating sociologically!! Apparently all of you lurk, incl Pedro with his usual cool abilities to get searches and data, Annie saving lives hanging dopamine and running vents, and then while no one posts and eveything is very quiet all of a sudden BAm there you all are when the,ah right topic, is posted.

what a crowd.

BIG smile!!!

Annie ....all that and then who needs the date??Lol!Connected by DROID on Verizon Wireless

Re: Citalopram side effects

I can see it now...the next, best combo drug: testosterone + sidenafil....prn before the old gal's hot date....it'll make millions! Think we could package it with McConaughey videos, personal lubricant and some filmy lingerie?

I'm sorry...I think I just went off the deep end.....

Annie

It may just anecdotal, urban-medical myth on the effect on the female.

That is why I suggested samples, even if it just a placebo effect, it is less expensive than the hormonal options suggested earlier.

I got the impression, Adolfo did not want to change any of the psychiatric medications.

What is the factual evidence that hormonal manipulation with testosterone in females woks?

Pedro Ballester, M.D.Warren, OH

-- Annie Skaggssville, KY

-- Annie Skaggssville, KY

-- MD ph fax http:///

[Guest guest]

thanks for the response to my question. she is mid 30's , she has no health insurance and no much money so I did not have the chance to work her up. She came to me in a mess, I adjusted her adhd and depression/anxiety meds. she responded well. she is recently complaining about the lack of libido. Yes I do have access to Uptodate and will review the topic there, it is a good idea.I will also read Pedro's info and suggestions I am working in getting to San Diego and meet you guys. I have to sit down with Ardiana look for the info about the hotel and everything. My summer is been busy, the fact that primary care around me is saturated and tread mill type is been a blessing for me. I noticed that people around me still want and long for the all good days of primary care, with continuity of care and primary care with emphasis in care. I was laughing at loud one day when I patient asked me: isnt your time is up? I looked at her with a funny looking face and she said : My previous PCP after 7 minutes she said your time is up. When I opened my drawer and I got my toys ( otoscope) and started to exam her she said : what is this? are you going to really exam me? I told her that what I normally do. we are open 3 days a week, and we are contemplating to make the faith move to open 5 days a week. Ardiana quitted her job at the hospital as NICU RN to work in the clinic as Pediatric NP, receptionist , biller and my Rock.we are still working with no salary and we are doing everything, I am the official janitor of my clinic ( at least I do not have to consult anything to the Janitorial Board of Directors)Word of mouth is a domino effect on my clinic. Well I wil leave something for San Diegito. Take care, Adolfo

Adolfo,Do you have access to UpToDate? they have some good articles on this topic, and their summaries should include the data that Pedro found.leslie-- Kernisan, MD MPH

Geriatrics

How old is she? If perimenopausal/menopausal, lack of estrogen may be playing a role in both her mood, attention disorder, and low libido. If she has had oophorectomy, and is past 50, then consider checking testosterone level if she does not respond to adequate estradiol replacement.

What was her libido like in the past- has it really changed? Is she really talking about level of interest or ability to arouse and orgasm? Sometimes, I combine Bupropion with an SSRI for various reasons including libido and ADD. If it definitely seems related to her citalopram use, then I would try switching her to escitalopram which has a less impact on libido in my practice experience.

What other marital problems does she have? Body

image problems? You are in Florida, yes? Consider referring to a qualified sex therapist.Carla Gibson FNP

To: IMP < >

Sent: Thursday, July 26, 2012 5:35 PM Subject: Citalopram side effects

I have a female patient with ADDH and depression anxiety.

I have her in adderall stable and with citalopram stable.

she is complaing of lack of libido, she is saying that she has marital problems because she does not have a libido.

I was wondering if somobody from the group have any ideas to help her.

Thanks Adolfo

PS: I do not want to change her meds because she was a train reck when she came to see me.

[Guest guest]

Adolfo,Congratulations and great job on those brave steps.

It is fun to be different than the other providers in your area (ie taking time, doing exam, listening, all that).Wow to Ardiana for going from NICU RN to primary care office!

Really looking forward to meeting you both in San Diego.Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax: 

www.SharonMD.com

 

thanks for the response to my question.  she is mid 30's , she has no health insurance and no much money so I did not have the chance to work her up. She came to me in a mess, I adjusted her adhd and depression/anxiety meds. she responded well. 

 she is recently complaining about the lack of libido. Yes I do have access to Uptodate and will review the topic there, it is a good idea.I will also read Pedro's info and suggestions 

I am working in getting to San Diego and meet you guys. I have to sit down with Ardiana look for the info about the hotel and everything. My summer is been busy, the fact that primary care around me is saturated and tread mill type is been a blessing for me. 

I noticed that people around me still want and long for the all good days of primary care, with continuity of care and primary care with emphasis in care. I was laughing at loud one day when I patient asked me: isnt your time is up? I looked at her with a funny looking face and she said : My previous PCP after 7 minutes she said your time is up. 

When I opened my drawer and I got my toys ( otoscope) and started to exam her she said : what is this? are you going to really exam me? I told her that what I normally do. we are open 3 days a week, and we are contemplating to make the faith move to open 5 days a week. 

Ardiana quitted her job at the hospital as NICU RN to work in the clinic as Pediatric NP, receptionist , biller and my Rock.we are still working with no salary and we are doing everything, I am the official janitor of my clinic ( at least I do not have to consult anything to the Janitorial Board of Directors)

Word of mouth is a domino effect on my clinic. Well I wil leave something for San Diegito. Take care, Adolfo

 

Adolfo,Do you have access to UpToDate? they have some good articles on this topic, and their summaries should include the data that Pedro found.leslie

-- Kernisan, MD MPH

Geriatrics

How old is she? If perimenopausal/menopausal, lack of estrogen may be playing a role in both her mood, attention disorder, and low libido.  If she has had oophorectomy, and is past 50, then consider checking testosterone level if she does not respond to adequate estradiol replacement.

What was her libido like in the past- has it really changed? Is she really talking about level of interest or ability to arouse and orgasm? Sometimes, I combine Bupropion with an SSRI for various reasons including libido and ADD.  If it definitely seems related to her citalopram use, then I would try switching her to escitalopram which has a less impact on libido in my practice experience.

What other marital problems does she have? Body

image problems? You are in Florida, yes?  Consider referring to a qualified sex therapist.Carla Gibson FNP

To: IMP < >

Sent: Thursday, July 26, 2012 5:35 PM Subject: Citalopram side effects

 

I have a female patient with ADDH and depression anxiety.

I have her in adderall stable and with citalopram stable.

she is complaing of lack of libido, she is saying that she has marital problems because she does not have a libido.

I was wondering if somobody from the group have any ideas to help her.

Thanks Adolfo

PS: I do not want to change her meds because she was a train reck when she came to see me.