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]

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.