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#1 NicholeA

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Posted 26 April 2017 - 05:54 PM

My mom was taking Cymbalta for 6 years for fibromyagia. We are 3 weeks off the nasty drug. She has experienced what we now know as persistent Sexual arousal without Sexual desire. Yesterday was the 2nd one which last 4 hours leaving her in an uncontrollable screaming tortured state. She went to the ER where they don't really know what it is or how to treat it. Has anyone else experienced this? Any ideas on how it can be treated. It's sad but the medical professionals are stumped because they are uneducated on it.

#2 fishinghat

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Posted 26 April 2017 - 06:07 PM

Hi Nicole

 

This is referred to as PSSD (Post ssri Sexual Dysfunction).  For most patients this develops during the first week or two after coming off the medicine. Symptoms include the severe sexual arousal, vaginal dryness, no ability to ejaculate or have an orgasm, vaginal/penis anesthesia (lack of feeling) and much more. For most the sexual arousal and increase in libido only last 3 to 5 days. This is then followed by a very slow return to a normal sexual state by the end of 3 months. If any or all of these symptoms last past 3 months they are typically permanent. There is no known treatment. I will post some literature on it.


#3 fishinghat

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Posted 26 April 2017 - 06:10 PM

J Clin Psychopharmacol. 2015 Jun;35(3):273-8. doi: 10.1097/JCP.0000000000000300.
Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship.

Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.
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Eur J Pharmacol. 2015 Apr 15;753:263-8. doi: 10.1016/j.ejphar.2014.11.031. Epub 2014 Dec 4.
Penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) responds to low-power laser irradiation: a case study and hypothesis about the role of transient receptor potential (TRP) ion channels.

⦁ Treatment of paroxetine-induced penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) by Low-power Laser Irradiation (LPLI) is unknown in medical literature. The aim of the current article is to report partial efficacy of LPLI for paroxetine-induced persistent penile anesthesia. We report on a male patient who presented with a history of reversible loss of smell, taste and skin sensitivity occurring within a week after start of 20mg/day paroxetine-hemihydrate for a depressive period. Concurrently, patient suffered from penile anesthesia, scrotum hypesthesia, anejaculation and erectile difficulties with normal sexual desire. During 2.5 years of paroxetine treatment and throughout 2 years after paroxetine discontinuation, genital and sexual complaints persisted. Penile anesthesia was treated by LPLI with single and multi diode pulsed laser probes. After 20 LPLI-treatment sessions of 15min each, patient reported partial return of penile touch and temperature sensation. Clinical improvement of glans penis sensitivity was reported to 20% and 40%, compared to pre-paroxetine treatment penile sensitivity during erect and flaccid states, respectively. However, anejaculation and erectile difficulties remained unchanged. Briefly, in the current patient with early onset of PSSD, LPLI treatment reduced paroxetine-induced penile anesthesia. It is hypothesized that SSRI treatment induces disturbances of transient receptor potential (TRP) ion channels of mechano-, thermo- and chemosensitive nerve endings and receptors resulting in the penile anesthesia in PSSD. It is further hypothesized that there are two types of PSSD, one of which occurs soon after the start of SSRI treatment.

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The Open Women' Health Journal, 2007, 1, 1-3
Prolonged Post-Treatment Genital Anesthesia and Sexual Dysfunction Following Discontinuation of Citalopram and the Atypical Antidepressant Nefazodone

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The Open Psychology Journal, 2008, 1, 42-50
1874-3501/08 2008 Bentham Open
Open Access
Persistence of Sexual Dysfunction Side Effects after Discontinuation of
Antidepressant Medications: Emerging Evidence
Audrey S. Bahrick*

http://pssd.nl/Persi... medication.pdf
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Persistent Sexual Dysfunction after Discontinuation of Selective
Serotonin Reuptake Inhibitors

Introduction. Sexual dysfunctions such as low libido, anorgasmia, genital anesthesia, and erectile dysfunction are
very common in patients taking selective serotonin reuptake inhibitors (SSRIs). It has been assumed that these side
effects always resolve after discontinuing treatment, but recently, four cases were presented in which sexual function
did not return to baseline. Here, we describe three more cases.
Case #1: A 29-year-old with apparently permanent erectile dysfunction after taking fluoxetine 20 mg once daily for
a 4-month period in 1996.
Case #2: A 44-year-old male with persistent loss of libido, genital anesthesia, ejaculatory anhedonia, and erectile
dysfunction after taking 20-mg once daily citalopram for 18 months.
Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since
taking several different SSRIs over a 2-year period from 2003–2005.
Results. No psychological issues related to sexuality were found in any of the three cases, and all common causes of
sexual dysfunction such as decreased testosterone, increased prolactin or diabetes were ruled out. Erectile capacity
is temporarily restored for Case #1 with injectable alprostadil, and for Case #2 with oral sildenafil, but their other
symptoms remain. Case #3 has had some reversal of symptoms with extended-release methylphenidate, although it
is not yet known if these prosexual effects will persist when the drug is discontinued.
Conclusion. SSRIs can cause long-term effects on all aspects of the sexual response cycle that may persist after they
are discontinued. Mechanistic hypotheses including persistent endocrine and epigenetic gene expression alterations
were briefly discussed. Csoka A, Bahrick A, and Mehtonen O-P. Persistent sexual dysfunction after discontinuation
of selective serotonin reuptake inhibitors. J Sex Med 2008;5:227–233.

http://psychrights.o...aetal(2007).pdf
OR
http://onlinelibrary...07.00630.x/full
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International Journal of Risk & Safety in Medicine 26 (2014) 109–116

One hundred and twenty cases of enduring
sexual dysfunction following treatment

BACKGROUND: There have been reports for over a decade linking serotonin reuptake inhibitors, finasteride and isotretinoin
with enduring sexual dysfunction after treatment stops.
OBJECTIVE: To explore the clinical pictures linked to all 3 drugs.
METHODS: We have selected 120 reports to RxISK.org reporting the problem and mined these for data on age, gender, drug
of use, and impact of the problem.
RESULTS: The data make it clear that the three drugs show extensive overlap in symptom profile, regardless of sex or country
of origin.
CONCLUSIONS: The availability of 120 reports from over 20 countries add to the case for the validity of the syndrome. This is
severe and enduring condition can result in death. An understanding of its physiology and an approach to treatment are needed.
http://wp.rxisk.org/...Is-and-PSSD.pdf
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The prescriber information for Prozac from Eli Lilly's website. Halfway through the 15th page is a clause which reads, “Symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment.
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Journal of Contemporary Psychotherapy June 2009, Volume 39, Issue 2, pp 135-143
Date: 09 Sep 2008
Sexual Side Effects of Antidepressant Medications: An Informed Consent Accountability Gap

Sexual side effects of antidepressant medications are far more common than initially reported, and their scope, quality, and duration remain poorly captured in the literature. Antidepressant treatment emergent sexual dysfunctions may decrease clients’ quality of life, complicate psychotherapy, and damage the treatment alliance. Potential damage to the treatment alliance is greatest when clients have not been adequately informed of risks related to sexual side effects. It had previously been assumed that sexual side effects always resolve shortly after medications are discontinued. Emerging evidence, however, suggests that in some individuals, sexual dysfunction side effects may persist indefinitely. The authors argue that all psychologists should be well-informed about sexual side effects risks of antidepressant medications, should routinely conduct a pre-medication baseline assessment of sexual functioning, and take an active role in the informed consent process.
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Wikipedia article
http://www.thefullwi...ual_dysfunction
---------------------------------------------------------------------------------------------------------------------------
https://www.ncbi.nlm...pubmed/25483212
Eur J Pharmacol. 2015 Apr 15;753:263-8. doi: 10.1016/j.ejphar.2014.11.031. Epub 2014 Dec 4.
Penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) responds to low-power laser irradiation: a case study and hypothesis about the role of transient receptor potential (TRP) ion channels.

⦁ Treatment of paroxetine-induced penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) by Low-power Laser Irradiation (LPLI) is unknown in medical literature. The aim of the current article is to report partial efficacy of LPLI for paroxetine-induced persistent penile anesthesia. We report on a male patient who presented with a history of reversible loss of smell, taste and skin sensitivity occurring within a week after start of 20mg/day paroxetine-hemihydrate for a depressive period. Concurrently, patient suffered from penile anesthesia, scrotum hypesthesia, anejaculation and erectile difficulties with normal sexual desire. During 2.5 years of paroxetine treatment and throughout 2 years after paroxetine discontinuation, genital and sexual complaints persisted. Penile anesthesia was treated by LPLI with single and multi diode pulsed laser probes. After 20 LPLI-treatment sessions of 15min each, patient reported partial return of penile touch and temperature sensation. Clinical improvement of glans penis sensitivity was reported to 20% and 40%, compared to pre-paroxetine treatment penile sensitivity during erect and flaccid states, respectively. However, anejaculation and erectile difficulties remained unchanged. Briefly, in the current patient with early onset of PSSD, LPLI treatment reduced paroxetine-induced penile anesthesia. It is hypothesized that SSRI treatment induces disturbances of transient receptor potential (TRP) ion channels of mechano-, thermo- and chemosensitive nerve endings and receptors resulting in the penile anesthesia in PSSD. It is further hypothesized that there are two types of PSSD, one of which occurs soon after the start of SSRI treatment.

https://www.ncbi.nlm...pubmed/25815755
Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship.
Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.


 


#4 NicholeA

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Posted 26 April 2017 - 06:24 PM

This sounds awful. I'm not sure how many episodes of this she can handle because they are so extreme. It is awful to watch someone endure such torture. The episodes usually come on during her sleep. Wish I could find someone else who has experienced the same thing. Thank you for your response. Feeling hopeless.

#5 gail

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    5 months on cymbalta, scary side effects, never felt good.
    Needed understanding and support, and a place where I was not alone. To read others stories and realizing that I was not the only one going through all that crap.
    In hope that one day, I can return the favors in some kind of way.

Posted 27 April 2017 - 07:16 AM

Hi Nicole
 
This is referred to as PSSD (Post ssri Sexual Dysfunction).  For most patients this develops during the first week or two after coming off the medicine. Symptoms include the severe sexual arousal, vaginal dryness, no ability to ejaculate or have an orgasm, vaginal/penis anesthesia (lack of feeling) and much more. For most the sexual arousal and increase in libido only last 3 to 5 days. This is then followed by a very slow return to a normal sexual state by the end of 3 months. If any or all of these symptoms last past 3 months they are typically permanent. There is no known treatment. I will post some literature on it.


Hi Nicole, it says, for most, that it lasts from 3 to 5 days. In my last four years here, I have not met a member that mentioned this that I can recall. Except for men, erectile dysfonction. Remember, 3to5 days for most! Try to be patient and come back to tell us how it went.

#6 fishinghat

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Posted 27 April 2017 - 08:26 AM

Actually Gail, through PMs and a couple posts like this there has been 6 (including me) that have had this condition. It is a shame that some are too embarrassed to talk about it. It needs to be a serious part of our discussions. Because of my PSSD I have seen several specialists. There is absolutely no feeling in my penis and I have not had intercourse in 4 years and never will again. I went into complete failure of ability to produce testosterone (it went from 400 to 62 in 7 days!!)  I know that at least one of the women who has complained has lost all sexual ability, sensation or response and a stop in estrogen production for at least 6 months (last time I communicated with her) but like you say the hypersexual arousal part usually only lasts a few days.


#7 fishinghat

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Posted 27 April 2017 - 08:53 AM

I thought I would add this. It is a list of the main PSSD forums that are out there. Many have very good information.
 
I hope it helps.

http://www.pssdforum.com/
An excellant forum
https://drugs-forum....sthesia.235906/
http://www.socialanx...on-pssd-269457/
https://rxisk.org/re...ring-from-pssd/
https://www.reddit.c...wwpssdforumcom/
http://ehealthforum....sd-t150490.html
http://pssd.forumfree.it/
http://survivinganti...-disorder-pssd/
http://www.longecity...al-dysfunction/

It is a very common condition.
 


#8 NicholeA

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Posted 27 April 2017 - 11:47 AM

Hi Gail, so what my mom is experiencing are episodes that last up to 4 hours of extreme oragasisms that come on about every minute and send her into a screaming thrashing state that is uncontrollable. We call 911 each time which has been twice so far, she gets to ER where they basically dope her up with about 5 different med to help settle her down but it seems to me the episode just stops on its own. During these oragasisms she dilates open in the vaginal canal. The doctors don't even know what it is or how to respond. I have yet to find someone that has experienced these episodes like my mom. It is horrifying to watch her go through this. It is not just a slight feeling that last for a few days, it is an extreme oragasim that lasts hours with no sexual desire. I am praying she doesn't have another one. We are almost 4 weeks off Cymbalta.

#9 gail

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    5 months on cymbalta, scary side effects, never felt good.
    Needed understanding and support, and a place where I was not alone. To read others stories and realizing that I was not the only one going through all that crap.
    In hope that one day, I can return the favors in some kind of way.

Posted 27 April 2017 - 03:23 PM

Hi Nicole,

Thank you so much for explaining. Wow, what an experience! I don't know what to say as I am so tarabusted by this!!! definitely never heard of that in the forum. But I saw this on The Doctor's tv program.

Two episodes of this, how extenuating! How rare! I can imagine your doctor(s) are way way confused to say the least. And your mom going through not one but hundreds of orgasms in four hours.

Do you mind me asking how old is your mom? Between those episodes, is she conscient about what just happened? Does she talk about it? And, did she cold turkey Cymbalta?

I wish that I could help, let's hope for relief shortly. Keep posting!

#10 NicholeA

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Posted 27 April 2017 - 03:55 PM

My mom is 64. She was on 60mg for 6 years and weaned herself off according to the Dr orders, not cold turkey. Yes she is totally aware and conscience between each one. She can communicate between each one. They get her so doped up that she usually doesn't remember going home afterwards but remembers how awful it was. She just wants to die the entire time it is happening and she is completely embarrassed by it. My dad and I just watch helplessly and try to comfort her through it.

#11 fishinghat

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Posted 27 April 2017 - 05:15 PM

Well, it may not help but tell your mom she is not alone. She should not be embarrassed as this is out of her control.

 

God bless and be patient. It should pass soon.


#12 gail

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    In hope that one day, I can return the favors in some kind of way.

Posted 28 April 2017 - 07:05 AM

Hi Nicole,

Thank you for answering, your mom has my age exactly. Putting my feet into her shoes, I would be embarrassed also, even though I shouldn't as Fishinghat said.

As hard as it is for the moment, waiting to see if....it's over. In a year or so, this will be the running joke in your family, at parties and so on. You will die laughing at what was once a terrible event.lol and your mother first!

#13 NicholeA

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Posted 01 May 2017 - 05:07 PM

I know we will look back one day and say it was all worth it. She has had a very good last 3 days. Was able to get out, drive by herself, do some yard work. No sexual arousal episodes at all, thank goodness. She feels really good with no pain from FM. Only thing is the Dr called today and said her labs show possible diabetes and renal disease. Now I just need to find out if renal disease is caused by Cymbalta.

#14 fishinghat

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Posted 01 May 2017 - 05:13 PM

Nearly all medicines can be traced to a risk of renal disease as it is our bodies purification system.


#15 fishinghat

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Posted 01 May 2017 - 05:26 PM

I could not find any specific research on renal toxicity for Cymbalta. I did find the following.

The following is from the drug insert for Cymbalta.

Since diabetes is frequently complicated by renal disease, consider a lower starting dose and gradual increase in dose for patients with renal impairment [see Dosage and Administration (2.6), Use in Specific Populations (8.10), and Clinical Pharmacology (12.3)].

8.10 Severe Renal Impairment
Limited data are available on the effects of duloxetine in patients with end-stage renal disease (ESRD). After a single 60 mg dose of duloxetine, Cmax and AUC values were approximately 100% greater in patients with end-stage renal disease receiving chronic intermittent hemodialysis than in subjects with normal renal function. The elimination half-life, however, was similar in both groups. The AUCs of the major circulating metabolites, 4-hydroxy duloxetine glucuronide and 5-hydroxy, 6-methoxy duloxetine sulfate, largely excreted in urine, were approximately 7- to 9-fold higher and would be expected to increase further with multiple dosing. Population PK analyses suggest that mild to moderate degrees of renal impairment (estimated CrCl 30-80 mL/min) have no significant effect on duloxetine apparent clearance [see Dosage and Administration (2.6) and Warnings and Precautions (5.14)].

The following is from the FDA website.

90,467 people reported to have side effects when taking Cymbalta.
Among them, 729 people (0.81%) have Renal Failure


#16 gail

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    Needed understanding and support, and a place where I was not alone. To read others stories and realizing that I was not the only one going through all that crap.
    In hope that one day, I can return the favors in some kind of way.

Posted 02 May 2017 - 06:09 AM

I know we will look back one day and say it was all worth it. She has had a very good last 3 days. Was able to get out, drive by herself, do some yard work. No sexual arousal episodes at all, thank goodness. She feels really good with no pain from FM. Only thing is the Dr called today and said her labs show possible diabetes and renal disease. Now I just need to find out if renal disease is caused by Cymbalta.


Yeah for the first part, so happy for all of you. Now the rest to be checked!



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