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Question for anyone who knows extensively about SSRI’s?

My doctor wants me to go up with Luvox by 50 mg every four days, (to 300 mg) and it has been over a week, so I am now on 150 mg a day. My biggest concern was sexual side effects and I actually didn’t notice any until I moved up to 150 mg a day. He even said I could take the dose at once, but I said I’d rather split it, so for now, 50 mg in the morning, 100 mg at night. Today I couldn’t achieve an orgasm, and I woke up with my pupils are fully dilated, although I’d noticed this in previous days, it was significant today, I didn’t even want to go out. I look like a shocker with these black eyes, but I don’t mind them personally, but the previous side effect, most definitely. I don’t need a lesson though, I am all too familiar with SSRI's. My question is pondering around this though, could this simply mean that there is now too much serotonin in my brain, and that 100 mg a day is “correcting the chemical imbalance” (if we want to go by that theory). I don’t think the chemicals are quite balanced if I can’t have an orgasm and my pupils are shot wide open and barely reactive to light. Perhaps this is an initial thing and it will go away with time? I am/have been moving up pretty fast in my opinion, four days is the minimum you should leave from what I’ve read, but he doesn’t want me wasting any time. He is a p-doc, so I don’t get to see him for another few weeks, but I was wondering about the above. I don’t want to go on too much, but this is for severe OCD, it has eaten up my life, making it hard for me to leave the house, so it is pretty serious. I just don’t want to flood my brain regardless, I’m booked in to begin CBT in a few weeks, I just want to be chemically balanced, but not chemically overbalanced. Anyway, he did say, and I already knew, that with exception to Zoloft, all other SSRI’s require high-max dosages (especially in males) for OCD, and then again, especially severe OCD like mine, he was even ready to suggest an atypical antipsychotic if we don’t see any improvement in a few months. He also told me one of the latest theories about why antidepressants take long to work, even though their chemical effects in the brain and side effects are immediate, SSRI’s are thought to be neuroprotective, in depressed and anxious patients. Apparently, the hippocampus in the brain is smaller than in “chemically balanced” people when compared to the chronically anxious and depressed, so when you administer an SSRI, it takes time for that part of the brain to expand. Peak effects for depression are in half the time, 4-6 weeks, and double for OCD 10-12 weeks, which is bad news for me. Anyway, without being objective to my information (and the docs), I don’t like it because I see it as closed minded, I’d be more than happy to be open to hearing your theory on what’s going on, and if it probably is better for me to soldier on or fall back on 100 mg. Though, in truth, as bloody painful as today was (literally), I don’t really want to unless I could be right. It took me a whole year to make the decision, lost a lot of time, two semesters of college, it was mainly all that crap on the internet about “PSSD” deterring me, some medical condition made up by 1,800 people with some sort of impotence problem out of the millions and millions prescribed this class of drugs. I have OCD though, so scaring people like me out of getting the treatment I need, those trashbags. It should be taken off Wikipedia because it isn’t even established as fact like they state it is in the SSRI article. My p-doc said he'd never heard of "PSSD" and of all he years on the bench, nothing about ongoing sexual dysfunction after discontinuation. And even if it exists, you'd have to be one unlucky bum to get it, considering all the people popping them everyday and getting off them, etc. Anyway, back to my question! :) Geoffrey, your ignorance astounds me.

Public Comments

1. Medically speaking, there's no such thing as a "chemical imbalance". You need to differentiate between what pharmaceutical companies say in television advertisements and what drug trials say. Drug trials say that SSRIs are not particularly efficacious in treating anything, and have no particular mechanism of action. They fiddle with brain chemistry in unpredictable and generally non-useful ways. No antidepressant has ever been shown to be particularly useful in the treatment of OCD. In fact, no drug has. The standard treatment for OCD is cognitive-behavioral therapy. You need to be taught new habits to avoid regressing into obsessive thoughts and compulsive behaviors. OCD isn't really a medical problem at all, so there's no medical intervention which helps it. Behavioral therapy is not a medical intervention. Unfortunately, many doctors are quite happy to throw drugs at any problem. While there are bad and lazy doctors, don't indict the entire field of medicine, since they are not the majority of it.
2. Extremely thorough post. Lets see. First, take the PSSD and toss it. There's only a dozen cases on the planet that have ever held up under scrutiny. Why do so many people claim to have it then? Well, for one depression causes sexual dysfunction, as does anxiety to a lesser degree. More, issues that have an extremely high rate of co-morbidity with depression (think various forms of abuse in childhood, substance abuse). So, a dozen cases in the hundreds of millions of patient-years of data. Not a big issue. Luvox is a messier drugs. The reason, initially that it got approved for OCD instead of depression is that it tends to upset the stomach quite a bit. OCD sufferers were more likely to put up with that side effect than patients with depression. So instead of competing with the five other depression marketed SSRIs, they did their studies for OCD and got approval there. The blown pupils is an oddity. As this is quite rare with pure SSRIs. This is ore characteristic of a noradrenergic effect. The pro-drug effexor is notable for doing this quite frequently. While the 'chemical balance' is largely marketing, aimed at explaining a very complex set of ideas in a very simple way to the general public, above's statement that these are totally ineffective is without any sort of merit at all. Now. That said. Sexual side effects occuring at a particular dose of one of these drugs are not noted for diminishing as time goes on, unlike a lot of their other side effects. That said, if this is a problem for you, it's time to look into other options. Zoloft's a possibility, Celexa gets a lot of love for its effectiveness in anxiety disorders, which OCD bears some relation to. One of the odd things about these drugs is that though sexual side effects, and some of their other more obnoxious side effects occur with one member of the group, it is entirely possible and indeed frequent to find that they do not occur with another member, even at similar dosing. You've just got to try and see. The possibility of an atypical antipsychotic does have some possibility. I've read individual reports of great success in this area. I'd stay away from the more heavy ones like Seroquel, and especially Zyprexa. Instead look at something like Geodon, which is notable for having a bit of antidepressant behavior wrapped together with a mild antipsychotic. Risperdal at low doses might have merit. I would suggest you take your question to the forums at www.crazymeds.us - you're likely to find some specific and high quality advice on that site, perhaps even from someone with a similar situation. I'd write a bit more, but real life demands preclude that right now.