Sertraline-Induced Anorgasmia Treated With Intermittent Nefazodone

Abstract

Sir: Hallucinogen persisting perception disorder is the reexperiencing of the perceptual symptoms experienced while intoxicated with the hallucinogen. Examples of these perceptual distortions include geometric hallucinations, false perceptions of movement in the peripheral visual fields, flashes of color, positive afterimages, macropsia, and micropsia. Various pharmacologic treatments of "flashbacks," including neuroleptics and benzodiazepines, and electroconvulsive therapy have met with limited success. 1 Case report. Mr. A, a 22-year-old male college student, presented to a college counseling center with symptoms of mild depression. Six months prior to his evaluation, he had stopped using lysergic acid diethylamide (LSD), after an 8-month history of LSD abuse during which he had used between 1000 to 1800 µg at least twice a week. Despite his abstinence, he noticed the persistence of LSD-like phenomena. These phenomena included visual illusions, trailing images, depersonalization, images in his peripheral field, and visions of colorful geometric forms when he closed his eyes. They occurred almost daily, were not distressing to the patient, and had preceded the onset of his depressive symptoms. He had no history of seizures or migraines.Antidepressant treatment was begun with sertraline 25 mg and was titrated upward slowly owing to concern about these flashbacks. Mild exacerbations of these LSD-like phenomena were noted for 2 to 4 days after each dosage increase, primarily as flashes of color, positive afterimages, and fleeting hallucinations in his peripheral vision. Within 1 month after the target dose of 100 mg was reached, these perceptual disturbances decreased until they had almost completely remitted. The depressive symptoms also improved. These gains were maintained for 4 months, at which point Mr. A graduated and terminated treatment.

Ejaculatory dysfunction and depression: pharmacological and psychobiological interactions

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Sexual functioning in depressed outpatients taking mirtazapine

“…Unfortunately, most antidepressants create or increase sexual dysfunction. The selective serotonin reuptake inhibitors (SSRIs) [Waldinger et al, 1998;Seagraves, 1989;Patterson,or no sexual dysfunction [Crenshaw and Goldberg, 1996;Feiger et al, 1996;Reynolds, 1997].…”

Amitriptyline-induced anorgasmia reversed by nefazodone

“…Attempts to treat antidepressant-induced anorgasmia with cyproheptadine, amantadine, methylphenidate, yohimbine, dosage reduction, drug holidays and drug substitution had mixed results. 1 We report a case of amitriptyline-induced anorgasmia reversed by switching over to nefazodone.…”

“…Attempts to treat antidepressant-induced anorgasmia with cyproheptadine, amantadine, methylphenidate, yohimbine, dosage reduction, drug holidays and drug substitution had mixed results. 1 We report a case of amitriptyline-induced anorgasmia reversed by switching over to nefazodone.A 31 year old married man was referred with a first episode of major depression of six months duration. Prior to the onset of depression he was sexually active.…”