PSSD: The Why And The How To Get It Fixed

[Hans]

Hi all,

I've been writing about the side effects of excess serotonin for a while now, but haven't directly addressed the sexual side effects as of yet. Since so many people struggle with sexual disorders, especially from SSRI use and post-SSRI, I decided to write an article on it to discuss why it happens and how you can possibly resolve it.
About 2 weeks ago I mentioned in another thread that this article was coming, so here it is:
PSSD: The why and the how to get it fixed » MENELITE

Let me know your thoughts.

 

[GenericName86]

Thank you Hans. Always enjoy reading your articles and I've been pretty keen for this one back when you mentioned it a while ago.

 

[Hans]

Thank you Hans. Always enjoy reading your articles and I've been pretty keen for this one back when you mentioned it a while ago.

My pleasure man. I'm glad I got it done. Hopefully it's helpful.

 

[Jib]

Really love your articles. Always very well thought out and well written.

 

[Lokzo]

@Hans well done my brother!

I love what you say about 5-HT1A. I seriously believe that this is the issue with Ashawagandha and why it caused me PSSD too.

A few of 5-HT1A’s beneficial actions include:

• Promoting vasodilation. This can cause someone to cool off as well as help get an erection.
• Inhibiting glutamate release.
  • If 5-HT1A is desensitized, glutamate will be elevated, which contributes to anxiety, depression, ADHD, rumination, etc.
• Improving cognitive functions, possibly via inducing prefrontal cortex dopamine and acetylcholine release.
• Stimulating the adequate release of cortisol during rest, while reducing the secretion of ACTH and cortisol induced by an array of stressors.
  • Overactivation of the adrenal axis is common amongst people with depression, low stress intolerance, social defeat, etc.
• Releasing oxytocin
• Releasing β-endorphins
  
  
  
  ^All of the above is all fixed when I take St. John's Wort.
  
  
  
  I discuss it in my video too.
  

 

[GenericName86]

What Zinc dosage/type would you recommend @Hans? Or what it be best to leave it out in a recovery protocol? @Lokzo you have put a lot of research into this too and had success, I think i remember you said it caused issues? What dosage was that at if you remember?

 

[Lokzo]

What Zinc dosage/type would you recommend @Hans? @Lokzo you have put a lot of research into this too and had success, I think i remember you said it caused issues? What dosage was that at if you remember?

Zinc unfortunately is not good for me... it acutely makes me feel good, but then crashes me for a week.

I just eat chicken hearts twice a week, to heal the almost broken heart haha!


Also @Hans - You should correct this section: "St Johns Wort, containing high hypericum, not hyperforin (R)."

It should say HYPERICIN, not hypericum

 

[Jib]

FWIW, I got extreme premature ejaculation issues from 6 months or so on Rexulti, which is basically Abilify 2.0, and a main feature is agonism at the 5HT-1A receptor.

Would be curious if anyone had any insights into that. Agonism at dopamine D2 is also a feature. I've been off it for months, but the issue did not resolve several months after discontinuing it. And I mean it was bad. I had sex regularly for several years and never had an issue like this. While on, and after stopping the Rexulti, I was literally unable to even reach the point of full insertion without ejaculation. Attempted maybe on 6 separate occasions and the same thing happened every single time. It was awful. Nothing else had changed other than starting that medication.

I hope the issue is gone now, some more months later, but I worry about the damage being permanent. It's basically the opposite of an anti-depressant in terms of the 5HT-1A receptor but I'd be curious to anyone's thoughts about it. It's rare but I have come across a couple reports of premature and/or spontaneous ejaculation with Abilify, which is largely the same drug.

 

[Hans]

Really love your articles. Always very well thought out and well written.

Thanks man, glad you're enjoying them!

 

[Hans]

What Zinc dosage/type would you recommend @Hans? Or what it be best to leave it out in a recovery protocol? @Lokzo you have put a lot of research into this too and had success, I think i remember you said it caused issues? What dosage was that at if you remember?

I prefer getting zinc from food, preferably red meat and organ meat. However, if someone can't for some reason, then low dose of 20-30mg is probably fine, depending on the deficiency and how it makes the person feel.

 

[Hans]

FWIW, I got extreme premature ejaculation issues from 6 months or so on Rexulti, which is basically Abilify 2.0, and a main feature is agonism at the 5HT-1A receptor.

Would be curious if anyone had any insights into that. Agonism at dopamine D2 is also a feature. I've been off it for months, but the issue did not resolve several months after discontinuing it. And I mean it was bad. I had sex regularly for several years and never had an issue like this. While on, and after stopping the Rexulti, I was literally unable to even reach the point of full insertion without ejaculation. Attempted maybe on 6 separate occasions and the same thing happened every single time. It was awful. Nothing else had changed other than starting that medication.

I hope the issue is gone now, some more months later, but I worry about the damage being permanent. It's basically the opposite of an anti-depressant in terms of the 5HT-1A receptor but I'd be curious to anyone's thoughts about it. It's rare but I have come across a couple reports of premature and/or spontaneous ejaculation with Abilify, which is largely the same drug.

5-HT1A agonists can cause PE whereas 5-HT1A antagonists can reverse it. Maybe you can try cypro and see if it helps.

 

[Frankdee20]

When we talk 5ht1a, we have the pre and post synaptic side, and activation or blockage on either side does different things,..

 

[Jib]

5-HT1A agonists can cause PE whereas 5-HT1A antagonists can reverse it. Maybe you can try cypro and see if it helps.

I'll try this if I can get my hands on it. Would you recommend something similar in the article, such as 'pulse' dosing it? I forgot to mention that Rexulti also antagonizes 5-HT2A.

I wonder what could explain the paradox of PSSD: why some people get delayed ejaculation, and some people get premature ejaculation, vs. erectile dysfunction, etc. I read a lot that 5-HT1A over-sensitivity causes premature ejaculation, and lower sensitivity at 5-HT1A and more sensitivity at 5-HT2C delays ejaculation.

So you would think after stopping a 5-HT1A agonist, the receptor would be desensitized after being artificially stimulated. So premature ejaculation seems like it would be a paradoxical effect, as you'd expect delayed ejaculation and erectile dysfunction, if anything.

The long-term receptor adaptations to these drugs is pretty scary. I wonder about an equivalent of "PSSD" with antipsychotics. I was also on Olanzapine and Seroquel and it seems entirely plausible to me that they cause long-term adaptations long after discontinuing the drugs, much like SSRIs.

Really not a fan of a culture that is so cavalier about prescribing these things. I even brought up concerns about PSSD with my doctor when he recommended an antidepressant and he had absolutely no response to my concerns.

 

[Hans]

I'll try this if I can get my hands on it. Would you recommend something similar in the article, such as 'pulse' dosing it? I forgot to mention that Rexulti also antagonizes 5-HT2A.

I wonder what could explain the paradox of PSSD: why some people get delayed ejaculation, and some people get premature ejaculation, vs. erectile dysfunction, etc. I read a lot that 5-HT1A over-sensitivity causes premature ejaculation, and lower sensitivity at 5-HT1A and more sensitivity at 5-HT2C delays ejaculation.

So you would think after stopping a 5-HT1A agonist, the receptor would be desensitized after being artificially stimulated. So premature ejaculation seems like it would be a paradoxical effect, as you'd expect delayed ejaculation and erectile dysfunction, if anything.

The long-term receptor adaptations to these drugs is pretty scary. I wonder about an equivalent of "PSSD" with antipsychotics. I was also on Olanzapine and Seroquel and it seems entirely plausible to me that they cause long-term adaptations long after discontinuing the drugs, much like SSRIs.

Really not a fan of a culture that is so cavalier about prescribing these things. I even brought up concerns about PSSD with my doctor when he recommended an antidepressant and he had absolutely no response to my concerns.

Yes I think pulsing with an antagonist will be a good balance between upregulating 5-HT1A and enjoying the effects of it.
There is more to PE than just serotonin, such as histamine, norepinephrine, thyroid hormones, etc., so I don't think it's helpful just to look at 5-HT1A. Rexulti is actually a partial agonist to 5-HT1A, which means it can also have antagonistic effects.
There is actually a study done on patients with PSSD that showed that their doctors didn't even want to look at scientific evidence against SSRIs provided by their patients. Crazy stuff.

Anti-psychotics are a different story than SSRIs. They are known to induce weight gains and it's hypothesized that it's due to modification of the gut microbiome, which result in long term side effects. So to recover fully after stopping, you'll have to re-modulate the gut. And I think this is true to PSSD, PFS, etc., as well. The bacteria in your gut is causing epigenetic modifications to enzymes, which results in long term effects, such as the epigenetic modification of 5-AR in PFS. So to reverse it, you'll have to lower the bacteria that's causing that epigenetic modification.

 

[oldfriend]

Interesting stack. Bromantane looks really interesting on its own. Would it be effective to make a tea from the herbs? Anyone have recommended doses for those?

 

[nomoreketones]

Thank you for your work on PSSD.

As someone suffering from PSSD for over 10 years (from 3 weeks of paxil use), I appreciate your contribution.

 

[Hans]

Interesting stack. Bromantane looks really interesting on its own. Would it be effective to make a tea from the herbs? Anyone have recommended doses for those?

I've never made tea with those herbs, but maybe you can use 1tsp powder of each and see if that's strong enough.

 

[Hans]

Thank you for your work on PSSD.

As someone suffering from PSSD for over 10 years (from 3 weeks of paxil use), I appreciate your contribution.

I hope it's helpful.
Paxil also negatively modulate the gut bacteria which resulted in a change in primary and secondary bile acids. Bile acids to important signaling in the body. Some are good and others are bad.

Paroxetine Administration Affects Microbiota and Bile Acid Levels in Mice
"Untargeted mass spectrometry and 16S rRNA profiling of fecal pellet extracts showed several primary and secondary bile acid level, and microbiota alpha diversity differences, respectively between paroxetine- and vehicle-treated mice, suggesting that microbiota functions are altered by the drug. In addition to their lipid absorbing activities bile acids have important signaling activities and have been associated with gastrointestinal diseases and colorectal cancer. Antidepressant drugs like paroxetine should therefore be used with caution to prevent undesirable side effects."

 

[oldfriend]

@Hans Isn't metergoline an antagonist of 5-HT1A? Is that something that should also be cycled? Metergoline is one of the few dependable things I've tried for low libido, but found greater benefit taking it every day.

 

[Hans]

@Hans Isn't metergoline an antagonist of 5-HT1A? Is that something that should also be cycled? Metergoline is one of the few dependable things I've tried for low libido, but found greater benefit taking it every day.

Sweet good to hear that it's working for you. All that I can find is that it's a 5-HT1B antagonist and nothing on 5-HT1A?
I don't think it need to be cycled unless you start to develop tolerance and need bigger and bigger doses.