• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » When Side Effects Help: Getting Creative

When Side Effects Help: Getting Creative

June 1, 2003
Daniel Carlat, MD
From The Carlat Psychiatry Report
Issue Links: Editorial Information | PDF of Issue
Daniel Carlat, MD Dr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
Yes, side effects can be your (and your patients’) friend. Here are several common clinical scenarios, culled from conversations with astute clinicians and from reflections on my own practice.

Poor sexual communication
SSRI side effects have forced us to broach the awkward topic of sex with our patients. Simply forcing the issue into the open often has unanticipated benefits. For example, a woman referred for panic disorder was asked about her sex life, in order to get a baseline history before starting Zoloft. She reported that she and her husband rarely had sex, because she thought he was uninterested. She agreed to bring him into her next psychopharm session, and it became clear that, in fact, her husband assumed that she was the uninterested party. Once better communication was established, their sex life improved, despite the fact that Zoloft caused decreased clitoral sensitivity.

Premature ejaculation
Premature ejaculation affects up to 30% of males in the general population, so if you don’t ask about this, you’re missing many cases. Some will remember a 1998 study played up by Luvox reps (Solvay Pharmaceuticals) that compared SSRIs for the treatment of premature ejaculation (1). Paxil worked the best, while Luvox didn’t even beat placebo. This was supposed to be a selling point for Luvox, but it’s also a nice endorsement of Paxil’s utility for this condition. A more recent study (2) found that the combination of Paxil 20 mg and Viagra 25-100mg works excellently in the most treatment resistant cases of premature ejaculation.

Over-active sexuality
Too much libido can be as bad as too little, although patients rarely seek treatment for the former. In one case, a married man presented with a chief complaint of cocaine addiction and mild depression. He very strongly associated his addiction with a parallel compulsion to engage prostitutes, from whom he would also obtain his drugs. On Effexor XR, not only did his depression lift, but his libido dipped, indirectly providing him with better control over his cocaine addiction.
Paxil, combined with Viagra, is an excellent treatment for premature ejaculation.

Agitated depression in underweight elderly patients
A common clinical constellation is the underweight, elderly patient with ruminative depression and insomnia. Remeron 15- 30 mg QHS almost always works well in such situations, because of its otherwise unwanted side effects of sedation and weight gain. Zyprexa, too, produces almost miraculous responses, at doses in the 2.5 mg QHS range. But beware that even very low doses of Zyprexa may ultimately cause excessive weight gain.

Irritable Bowel Syndrome
Low dose doxepin (Sinequan) is a favorite of many primary care physicians for symptomatic treatment of IBS, often in the the 25-50 mg QHS range. Its side effects of constipation and sedation are often perfect for such patients. Word on the street has it that Remeron works just as well.

Hypotension
If you have an anorexic patient with hypotension and comorbid depression, it would be pretty hard to argue against turning to Effexor XR as first-line. While at average doses it does not cause more hypertension than does placebo, at 300 mg and above, chances are pretty good that the norepinephrine reuptake inhibition will kick into high gear and help to bring up your patient’s too low blood pressure.

TCR VERDICT: Look for the Silver Lining!

1.Waldinger MD, Hengeveld MW, Zwinderman AH, et al. Effect of SSRI antidepressants on ejacuation. J Clin Psychopharm. 1998; 18(4):274-81. 2. Chen J, Mabjeesh NJ, Matzkin H, et al. Efficacy of sildenafil as adjuvant therapy to selective serotonin reuptake inhibitor in alleviating premature ejaculation. Urology. 2003; 61(1): 197-200.
General Psychiatry
Carlat 150x150
Daniel Carlat, MD

20 Years of The Carlat Report

More from this author
www.thecarlatreport.com
Issue Date: June 1, 2003
SUBSCRIBE NOW
Table Of Contents
The MAOI-Cheese Interaction
The Drug Holiday
Dr. Ronald Pies shares his wisdom
When Side Effects Help: Getting Creative
Side Effects Management: A Primer
Sexual Side Effects: Solutions
DOWNLOAD NOW
Featured Book
  • MFB6eCover.jpg

    Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)

    Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto84222831.jpg
    General Psychiatry

    The Adderall Shortage

    Adderall is in short supply, and the backlog is having a domino effect on other stimulants. Find out why, and how long it will last.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.