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Old 04-23-2005, 08:54 AM   #1
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Question Adult Question for Shoreline, anyone, help

Hi, I'm new to the boards, I have a fusion at C-7 from 10 years ago, have had chronic pain ever since, Have been diagnosed with ddd, also have nerve damage in right arm and hand due to old doctor telling me at the time 'If it was ruptured you'd be screaming, just a torn trapezoid' (I WANTED to scream, finally had to BEG for an MRI) I also have chronic lower back pain from bulging discs and a facet dysfunction. Have an excellent doctor now, have been with her for 9 years, and she always has time to listen to my concerns. I take 100 mg of tramadol 3X daily, Lortab 7.5 2X daily (she will raise this to 4X daily when and if I need it, I just have to call first), Zanaflex as needed, and Prozac 60 mgs. per day. My question is this, I have lost not all but a lot of my sexual drive. I'm a 42 year old woman and in a commited relationship, my husband is very understanding, and I have discussed this with my doctor also. It is a side effect from being in pain, of course, But I think it is made worse by the anti-depressant I'm taking. I have been on wellbutrin and zoloft but those were even worse than the prozac for killing my libido. Shoreline, you seem so well versed in meds and side effects, can you tell me if there is a different med I should be on? I would like not to change my pain meds, we tinkered with them for several years and my doses and quality of life are stable and for the most part, while I am not 100% pain free, I feel I have a good balance of quality of life, I'm active and happy, things I thought I would never be again when this whole thing started. Do you know of an antidepressant that has restored some sexual interest in pain patients? I'm not completely uninterested, but I can go weeks with no sex and not give it a second thought. Is it me? is there anything anyone here has found that works for this? sorry if this is off topic, I'm not sure if this is a common problem for pain patients, but it seems to me likely that it is. Thanks for letting me post on the boards, you all are so informed and friendly, I'm so pleased to have found you! anyone have any advice for me? ~Elaine/ Fabby

 
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Old 04-23-2005, 07:14 PM   #2
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Re: Adult Question for Shoreline, anyone, help

Sorry, I don't really have any advice for you, but I did want to say that my research and from what my doctor has said is that Wellbutrin is one of the least killers of the libido. My doctor switched me from Zoloft to Wellbutrin just for that reason several years ago. Now I'm on Lexapro, 20 mgs. Discuss it with your doctor and I hope you find a solution for your problem.
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Old 04-23-2005, 11:25 PM   #3
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Re: Adult Question for Shoreline, anyone, help

Thanks Director! I see my doctor next week and I will discuss with her changing me from prozac to wellbutrin or lexapro. Is that a seratonin re-uptake inhibitor like prozac, or is it more sedating and old school like elavil? I'm doing well on the prozac as far as treating my depression, so I think a similar med with fewer 'side effects' would be ideal. Thanks for taking the time to answer my kind of embarrassing question, lol, I really appreciate it!

 
Old 04-24-2005, 09:16 PM   #4
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Re: Adult Question for Shoreline, anyone, help

Hi Fabrashamx!

I would like to address your question if I may. I am 46 year old woman and am on various meds. I am not taking an anti-D right now, but have in the past used Effexor, Wellbutrin XL, and Cymbalta. I was dx'd with FM in early 2002 then developed multiple herniated discs later that same year. I also have Chronic Fatigue Syndrom, carpal tunnel syndrome, buritis in my right hip and right shoulder, CMP and am currently being tested for an auto immune disorder. So....I understand about the libido problem.

I quit taking the Anti-D's as they were given to me for the exact reason you mention in your post, serotonin re-uptake. I personally disagree with taking those type of meds for that purpose, I choose an alternative homeopathic supplement to address the serotonin issue. Anti-D's for Fibro is kind of a pet peeve of mine and I won't get on the soapbox right now, but I believe they did me more harm than good, as they were used for something other than depression. I do believe in using Anti-D's for depression if you find one that works well for you.

Even though I'm not using the Anti-D's any longer I still have a problem with my libido, which I'm sure some of the other meds I take can contribute to. I am like you, I can go weeks without missing sex at all. I could care less if I ever have sex again, to tell you the truth, but I love my husband and that isn't being fair to him. So I asked my doc about it and he ran a full testosterone blood work on me. Well, we found out that my testosterone level is extremely low. Mine is a 4 where normal is 14 (or is it 10?) LOL I think it's 14, but no matter, I'm low. But he is so hesitant to prescribe testosterone meds for me because of the side effects. I'm sure you know as well as I do what extra testosterone can do to a woman. I'm going to talk with him about it again, tho, since mine is so low, if he can't just maybe prescribe me something extremely low in doseage. I'd be willing to shave a mustache if I would only show some interest in sex!

I know that if you continue your Anti-D's your libido will be supressed to some degree, but maybe you could have your doc check your testosterone level to see if you are low, which would also contribute to your low libido. So it may not be only your meds.

Also, you should consider that women, and men from what I read, have a difficult time reaching an orgasm while on medications. So even if you have increased libido, you may still not be able to reach an orgasm, or it may take longer. I noticed that my orgasm changed after my uterus was removed. I still had them, but they were "different" and took longer to "get there". I know this can be embarrassing to talk about, but hey, I'm sure we are not alone. Matter of fact, this topic was discussed at length on the Fibromyalgia board. One woman had me laughing so hard, she called it "getting to the promised land"! So, you see, it's pretty common, but yet can be serious when you are in a relationship. I feel guilty, terribly sometimes, and I know it's frustrating. It makes sense tho, when we ingest all these medications with all their different chemical makeup, it is bound to affect how we function in more ways than one. Kind of a catch-22, we take meds to make us feel better, but the side effects can make us feel bad.

I surely empathize with your problem, and understand your frustration and concern. My only advice would be to have your testosterone level checked, just see if it is below normal. Then I would try to include things in your relationship that we used to do when we were in the "date mode". You know, do something to get the engines roaring. Whatever works for you and your partner. I think those of us on medications have to try a little harder to be intimate, and be thankful for an understanding partner, and also to learn to not feel guilty about something you cannot control.

I watched a TV special once about a patch for testosterone, that was developed for people like us, with low testosterone levels, or those of us who are on meds that supress our libidos. It sounded great, and the women who tested it said they had little or no side effects and they noticed a significant increase in their libido AND in their "response". But, the FDA won't approve this patch for the U.S. You can get it in Europe, but not here. Claimed that it needed more clincal trial with larger numbers. ***sigh*** So, what's a girl to do? I guess, take the reins and do what we always do, find a way by ourselves.

I hope some of what I said here helps you out. Just know that I, as well as many other women like you, understand how you feel. Maybe someone else will jump in here with some different info. Or someone (woman) who has taken testosterone to help with their libido will pop in and tell their story. I know that it's given to women, but not often.

Nice to meet you, and I hope to hear from you again.
tk

 
Old 04-25-2005, 06:19 AM   #5
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Re: Adult Question for Shoreline, anyone, help

Hi FabbyLIke Director said, Wlbutrin is the antiD they use that's supposed t have the least sexual side effects, Hoever someof the newer generation antiD's although still SSRI are supposed to have less than problems than some of the older. I didn't see any one specific drug that jumped out as a notorious labido killer other than Zoloft, but the problem may be that Ultram also effects SSRI and can be compounding a problem caused by the Zoloft.

PM docs are great at what they do, but they aren't endeocrinologist or GYN , and that's ho I recomend you see about the labido ssue.

Unfortnately, I really haven't kept up on endocrinology and there may be new products on the market I'm not even aware f.

The 3 routes of deliver for testosterone for men are Anrdrogel,a topic gel rubbed intot he skin, shots can be given wekly bbut you have alot of fluctiuation in zT levels with shoots, You may have a great weekend from a frday shot but by tuesday you would be back at square one. And they do make a small T patch that adheres to the scrotum, . But your GYN or an endocrinologist shoouldbe up on what's available and usingproducts designed for men in much smaller doses.

Hey TK, I understand antiD's being the cure for fibro being a pet peeve, it sends that message that things are all in your head, But there are some proven benefits to SSRI and the oldor meds like elevill reducing substance P which is commonly found at extremely high levels in peoples spinal fluid that have Fibro, substance P is a neuro inflamatory agent that's ony produced through the changes your bodies chemistry undergoes with chronic pain. I think we talked about the difference between chronic and acute pain. If I'm confused it can be found in the first part of DR Brookoofs article
[url]http://www.hosppract.com/issues/2000/07/brook.htm[/url]

I also checked for potential drug-drug interaction between zoloft and Ultram because it rang a bell, Take this advice with a grain of salt and discuss it with your doc. If you discontinue either med abruptly you could experence significant abstinence/wtithdrawal syndrome.
sertraline and tramadol (major Drug-Drug)
Description:

GENERALLY AVOID:
The coadministration of selective serotonin reuptake inhibitors (SSRIs) with tramadol, which has weak serotonin reuptake inhibiting effect, may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5HT1A receptors. Patients receiving this combination may also have an increased risk of seizures. Pharmacokinetically, coadministration with certain SSRIs, namely fluoxetine, paroxetine and possibly sertraline, may result in decreased plasma concentrations of the active O-demethylated (M1) metabolite of tramadol due to inhibition of CYP450 2D6, the isoenyzme responsible for the formation of the metabolite. The clinical significance of this potential interaction is unknown. However, M1 is thought to possess up to 6 times the analgesic effect of tramadol, thus diminished therapeutic response to tramadol should be considered.

MANAGEMENT:
In general, the concomitant use of SSRIs and tramadol should be avoided if possible, or otherwise approached with caution if potential benefit is deemed to outweigh the risk. Patients treated with the combination should be closely monitored for signs and symptoms of excessive serotonergic activity such as CNS irritability, altered consciousness, confusion, myoclonus, ataxia, abdominal cramping, hyperpyrexia, shivering, pupillary dilation, diaphoresis, hypertension, and tachycardia.

----------------------------------------------------------------------------
Although problems with labido are not uncommon, it doesn't mean we simply have to live with it because our shrink or PM doc don't know how to manage this particular side effects that falls outside their specialty.
Bottom line is, Just because one doc thinks it's a problem you have to live with dsoesn't make it so, It may take more trial and error but there is likely an answer.
Good luck, Dave

 
Old 04-25-2005, 09:41 AM   #6
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Re: Adult Question for Shoreline, anyone, help

Elaine,

You are getting great advice here. Given the duration of your pain problem and the fact that you are taking opioids it is likely and possible that you may be experiencing low testosterone levels. I will add that most major pain associations and conferences have now begun to address this issue and are providing direction to their members and attendees.

Our clinic was one of the first to intensively examine this issue and replacement therapy (IMO) often provides more immediate results for females than males. Your PM or an endocrinologist,if they choose to send you to one, can obtain serum free and total testosterone levels to find out if this is the culprit.

Good Luck

 
Old 04-25-2005, 09:49 AM   #7
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Re: Adult Question for Shoreline, anyone, help

Just from my experience . . . .

Zoloft – Was terrible for my sex drive. It was non-existent. Also going on and off of it was really hard. If I missed a day for some reason I would start feeling like there were electrical pulses in my head.

Wellbutrin – actually went above and beyond with increasing the drive!! I was amazed! (Although I had to go off of it because of irritability, increased blood pressure and increased headaches.) If not for those side effects I would have loved to stay on it!! I had so much energy too!!

I am now on Lexapro. It seems to be the best for me with the least side effects. I has reduced my sex drive but not as bad as Zoloft.

I did take Prozac for a while but it made me so tired I could barely function.

I hope this helps. Good luck!

 
Old 04-28-2005, 10:11 AM   #8
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Thumbs up Re: Adult Question for Shoreline, anyone, help

Wow thanks so much, Director, Et318,Shoreline,Drewtn, and my new gal pal TKgood! you all gave me some great advice and I have a list of what to discuss with my doctor on tuesday. Tk, I know exactly what you mean about the opiates making orgasm hard if not impossible to acheive-It's like riding the horse out side walmart-kinda fun, but you don't really get anywhere, heehee! I remember reading somewhere that alcohol makes women more sexually aggressive because it actually raises her testosterone quite a bit, But that doesnt help us, for most if not all of us I assume drinking is a no-no with our medications. I knew a man who was on the patch for low testosterone , he went from having no sex drive to being quite assertive about it, but he had some anger issues and had to stop using it, Now he's on pill form and doing much better. (the things wives tell each other about our husbands, lol) I will see what my doctor says or if she refers me to a specialist, and will keep you posted! Thanks again for all your kind and understanding answers, I am so happy to have found these boards! ~Fabby / Elaine

Last edited by Fabrashamx; 04-28-2005 at 10:13 AM. Reason: because it's help, not halp, lol

 
Old 04-28-2005, 09:17 PM   #9
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Re: Adult Question for Shoreline, anyone, help

Quote:
Originally Posted by Fabrashamx
Wow thanks so much, Director, Et318,Shoreline,Drewtn, and my new gal pal TKgood! you all gave me some great advice and I have a list of what to discuss with my doctor on tuesday. Tk, I know exactly what you mean about the opiates making orgasm hard if not impossible to acheive-It's like riding the horse out side walmart-kinda fun, but you don't really get anywhere, heehee! I remember reading somewhere that alcohol makes women more sexually aggressive because it actually raises her testosterone quite a bit, But that doesnt help us, for most if not all of us I assume drinking is a no-no with our medications. I knew a man who was on the patch for low testosterone , he went from having no sex drive to being quite assertive about it, but he had some anger issues and had to stop using it, Now he's on pill form and doing much better. (the things wives tell each other about our husbands, lol) I will see what my doctor says or if she refers me to a specialist, and will keep you posted! Thanks again for all your kind and understanding answers, I am so happy to have found these boards! ~Fabby / Elaine
Hey Elaine!

All my friends call me TK, so call me TK! I would be interested in hearing what your doc says about your situation. Ask them to run a full testosterone work up on you. And I'd be interested to see what your doc recommends if you happen to have low testosterone. My PCP is a little leary of prescribing anything to increase my testosterone. I would love to try it though. My rheumy totally blames the narcotics for my low testosterone as she doesn't believe in me taking narcotics for my Fibromyalgia let alone all the other things, mainly my lower back problems. She already told me that she doesn't prescribe narcotics for Fibromyalgia. Which is fine, cuz the whole time she was yabbering on about "all" the narcotics I take, I was thinking, "that's why I see a PM doc!" I don't know, I can see where the narcotics would mess with your libido, but to actually mess with your hormones, isn't that more a physiological change? Let's face it, us "elderly" women have changing hormones, we lose some hormones at this time in our life, narcotics or not. Menopause will cause your testosterone to be low, so I didn't like that she blamed my low testosterone totally on my narcotics. I'm telling my PM doc on her! LOL I will mention it to him, see what he says. Maybe he can recommend something.

So, I'd be interested in hearing what your doc says. I think it's very frustrating, and I can only speak from a woman's point of veiw, to have lost all interest in sex, and work yourself to death trying to reach an orgasm, when this is supposed to be "our" time.

Nice to hear from you again, and keep us posted k? I would gladly trade a mustache for enjoyable sex any day! LOL

Here's wishing you a good spirit,
tk

 
Old 04-29-2005, 08:04 AM   #10
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Wink Re: Adult Question for Shoreline, anyone, help

Hi There,

I've been on almost all of them at one time or another over the years and the only two AD meds that didn't create this problem are Effexor and Cymbalta. In fact, I think they helped my sex drive!

Good luck,

Robin

 
Old 05-03-2005, 11:58 AM   #11
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Question Re: Adult Question for Shoreline, anyone, help

Hi Tk, Shoreline, all, Thanks so much for your help, I saw my doctor today, told her about my lack of sex drive, And heres what she said: First of all, she took me off the 40 mgs of prozac a day and switched me to Lexipro. I take 1 lexipro and 1 prozac for a week then switch to all lexipro. She said it should take about a month before I notice a difference, But if she sent me to a specialist, the first thing they would do anyway is rule out an RX problem. If I haven't noticed an increased sex drive in 6 weeks, she will order tests to see where my testosterone levels are. The opiates (60 7.5 lortabs and 240 50mg. ultram per month) could also be the culprit, as could the pain itself (I'm sure I'm preaching to the choir here! lol ) But my doses are working for me and I'm not in that nightmare of accute pain every 6 weeks needing IV relief, So I'm hoping its my AD! She also said we might try lowering my tramadol dosage and upping the lortab. I don't know if this is helpful to you, TK, I think you said you don't use an AD? In my case, accute pain drove me to them, But I'm Irish Catholic, and I think we should be given them from birth on, haha! Has made a huge difference in my ability to cope with pain. My fusion has been swelling and giving me deferred headaches, My doctor has had the exact same surgery as me, Bone fusion at C-7 with nerve damage and ddd. She said with the thunderstorms we've been having, Fusion folks turn into walking barometers. She said her pain goes from a 4 to a 10+ on those days too. I travel over 60 miles to see this doctor, I followed her when she opened her own practice, after my old doctor moved and my neurosurgeon acted like my pain was an insult to his surgical skills and I must be a drug addict. I have a pain contract with my doctor and I have to make my meds last 30 days, but if I become accute, she will get me in usually that same day and and write me up to 150 lortabs. I am careful to use one pharmacy and she is my only doctor except dental. Its been so great to find these boards and realize I'm not alone! Will post again and let you know if the change in meds has brought back my mojo! heehee! Heres to a pain free day for us all!~Elaine / Fabby

 
Old 05-28-2005, 04:01 AM   #12
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Thumbs up Re: Adult Question for Shoreline, anyone, help

Hi its me again! Well its been about a month and I have noticed a big improvement, I went from 40 mg. of prozac a day to 20 mg. Lexipro. The depression part seems the same, I.E. I am getting the same results and feel like I am better able to deal with stress. It took about 3 weeks to notice a change in libido, But I feel much more responsive than I was on the prozac. Of course the pain itself is still a deterrent some days, but I don't feel like a eunuch anymore..(can women be eunuchs? lol ) Thanks for all your wonderful advice, hope you are all having a good day and, by the way, my husband wants to say thank you too!

 
Old 05-28-2005, 02:14 PM   #13
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Re: Adult Question for Shoreline, anyone, help

Hey Elaine!

Nice to "see" you again.

You mentioned Lexapro. I don't know if I have replied to you since I saw my new (third) Rheumy or not, but she gave me samples of Lexapro and of course I thought, "here we go again, giving the Fibro patient anti-d's!" So, I didn't use them of course, stubborn you know! LOL

HOWEVER: I started seeing a Psyciatrist again. I felt I needed to and plus it helps my SSD case! Hey, I'll see a Psyc if it helps me get my SSD! LOL But, I was feeling awfully anxious lately. I have a lot of upcoming tests and new dx's going on. It just never ends! And the Psyc gave me samples of Lexapro! I had a good supply of samples. I had heard and done research on Lexapro after my Rheumy gave me the samples and learned that Lexapro treated depression and anxiety. Of course it's an SSRI, but I don't care about Serotonin and FM anymore, I just want to stop getting frustrated and having little tantrums where I throw my undies all over my bedroom cuz I can't find the pair I want! LOL

I have been on Lexapro for a couple months now and I have noticed a decrease in my anxiety level. I was dx'd with major depression and GAD. Geez, you'd think the two would balance each other out!

I didn't read anything about it's affect on your Libido. Is it supposed to have less of an effect on supressing it? My testosterone level is low, it's a 4, but I can't seem to get anyone to send me to an Endocrhonologist. Like I said, I'd be willing to wear a mustache if my testosterone level would rise.

I'm glad you are feeling more "human" my friend. It's good to hear from you.

I'm currently waiting on two MRI's, one on my brain (checking for MS) the other on my lower back. I saw a Neurologist who told me point blank that my nerve damage that has made me lose function in my right leg is too bad now and surgery on my lower back is not an option, it won't help. So, I want to SEE! My Rheumy seems to think I don't need an MRI of my lower back, even though I haven't had one in three years, but I disagreed. I said "I KNOW my back is worse, I can't move around like I could when it first started to bother me". I'm also scheduled for an EMG on my right leg, checking I guess on how bad the nerve damage is and where it's coming from. Heck I can TELL them where it's coming from! LOL I'm also having an Ultrasound on my heart, I guess my heart murmur (that I've had since I was a teen) sounds "funny", weak were his words. And finally! An Ultrasound and blood work on my Thyroid. I had a bone scan that should some abnormalties that may be caused by problems with my Thyroid. O K A Y? Hmmmm? The bone scan also showed increased DDD and abnormalties in the Cervical and Lumber area, particularly at L-4. See, my lower back damage goes both ways, L-3 damage is to the left, and L-5 and S-1 are to the right. The bone scan also showed slight Scoliosis in the Thoracic area, which I'm told is common in women. Must be all those children and groceries we hauled around in our lives! LOL It's funny though, cuz during the scan I could see the monitor and I thought I noticed a slight curve (abnormal curve) in my spine from the frontal view. And an area in the lumbar area that stuck out away from the spinal column. It's pretty freaky seeing your skelatin on screen!


Anyhoo, good to hear from you again dear. I still would like to know if your doc told you that Lexapro was not as suppressive on your libido?

Thanks,
tk
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Old 05-28-2005, 02:41 PM   #14
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Cool Re: Adult Question for Shoreline, anyone, help

Hi Tk! Good to 'see' you again, too, sweetie! Yes, that was the main reason my doctor switched me from prozac to lexapro, to see if it would increase libido, she had heard it was much much better than prozac in that reguard..I had no idea that it would also treat anxiety, but now that you mention it, I DO notice a big improvement in that too. That 3 am free floating anxiety where I feel like I'm losing ground and the pain is just too much to handle, I stay 'in the moment' much better than I did on the prozac, and am more comfortable letting tomorrows problems stay out of todays issues. I really had NO interest in sex, and it had gotten so bad so slowly, I just realized one day I was almost asexual. So YES my doctor switched me to the lexapro specifically for the libido issue, and after a month, I am much much improved in that area! I also feel my depression is as good or better than it ever was on the prozac and my anxiety is much improved as I said. I'm so sorry you are having such a rough time, those endless tests can be physically and spiritually exhausting, I hope you get some better news out of it and I will be sending good thoughts your way! Thanks for all the info, SO great not to feel so alone anymore! Your Friend, Elaine / Fabby

 
Old 05-28-2005, 08:37 PM   #15
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Re: Adult Question for Shoreline, anyone, help

Elaine,

Thanks, I thought I was feeling a little more "frisky". Not quite "friskier" than the pain yet though! LOL That's good to know. I'm glad you told me. Loss of Libido from anti-D's was one of the reasons I stayed away from them, but I know that my pain meds and muscle relaxants also contribute to not feeling "frisky".

Thanks for your good thoughts, I'll take them with me to all my lovely tests.

I'm glad the Lexapro is helping your anxiety. Lexapro is a fairly new medication. Still and SSRI and given to Fibromyalgia patients, but it is meant to treat both depression adn anxiety, which is great. Usually anti-d's are more stimulating and have nasty side effects and meds for anxiety are more sedating, so it's good there is a med that can treat both with minimal side effects. I haven't noticed any side effects as of yet, have you? Chances are I'll need a higher dose after time, I'm taking the 10mg now and I don't know what doses it comes in really. But so far so good.

Nice to talk with you my dear friend,
tk
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