Expert: Ivan Goldberg, M.D. - 10/25/2009

Question
QUESTION: I never discusse this topic with my psychiatry because, besides the embarrassment, he doesn't seem to understand my concerns on sexual issues. I feel I suffer from impulsive masturbation. I think the right thing for a healthy man is to control his sexuality and not be controlled by it. This is what happens to me. That's why I feel unease with my impulses.

Nowadays he believes I suffer from cyclothymia. I am not sure about it. The right thing is that I have a long history of depressive phases, OCD-like episodes and occasional panic-attacks, as well as delayed phase sleep problems.

In addition I find it hard to begin and keep relationships (I never fell in love with anyone, though I am 33). And, of course, the issue of excessive drive for masturbation. I get aroused easely by self-destructive fantasies - something abnormal and never closed with love and intimacy.

I feel things got worse after I stated taking bupropion (minimal dose), two years ago. I couldn't stop focusing sex even unconsciously. I felt like masturbating even at work! I begged my psychiatist to give me another antidepressive. Nowadays I am on sertraline 100mg since nine months ago. I feel that my impulses grew stronger when the dose was changed from 50mg to 100mg.

What can I do to decrease my excessive impulse with sex? What can be the cause? Can antidepressives be triggering it? If so, is it normal?

thanks in advance.

ANSWER: Hi Bruno . . .

Excessive sexuality is frequently a symptom of bipolar disorder. Both mania and hypomania have been associated with an increase in sexuality. In people with major depression, SSRIs such as sertraline often decrease both sexual interest and performance, in people with bipolar disorder, SSRIs may increase sexuality.

When I have a patient who becomes hypersexual on antidepressants, I stop the antidepressants and start lithium.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Ok, excessive sexuality have been associated with hypomania a mania. But in my case I guess I have not enough symptoms. Only hypersexuality bothers me clearly. There have been times when I took valproate. But in those cases my doc found me too "stressed" and irritable at work. In fact I'd usually had to take 1/2 to 1 mg of clonazepan in the morning because I would get too unpatient and irritable and it was a little hard to hide it from the public (I work in a bank). Besides, I've had to spend several days far from work more than once because of this bothering mood state.
But my point is that it happened a few times. Besides it, I don't remember if I had other peculiar symptoms at those times.
On the other hand, to be honest I have had much trouble with sleeping/awaking time and I can't stop taking clonazepan even if in low dosage, or else I get an inner felling of unrestlessness, unquiet mind, as well as a physical unease. If I refuse to take clonazepan, I wake up a few minutes after falling asleep scared, confused, with my heart pounding, my mind very confused... If I insist in not taking clonazepan I may have a strong panic-attack-like episode (very frightening - impossible to control my mind and breath). For the sleeping problems I was given zolpidem hemytartarate 5 mg yestarday. I hope this will work.
Does it all match with a (maybe atypical) case of hypomania? If so, how can I cool things down in sex aspect? Valproate could be helpful?

thanks

Answer
Hi Bruno . . .

The additional information you provide suggests to me that the possibility that you have a significant mood disorder is even stronger than I originally thought. Valproate, Tegretol, Trileptal, and lithium are all possible treatments for people who have hypersexuality on the basis of a mood disorder.

This may be a good time for you to seek a second opinion regarding your diagnosis and treatment. If you cannot find an expert psychiatrist locally, you can find one at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .

Ivan
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