Expert: Ivan Goldberg, M.D. - 12/9/2010

Question
QUESTION: hi Dr. Goldberg-
I've been on different medications for bipolar II and paxil was always in the mix for 8 years.
I was switched to lexapro and now have been off anti-depressants about 2 years.
My psychiatrist had told me that loss of libido from   paxil would be a trade off for the depression.
It wasn't a placebo effect since I just recently remembered his warning- anyway I just swallow meds as a normal routine and get on with my day.
  Right now I'm on lamictal,neurontin,klonipin.

Question-Since there has been no improvement in my libido at all since stopping the paxil I wanted to know if paxil can cause permanent impairment for some people or might the blood pressure medication (ziac) started at the same time be a contributing factor at all.

ANSWER: Hi Jan . . .

There is no doubt that paxil can lower libido in both men and women. The effect can be a profoundly disturbing one and often leads to patients requesting to no longer be prescribed Paxil. The effect is a temporary one and regularly disappears within a couple of weeks of stopping the Paxil

The same libido lowering effect may be seen with Lamictal, but less frequently. Again, the effect is a reversible one and disappears a few weeks after stopping Lamictal.

If you have not seen it, you may want to check-out a web site where people taking lamictal report on their experiences. While I think these reports must be taken with more than a grain of salt they are nevertheless interesting. You may find the reports at:

http://www.druglib.com/ratingsreviews/lamictal/

Best regards . . .

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

QUESTION: Thanks,I'll also try getting a blood test for hormone levels.
  
I was wondering if my long term use of blood pressure medication -given by my internist-can give slightly out of range kidney levels results,that might have been passed over as "close enough" but later given a second look after my first lithium blood test came in -ordered by my psychiatrist?  
Besides "lamictal and lithium", can you recommend something else I might try for bipolar II without the  libido problem?

Thanks for depression central.I've been to it many times and my Dr. has also told me about it.
thanks very much.  

Answer
Hi . . .

If the medication for hypertension was started prior to the lithium, one can always look at earlier blood tests and see if there were any subtle abnormalities prior to starting lithium.

Any combination of an antidepressant ans a mood stabilizer can be used but the it has been my experience that none of them work as well as the lithium-lamotrigine combination.

Best regards . . .

Ivan
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