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Dr. Andrew Rynne

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Have anxiety and panic attack. Have erectile dysfunction with pristiq. Added Buproprion which causes anxiety. What to do?

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Dr. Preeti Parakh

Addiction Medicine Specialist

Practicing since :2002

Answered : 1486 Questions

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Posted on Sat, 14 Dec 2013 in Anxiety and Stress
Question: I have anxiety and sometimes panic attack. I was put on pristiq 50 mg but I have erection dysfunction on it. It was added buproprion 75 mg, it works for the sexual problem, but it causes me an increase of axiety. I feel like i have a lump in my throat. So what can i do? What can be added to pristiq to conteract the sexual dysfunction? Please help. Thank you.
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Answered by Dr. Preeti Parakh 4 days later
Brief Answer: Mirtazapine can be added to Pristiq. Detailed Answer: Hi, Welcome to Healthcare Magic! Bupropion and Mirtazapine (Remeron) are the two antidepressants which work very well in people who have sexual dysfunction on SNRIs (Pristiq, Effexor etc) or SSRIs (Zoloft, Paxil etc). Though bupropion has been ruled out in your case, you still have the option of trying mirtazapine (Remeron). If it works for you both in terms of sexual functioning and control of anxiety, then you can even choose to stop Pristiq and remain on only mirtazapine. It is started in the dose of 7.5 mg at bedtime, which later is raised to 15 mg at bedtime. It causes some sedation and so, is taken at bedtime. But it is not addictive and not like benzodiazepines. I have another suggestion for you. If you have not tried SSRIs at all, then you can try paroxetine (Paxil) in place of Pristiq. Though SSRIs also have sexual side effects like Pristiq, it is not necessary that you are definitely going to have them. Paroxetine works very well in anxiety and is also used to treat premature ejaculation. There is one more suggestion for you. If possible, try practicing relaxation exercises. Taking slow and deep breaths is the most simple relaxation exercise while progressive muscular relaxation is slightly complicated but works very well. You can find detailed instructions on many websites. Relaxation exercise will reduce your anxiety a lot and you will need lower dosages of medications. Hope this helps you. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Preeti Parakh 26 hours later
Hello, Thanks for the detailed reply. Strangely now my libido is back and sexual function as well. I am taking only Prisitq 50mg. Do you still suggest adding remeron at bed time? I experience insomnia, i read it could help with that. Thank you again for your time.
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Answered by Dr. Preeti Parakh 1 hour later
Brief Answer: I think you should wait for some time. Detailed Answer: Hi, Its great that your sexual dysfunction is gone and you are doing well only on Pristiq. I feel you need not start Remeron at present just for insomnia. The insomnia can be expected to improve when your anxiety improves further. In my opinion, you should wait for some time before deciding if you need to start something for insomnia. If required, Remeron can be started then. Best wishes. Dr Preeti Parakh MD Psychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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