SSRIs, or selective serotonin reuptake inhibitors, include GlaxoSmithKline Plc's Paxil, Eli Lilly and Co's Prozac, Pfizer Inc's Zoloft and Symbyax, Forest Laboratories Inc's Celexa and Lexapro, and Solvay Pharmaceutical's Luvox, which is also sold generically as fluvoxamine. Many people have benefited from the use of SSRI drugs. However these medications do have side effects and doctors have to balance the benefit and risks of these antidepressant drugs.
   Those who wish to explore natural antidepressant therapies would likely benefit from some of the information discussed in this depression article. Natural antidepressants are a good option for those with mild or moderate depression. There are several to consider including 5-HTP, tryptophan, SAM-e, St Johns wort, and Mind Power Rx. Discuss with your health care provider before initiating treatment with natural antidepressants. Use low dosages at first until you find out how they influence your body and mind. Use one supplement at a time to learn how it affects you. If you combine several supplements, you will not know which one is helping, and there could be side effects. Combining natural supplements with SSRIs carries a risk for side effects since many herbs and nutrients are quite potent.
 

Types of SSRI drugs
Celexa is the product name for citalopram, a type of SSRI drug. In 2001 FDA warned that it can cause abnormal changes to the electrical activity of the heart.
Lexapro also known as Cipralex - escitalopram
Luvox - fluvoxamine

Paxil - paroxetine
Prozac - fluoxetine - also known by the brand name Sarafem
Zoloft - sertraline generic name
 

How effective are SSRI medications?
Antidepressants, whether SSRIs or other types, fail to cure the symptoms of major depression in half of all patients with the disease even if they receive the best possible care, according to a definitive government study published in 2006. Significant numbers of patients continue to experience symptoms such as sadness, low energy and hopelessness after intensive treatment, even as about an equal number report an end to such problems.

Sexual side effects, reversing sexual adverse reactions
It is quite well known that SSRIs increase serotonin levels and serotonin has an inhibitory effect on sexuality. Sometimes the sexual side effects can last several weeks or months after the meds are stopped.

Exp Biol Med. 2013. Fresh onion juice enhanced copulatory behavior in male rats with and without paroxetine-induced sexual dysfunction. This study conclusively demonstrates that fresh onion juice improves copulatory behavior in sexually potent male rats and in those with paroxetine-induced sexual dysfunction by increasing serum testosterone levels.

I have heard that I might be a good fit for the script as I have agoraphobic tendencies, mostly caused by diagnosed body dysmorphic disorder and major depression, I have extreme anxiety and loss of ability to participate in social and occupational situations. I also have serious erectile dysfunction caused by the social anxiety as my erectile dysfunction is not present when I am alone, and bad memory loss. I am on 80 mg Paxil and 30 mg Buspar. While they have helped, it seems not to be enough and my doctor, though he has helped me tremendously with CBT, is a minimalist when it comes to scripting.
   Paxil can cause erectile dysfunction, and Buspar may also inhibit sexuality. You may wish to explore natural options with your doctor.

I am 29 years of age and i am taking escitalopram antidepressant 7.5 mg. I was previously on 10mg which suppressed my libido pretty bad. After reducing the dose by 25% my sexual function has improved for the better. But still i need to take the combination of tongkat ali, yohimbe bark and horny goat weed to achieve a satisfactory response.

I took Cymbalta for about 2 months since December 2011 to the beginnings of February 2012. After that I have suffered from really bad PSSD (Post-SSRI sexual dysfunction) until now and I haven't recovered. I went to see a neurologist and he told that not much could be done through the conventional medicine and recommended me your website. Not much is known about why Cymbalta causes PSSD but it is thought that since maybe it raise serotonin on the blood then the Dopamine levels go down and that's why the sexual dysfunction comes. I was reading about the mucuna puriens supplement and the Passion Rx. Which of these two supplements are more potent for sexual enhancement after SSRI treatment?
   Passion Rx is more potent.

Bone fractures in older adults are increased
The chronic use of SSRI antidepressant drugs doubles the risk of fractures in adults 50 years of age or older. These agents apparently decrease bone mineral density and raise the risk of falls, both of which are known to increase the fracture risk, Dr. David Goltzman, from Royal Victoria Hospital in Montreal bases his findings from a population-based study of 5008 community-dwelling adults who were at least 50 years of age. SSRI use, BMD, and history of falls were determined for each subject who were followed for over 5 years. The most common site of fracture, seen in 40% of cases, was the forearm, followed by ankle and foot in 21% of cases. "Animal studies have shown that SSRIs can decrease bone mineral density," which primarily involves a reduction in the amount of bone," adds Dr. David Goltzman. Arch Intern Med 2007.

Danger, caution

SSRIs or certain SNRIs in combination with migraine drugs known as triptans could result in a life-threatening condition called serotonin syndrome. Persistent pulmonary hypertension can occur in newborns if the mothers took SSRIs during pregnancy. Pregnant women and those who plan to become pregnant should avoid taking SSRI antidepressants because of the risk of birth defects. People taking Celexa and Lexapro may have an increased risk of developing an abnormal heart beat.

NSAID and SSRI side effects
Selective serotonin reuptake inhibitors (SSRIs) and nonsteroidal anti-inflammatory drugs (NSAIDs), when combined, can interact to increase the risk of upper gastrointestinal bleeding.

Women prescribed a common class of antidepressants to ease menopausal symptoms may face a long-term rise in their risk for bone fracture. The antidepressants in question are selective serotonin reuptake inhibitors (SSRI) medications such as Celexa, Paxil, Prozac and Zoloft.

Meta-analysis: Gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs.
Aliment Pharmacol Ther. 2007. School of Medicine, Health Policy and Practice, University of East Anglia, Norwich UK.
SSRIs have been associated with upper gastrointestinal hemorrhage but the magnitude and characteristics of this reaction and possible interaction with concurrent Non-Steroidal Anti-Inflammatory Drug (NSAID) therapy are unknown. We searched PubMED, Science Citation Index, and trial registries for data on SSRIs, NSAIDs and UGIH. We evaluated spontaneous case reports from pharmacovigilance databases. SSRI use, alone and in combination with NSAIDs, substantially increases the risk of upper gastrointestinal hemorrhage. Clinicians should consider this when managing patients at risk of, or presenting with upper gastrointestinal hemorrhage.

Withdrawal and natural alternatives
I am wondering what supplements could be helpful for SSRI withdrawal. Would there be a different approach in the case of tapering off an SSRI versus going cold turkey? It is my understanding that the former is usually preferable, but it is possible that in a certain case the abrupt cut-off would be necessary, for instance if a dangerous drug interaction had occurred between the SSRI and another medicine. Perhaps there are other scenarios where the abrupt cutoff might be preferable, but I can't think of any. Thank you for addressing this, especially since I can't find information anywhere about the latter part of the question. I have yet to come across a single recommendation for going 'cold turkey', so maybe that's why managing it is rarely addressed.
    There are no recommendations that apply to everyone. Firstly one has to consider the level of depression being treated, is it mild, moderate, or severe? How long has the SSRI medication being used and what dosage? Are there risks for suicide if the medication is stopped abruptly? What other medications and supplements is the person taking? What is their age and overall health status including their heart condition? Each person is unique and is likely to respond differently. Some may benefit from an abrupt withdrawal but most likely a good option is to taper slowly over a week or two.

I am currently weaning off an SSRI med called Lexapro. It made me feel numb which I didnt like, however I have read that after taking an SSRI people can suffer from SSRI discontinuation syndrome. This includes many symptoms like brainfog and extreme depression and cognitive problems. I have also read that after taking an SSRI, the serotonin receptors are down-regulated and so can't re-uptake serotonin until they upregulate again. No one seems to know how long this process takes. Do you know anything about this or anything that could help reduce the symptoms? Many thanks for reading.
    There are some people who may have the withdrawal symptoms you mention. There are some natural antidepressants that can be tried such as 5-HTP, SAM-e, or St. John's wort. Certain natural supplements for brain enhancement that could be effective include acetyl l carnitine and Mind Power Rx.

I read the information on Passion Rx and SSRI medications. I had to stop taking SSRI's (last one was Cymbalta) because of side effects and no results. In fact the sexual side effects are hanging on to this day, Resolving very slowly. I took EMSAM (MAOI) and now switching to PARNATE (MAOI) instead. These drugs also seem to have sexual side effects but they appear related to dose and do not seem to hang on the way the SSRI side effects did when the drug is reduced. Oddly the MAOI may be helping with the SSRI hang over effects but causing some effects of its own! So I am between a rock and a not so hard place. Can anyone use the libido formula with a MAOI (PARNATE) under the same caveats you gave for an SSRI? Any additional caveats? Would it matter if the formula was with or without Yohimbe?
   One should use the same cautions, with or without yohimbe since the results of combinations of herbs and medications are sometimes not easy to predict.

Autism, no benefit
Cochrane Database Syst Rev. 2013. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.

A 2015 study shows that women who take antidepressants in the later stages of pregnancy are more likely to have a child with autism. The study specifies one particular group of antidepressants in particular — the SSRIs, or selective serotonin reuptake inhibitors, such as Prozac, Zoloft or Paxil.

SNRI medications and their role in treating depression and safety issues
SNRIs are selective serotonin / norepinephrine reuptake inhibitors. These include Lilly's drug Cymbalta and Wyeth's Effexor.

J Psychopharmacol. 2013. Does adding noradrenaline reuptake inhibition to selective serotonin reuptake inhibition improve efficacy in patients with depression? A systematic review of meta-analyses and large randomised pragmatic trials. There is substantial evidence that noradrenaline has a role in the pathogenesis and treatment of depression. This review aims to examine the evidence of including noradrenaline reuptake inhibition with serotonin reuptake inhibition with respect to increasing efficacy in the treatment of depression. Evidence from meta-analysis of randomised controlled trials (RCTs) and randomised pragmatic trials was found in support of greater efficacy of the serotonin noradrenaline reuptake inhibitors (SNRIs), venlafaxine and duloxetine, in moderate to severe depression compared to SSRIs but no evidence was found for superiority of milnacipran. There is sufficient current evidence that demonstrates an increase in efficacy, when noradrenaline reuptake is added to serotonin (5-HT) reuptake, to suggest that patients with severe depression or those who have failed to reach remission with a SSRI may benefit from treatment with a SNRI.

Suicide risk
In a letter to doctors in May, 2006, GlaxoSmithKline and the Food and Drug Administration warned the SSRI Paxil may raise the risk of suicidal behavior in young adults. The warning letter was accompanied by changes to the labeling of both Paxil and Paxil CR, a controlled-release version of the SSRI drug, also called paroxetine. A review of clinical trial data on 15,000 patients treated with both SSRI Paxil and dummy pills showed a higher frequency of suicidal behavior in young adults treated with the SSRI drug. The FDA reported that there were 11 suicide attempts — none resulting in death — among the patients given the SSRI drug in the trials. Just one of the placebo pill patients attempted suicide.

Eye problems, Increased risk for cataracts in the eye
Dr. Mahyar Etminan, of Vancouver Coastal Health Research Institute and University of British Columbia has found that people who take selective serotonin reuptake inhibitors (SSRIs) drugs for depression have a higher-than-average risk of developing cataracts. Different SSRIs may pose different risks. For example, current users of fluvoxamine (Luvox) have a 39 percent higher chance of being diagnosed with cataracts and a 51 percent higher chance of having cataract surgery. With venlafaxine (Effexor), one's risk may be roughly 26 percent higher than average and with fluvoxamine, it may be 30 percent higher. Current venlafaxine (Effexor) users had a 33 percent higher likelihood of cataracts and a 34 percent higher likelihood of cataract surgery, while taking paroxetine (Paxil) carried a 23 percent higher risk of cataract surgery. In the current study, current use of fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) did not seem to raise the odds of cataracts or cataract surgery. And past use of any SSRI also did not appear to pose a risk. "We found different risks with different agents. However, we don't want to dwell on this with just one study and think whether the risk is different with different agents should be validated in future studies," Dr. Mahyar Etminan said. Ophthalmology, published online March 8, 2010.

SSRIs and serotonin-norepinephrine reuptake inhibitors increased the risk for eye dryness.

Cancer benefit
Anticancer Res. 2013. Fluoxetine-induced apoptosis in hepatocellular carcinoma cells. In addition to being used to treat mental disorders, a serious complication of cancer, antidepressants have been reported to improve cancer patient immunity, inhibit cell growth and have an antitumor effect on various cancer cell lines.

Irritable Bowel Syndrome

The results of a small, controlled crossover study suggest that treatment with SSRI antidepressants can reduce abdominal symptoms and promote overall well being in patients with irritable bowel syndrome (IBS), independent of their effects on depression. These findings confirm that serotonin has an important role in gastrointestinal tract activity. Whether small amounts of 5-HTP would be helpful is something to consider.

Pain management
Pain Res Manag. 2016. Treating Chronic Pain with SSRIs: What Do We Know? SSRI medications seem to have an effect on most of chronic pain conditions; however, further clinical trials with good methodology leading to low risk of bias are needed in order to conclude once and for all the effect of this drug class as treatment for chronic pain conditions.

Pregnancy
Use of SSRIs during the second half of pregnancy may be associated with a condition called persistent pulmonary hypertension of the newborn. Newborns with this rare but life-threatening condition do not receive enough oxygen in the blood and require intensive-care treatment to survive. Babies born with this condition are several times more likely than healthy babies to have been exposed to SSRIs. Numerous reports in Canada and abroad have already indicated that some children exposed to SSRIs and other newer antidepressants during pregnancy may develop serious complications at birth. An increase in the overall risk of major birth defects has also been associated with SSRI use. Health Canada is advising women who are taking antidepressants known as Selective Serotonin Re-uptake Inhibitors (SSRI) and who are pregnant or intend to become pregnant to discuss the situation with their doctor due to potential risks to the baby. Generally, SSRI treatment should only be continued if the benefits to the individual patient are thought to outweigh the risks to the unborn child, while also considering the benefits and risks of switching to another treatment option or stopping treatment altogether.

   SSRI medication exposure in the womb may not linked to depression - Children who were exposed to SSRi medications in utero do not appear to be at increased risk for internalizing behaviors such as depression, anxiety, and withdrawal. Impaired maternal mood, by contrast, did increase the risk of internalizing behaviors. The findings are based on an assessment of internalizing behaviors in 4-year-old children born to 22 mothers who used SSRIs during pregnancy or 14 mothers who did not. The results appear in the American Journal of Psychiatry for June 2006.
   Babies born to women who take SSRIs during pregnancy appear to be at increased risk of having a low birth weight and to develop respiratory distress. The use SSRI antidepressant drugs early in pregnancy seems to moderately raise the risk of congenital malformations in offspring.
   When pregnant women take antidepressants, it sometimes causes their babies to hit developmental milestones late. Pediatrics, February 22, 2010.

There is a possible association between in utero exposure to SSRIs or other serotonergic / noradrenergic antidepressants and alterations in neurobehavioral development, bleeding, and QTc-interval prolongation. The available evidence suggests that SSRIs and other serotonergic / noradrenergic antidepressants should be used with caution during pregnancy, with careful follow-up of infants exposed to these agents in utero.

Failure
When patients with major depression fail to respond to a course of the SSRI Celexa (citalopram) or cannot tolerate its side effects, approximately one third of those whose treatment is augmented with either bupropion (Wellbutrin) or Buspar (buspirone) will experience a remission of their depression. If they are instead switched to Wellbutrin, Zoloft (sertraline), or Effexor (venlafaxine), about one out of four will remit.

Weaning off SSRI drugs

It has been more than two decades since Prozac — the first of the antidepressants known as SSRIs, or selective serotonin reuptake inhibitors — hit the market. Since then, many patients have reported extreme reactions to discontinuing the SSRI drugs. Two of the best-selling antidepressants — Effexor and Paxil — have prompted so many complaints that many doctors avoid prescribing them altogether. Patients report experiencing all sorts of symptoms, sometimes within hours, but most often within days, of stopping their SSRI medication. They can suffer from flu-like nausea, muscle aches, uncontrollable crying, dizziness and diarrhea. Many patients suffer “brain zaps,” bizarre and briefly overwhelming electrical sensations that propagate from the back of the head. There are case reports of people who have just quit SSRI antidepressants showing up in hospital emergency rooms, thinking they are suffering from seizures.
  The brain chemical affected by most of the SSRI antidepressants on the market today, serotonin, does a lot more than regulate mood. It is also involved in sleep, balance, impulse control, relaxation, digestion and other physiological processes. So when you throw the brain’s serotonin system out of whack, which is essentially what you’re doing by either starting or discontinuing an antidepressant, virtually the whole body can be affected.
  Generally the SSRI drugs that are metabolized most quickly cause more severe symptoms. Effexor, with a half-life of just a few hours, is one of the worst SRIs in that regard; Prozac, which has a half-life of about a week, is considered the best. Some doctors have been able to minimize withdrawal symptoms in patients who are quitting Effexor or Paxil by gradually switching them over to Prozac, then tapering them off the more easily discontinued drug.
  Would taking 5-HTP or St. John's wort reduce the symptoms of SSRI withdrawal? Perhaps they may help, but research is lacking.
 

Email from a Researcher
I just wanted to inform you about a paper I published recently describing permanent sexual side effects in former users of SSRI antidepressants. These three cases are just the tip of the iceberg, and it appears to be very common. A good reason to stick to herbal remedies as much as possible....
Yours sincerely,
Antonei Csoka, Ph.D. Assistant professor Dept. of OB-GYN and RS University of Pittsburgh http://www.pdc.magee.edu/faculty/csoka.html
 

Questions
Q. I have been taking a SSRI anti depressant for 10 months which has been very helpful for panic disorder. It has also flattened out my emotions so although the anxiety has gone I don't feel a sense of wellbeing or happiness. I have consulted my doctor as you suggested about combining SAM-e and Citalopram but she doesn't know anything about SAM-e. I understand that you can't give personal advice and that there haven't been many studies on SSRI's and SAM-e. Do you know of any other way I can find out about personal experiences of combing the two?
   A. SAM-e is very potent and we are not aware of studies, you could do a google search to find personal experiences using various key words, for instance SAM-e Citalpram or SAM-e SSRI or SAM-e Prozac, etc.
 

Q. I am currently taken 200 mg per day of SSRI zoloft. Is tryptophan safe to take with SSRI zoloft, or is it counter productive since Zoloft tries to block serotonin levels between the various brain cells. What about 5-HTP supplements?
   A. Tryptophan increases serotonin levels just like the SSRI Zoloft, therefore caution is advised. If your doctor approves, you could take half or a third of the Zoloft dose and only a third of a tryptophan dose to see how you do and then monitor based on this. The answer for 5-HTP would be similar to that of tryptophan since their actions are similar in some ways.

Q. Is tryptophan as good as a SSRI for depression?
   A. It's difficult to compare, although they both influence serotonin levels, their mechanism of action is different. I have not seen head to head studies involving an SSRI and tryptophan to know how similar or dissimilar they would be in terms of clinical improvement in depression.

Q. Do you have a supplement that might ease a very gradual withdrawal off Lexapro SSRI? I have been taking Lexapro for years and find myself sleeping too much/much too overweight; in short, it's time to discontinue. I take thyroid and blood pressure meds and want to make this transition as gentle as possible, no matter how long it takes. I thought perhaps a 50mg. dose of Sam-E once the physical side effects start. I know you want to be careful answering this question, understandably so.

Q. I've been on a SSRI for three years and am in the process of weaning off the medication in the hopes of switching to a natural alternative with fewer side effects. I've read that the withdrawal effects of stopping SSRI medications can be incapacitating. In your experience, are there nutritional supplements that can mitigate the effect of withdrawal from SSRIs (or SNRIs?) If so, would you have your patients begin these supplements during the weaning process, or only after the weaning is complete and the patient has stopped the medication entirely? (I know I'll have to do this under the supervision of my doctor, but I was hoping I could use your SSRI weaning philosophy as a point of comparison.)
   A. Each patient is different depending how long they have been on the SSRIs, which SSRI medication they are using, the SSRI dosage, how their body reacts, their current mood and disposition, their dietary habits and exercise program, their sleep patterns, etc. etc. Plus, each person responds differently to natural supplements, and the dosages and timing can make a huge difference. Each case is unique and hence we can only give general guidelines. Start with low dosages of 5-HTP or St. John's wort, or SAM-e even if it means using a portion of a capsule and gradually decrease the dosage of the SSRI over time.

Q. I would like to get your opinion on this. I see it was conducted in the year 2000 but I can't seem to find any follow up on it. Specifically how does this relate to the massive prescribing of SSRI and what chances individuals who are taking these types of medications are doing harm. Also if serotonin is the culprit, would it make a difference if it was a natural mood booster or pharmaceutical if they both delivered the same effect? Getting a straight answer on this one isn't easy. http://www.antidepressantsfacts.com/Thomas-Jefferson-University-Hospital.htm
   "Researchers from Jefferson Medical College in Philadelphia have found changes in brain cells in rats treated with large doses of several anti-depressant or anti-obesity drugs. In some cases, the cells shriveled or took on abnormal corkscrew shapes. While the clinical significance of the findings isn’t known, the scientists say, they may raise new concerns about the prolonged use of such commonly prescribed drugs as fluoxetine (Prozac) and sertraline (Zoloft). The work also highlights the need for similar studies on other classes of drugs that act on the central nervous system."
   A. It is difficult to compare the effect of massive doses of a drug or nutrient - in this case SSRI drugs - in rodents to what would happen when reasonable amounts are used in humans. I am not comfortable with people taking SSRI drugs for long periods due to potential SSRI side effects. Whether the doses of SSRIs used in treating depression in humans cause neural damage is not fully clear to me at this time but could be of concern. It's possible that high doses of certain nutrients such as 5-HTP could do the same damage, but I have not seen any postmortem evidence of such. In low doses 5-HTP is actually considered an antioxidant. SSRIs may influence neurons in a different way than 5-HTP. I realize people want clearer answers, but until more research is done this is the most one can say. Bottom line: use a SSRI medicine in as low a dose as possible, and take breaks from use.

Q. I read that Mind Power Rx should not be taken with an SSRI. Yet Mind Power Rx has so many good things for brain function and I am interested in getting some for my aged father who is showing some dementia, but he is on the SSRI Lexapro. What are  the reasons not to take the two together?
   A. Unexpected reactions occur when herbs and supplements are taken with SSRI drugs, and it is difficult to predict what those could be. Some potential side effects could be rapid heart beat, insomnia, restlessness, etc although some people may find no side effects when combining SSRI drugs and herbs. We prefer to be on the cautious side and not use them the same day.

Q. I really just want to take some time to say thank you to Ray Sahelian, M.D. for creating Passion Rx. I mean it from the bottom of my heart. I have been on antidepressant medications SSRIs for seven years now, and didn't realize what I was missing. I am a 25-year-old male. I did notice that I had virtually no attraction to anyone, and this was causing a depression all on its own. I know that Physician Formulas says not to take Passion Rx with SSRI antidepressants, but I can tell you that in my case with SSRIs it has not a problem. I take the pills as suggested: one once a day for two days, then two days off. I owe so much to you! I feel like a human being again. Thanks a million!
   A. Wow, we truly appreciate your report. Can you fill me in on a couple of things. Which SSRI are you taking and in what dosage for how long. Which Passion Rx were you taking, with or without yohimbe?And did you take a full capsule or part of a capsule, with breakfast or before breakfast. Did you notice the benefit the first day or did it take several days? We are so glad that Passion Rx helped you. This is the first feedback we have had by someone on SSRIs.
      Q. I have been taking the SSRI Lexapro 20 mg/day for six months. I take a whole capsule of Passion Rx with yohimbe in the morning, at least a half hour before eating anything. It took till the second day to notice a change in orgasm, and by the third day my libido, sexual thoughts, harder erection, more stamina, increased sensation, and more powerful orgasm all ensued. This has remained almost everyday. I cannot thank you enough. I actually forgot how pleasureful sex can be. I should let you know that I've been taking Passion Rx for about a month. | have recommended Passion Rx to both my sisters, thier partners, and my parents.
         A. Very interesting. We would suggest using the Passion Rx less frequently now. Once people notice the effects, they can take it less often and we also suggest at least a full week off each month.

Q. I am 34 year old female taking Celexa for anxiety and a side effect of the medication is low sex drive and difficulty achieving an orgasm, is it ok to take the Passion Rx formula or would it interfere with the SSRI medication? I also wanted to know if it's ok to take Mind Power Rx herbal supplement together with Celexa?
   A. It is difficult to predict the reaction to the combination of Passion Rx with a SSRI antidepressant medication such as Celexa. Celexa is known to cause loss of sex drive. Passion Rx can enhance sex drive but it may be more difficult since there is always the inhibition going on from the SSRI drug. If your doctor approves, you could try half a capsule of Passion Rx every other day, or two days on, one day off. And be patient for 2 weeks to one month. If you find you are having trouble sleeping, reduce the frequency of use of Passion Rx. Mind Power Rx may be taken at one capsule during the days when Passion Rx is not being used. If you notice any side effects with the combination, stop the herbs and resume at a lower dosage after two days. Your doctor may also advise you to reduce the SSRI dosage by half on the days that you take Passion Rx or Mind Power Rx.

Q. I am a 35 year old married man . I have been taking Passion Rx for the last 5 days now. I have had a low libido due to depression and also because i am on SSRI medication for 3 years now . Although there was major improvements in my depression / mental health and it did save my career and marriage . It took a toll on my sexual health (although the depression itself did reduce my libido) , the SSRI has had a negative effect too. Previously, Viagra has not helped much , except for erections and moreover my doctor stopped me that because of the side effects. I am taking Lexapro 10 mg, and my doctor agreed to try Passion Rx. I have had no interactions when taking Lexapro with many herbs with my doctor supervising me. My doctor started me on 1/2 a capsule of passion Rx for the first 2 days. Did not notice anything on the first 2 days. There was only a small effect on the 3rd day. As i had good tolerance for the first 3 days , The 3rd day my doctor told me to take 1 capsule. But so far i have noticed only minor improvements. i did not find any moderate to major improvements in my libido. I thought most of your customers respond on the 3rd day. Unfortunately for me only minor changes, even on the 5th day. Does it have to do anything due to depression and also the Lexapro i am taking for the last 3 years. I am not sure if it will take much more time for major improvements. My doctor Insists me to continue, since i did not have side effects or interactions with Lexapro i am taking, and that its difficult to predict because each persons body chemistry is different. Any opinion and Suggestions from your Side ? Does it take some your customers a longer duration to see the effects . And sometimes how long can it take , so i can know if there is a chance it can work for me.
   A. Most users of Passion Rx who are not taking SSRI drugs notice the benefits in about 3 days to a week. The response is sometimes quicker with Passion Rx with Yohimbe. SSRI drugs enhance serotonin which is a potent inhibitor of sexuality and libido. Hence, the Passion Rx has to counter the continuous effect from the Lexapro. Therefore it may take 2 to 4 weeks for the full benefits to come about. We do suggest not taking it more than 2 days in a row. One option is to use it every other day, or take 2 days on, one or two days off.

Q. I am looking for help with my sex drive. I am currently taking Zoloft for my depression. It is an SSRI which has a profound effect on my sex drive. I finally find an anti-depressant that is working wonderfully for my depression, but has me having no desire what so ever! I have done some research on the web and it seems that the one anti-depressant that doesn’t have sexual side effects is Welbutrin. I can’t take Welbutrin because I have a seizure disorder. My goal is to find something that will work in conjunction with my Zoloft since it is working for my depression better than anything I’ve tried so far. I read on your website the below Q&A. If you don’t recommend taking it the same day, but I am required to take my Zoloft daily – is there no hope for me and my sex drive? I’m getting married soon and I have absolutely no desire since being on Zoloft.
   A. The issue is complicated since you also have a seizure disorder, so I can't make any suggestions since the effects of sexual herbs on seizures has not been studied well.

Q. Can I take Passion Rx with yohimbe if I am on antidepressants?
   A. Most antidepressants, such as the SSRIs like Prozac, Paxil, or Zoloft increase serotonin effect and thus blunt sexual drive and sexual enjoyment. We don't recommend using Passion Rx the same day as antidepressants since unexpected reactions could occur. If your depression is mild, and your doctor does not believe you need to take the antidepressant pills every day, then you could try Passion Rx on the off days.

Q. The Road Back Drug Treatment program started by James L. Harper is claiming to help people get off of SSRIs like Paxil and benzodiazepines. Do you think this organization is legitimate or a hoax. The supplier for their supplements is called TRB. I would be curious to know if you think this is a bogus operation. I do not want to spend money on phony products that claim they can de-tox off of drugs.
   A. I prefer to minimize my comments regarding specific information on other web sites. I just try to keep my website as up to date as possible.

I was just looking at your website and I wondered if you might be able to answer a question about SSRIs for me. I know the side effect profiles have some similarities and some differences, but is there a reason someone may be sensitive to SSRIs in general? This is someone who is typically sensitive to medication. The person has depression and anxiety, is a woman in her 60s. Xanax in small doses (0.5 to 1 mg every 8 hours) is effective, but SSRIs seem ineffective and even worsen her symptoms. Recently on Zoloft she became very apathetic and did not want to eat or drink. She also tended to fall and, maybe because of the apathy, did not seem to even try to catch herself. She is sensitive/allergic to latex, iodine, and mercury. I know that some preparations of injectables have had mercury. Could any of these substances be present in the SSRIs and cause these symptoms? Any other reason?
    It is difficult to know without examining a patient, but older people can be very sensitive to medications and the dosage used should be half or a quarter of the normal adult dosage. Natural alternatives are usually safer. The addition of an SSRI medication on top of Xanax or a benzodiazepine could cause worsening of symptoms. Older people should not be overmedicated.