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Suggest Remedy For Sexual Dysfunction In A Diabetic

Posted on Mon, 26 Oct 2015

Question: I am a 32-year old Type 1 diabetic and have been on Insulin for the last 16 years (currently taking Human Actrapid - 13 units morning, 8 units afternoon, 12 units dinner; and Basalog - 22 units afternoon). I have also been taking medicine for depression/anxiety for the last 14 years. I am currently on Bupron XL 300 mg for the last 3-4 years. However, this medicine does not keep me very well. I feel "okay" but not "good" or "great". I have to constantly take Clonazepam 0.25 mg on an SOS basis to make my mood better (almost once every 2 days). Earlier, I have taken many medicines (SSRIs, SNRIs, etc. - almost all of those) that have given me many side effects (such as zero sexual desire, drowsiness, yawning, etc.). I am working in a private firm and it is impossible for me to live with these side effects. Bupron XL 300 mg does not give me these side effects but doesn't treat my depression either (my sexual desire is still low, though). I went to a psychiatrist again last year and he tried many medicines, namely, Mirtazapine, Escitalopram, Venlafaxine, Agomelatine, etc. but these again caused a lot of side effects, and taking only one of these medicines was not of much help. Agomelatine caused fewer side effects but taking only Agomelatine 25 mg was not really helpful, so I had to return to Bupron XL 300 mg (and I stopped all other medicines). I have been married for 6 years and have not been able to have intercourse so far and we are trying for a kid now (my wife is aware of everything and is supportive). Not being able to have sex is causing a lot of stress for both my wife and me. The problem I am facing is I am low on sexual desire and despite taking medicine for erectile dysfunction (Tadalafil 10 mg or Udzire 100 mg), my penis does not become hard enough for an intercourse. I think it is because my mood needs some more improvement. I feel that when I try to do sex with my wife, there is not enough stimulation or libido. Is it possible to add a medicine, which has low side effects, to my existing medicine, Bupron XL 300 mg? I do not want to stop Bupron XL 300 mg as I have already tried that and it doesn't help. So I just want to know if there is a mild medicine (with low side effects) that I can ADD to my existing medicine to make my depression better, so that my mood becomes better and I FEEL like having sex with my wife. Please help.

Answered by Dr. Dr. Chintan Solanki (27 minutes later)

Brief Answer:
Vilazodone, armodafinil or modafinil and for sex issues tetrafol plus

Detailed Answer:
Hello,

Thanks for writing to us. I read your query twice and understood your concern.

Vilazodone is a new drug without sexual side effects. It can be a good option for adding to bupropion.

Another option is armodafinil or modafinil. They are mood elevating agents.

You can discuss with your psychiatrist and start one of them with bupron.

I also suggest checking vitamin B12 and thyroid level.

In diabetes sexual dysfunction is common. As well as you rightly told that depression is reason for low libido. I would like to mention one medicine for that. You can use medicine cum vitamin supplement containing pyridoxal-5-phosphate, mecobalamin and l-methylfolate (trade name tetrafol plus) is very helpful in my patients. It has shown improvement in 50-60% patients of mine with ED having hypertension & diabetes. You may get this medicine over the counter as it is vitamin product. Take it for at least 20 days twice a day after meal and if you feel some improvement continue for 2 months.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar