Chapter 3-Novel Interventions for Low Libido-Emotional Health

What Would Compel an Otherwise Sane Person, or Even a Medical Doctor, to Attend a Lecture at 6:30 A.M. on a Sunday?

Novel Interventions for Low Libido-Psychological Effects

Major Depression

Depression is the leading cause of disability in the U.S. for people aged 15-44.  Twice as many women suffer from major depression as do men.  A depressed mate experiences a loss of desire, weak or non-existant orgasms and finds sex, like all of life, less enjoyable.⁽¹⁾

The lifetime prevalence of depression is 17% affecting twice as many women as men.

19%-34% of depressed patients do not respond to acute treatment and 29–46% may fail to achieve and maintain a full remission.  The recurrence rate of depression is between 15% and 50% of all patients despite continuous antidepressant treatment.

Poor libido, drive, and performance is common in treatment-resistant depression.  Five of nine signs and symptoms are necessary for the diagnosis.                            

Treatment-Resistant Depression

S/S  (Need 5 of 9)

• Sadness or depressed mood most of the day or almost every day
• Loss of enjoyment of a previously pleasurable activity
• Significant weight change (+ or – 5% in 1 month)
• Insomnia or excessive sleepiness nearly every day
• Noticeable physical restlessness or feeling rundown
• Fatigue or energy loss every day
• A feeling of hopelessness or excessive guilt
• Concentration and decision-making problems
• Recurring thoughts of death/suicide/suicide plan or attempt

Patients on multiple medications either serially, or in combinations, the world record upon entering our clinic was a forty-two-year-old gentleman on seven antidepressants and antianxiety agents concurrently.

Aside from the above symptoms, a serum prolactin level < 6.0 ng/ml (“Normal”  11-14 ng/ml) is almost pathologic for the above condition.

Treatment for resistant depression may include:

Chromium: To elevate serotonin levels.

Folate: A building block for serotonin, dopamine and norepinephrine.

Carnitine: To increase serotonin and noradrenaline.

Inositol: To influence signaling pathways in the brain.

Serine: To regulate brain chemistry

St. John’s Wort: An herbal remedy with no know negative sexual side effects

Similarly, only about 60% of patients with anxiety respond to front-line treatments. Up to 30% of patients may be treatment resistant.^{2  “}Traditional” therapy includes SSRI’s, SNRI’s and cognitive-behavioral therapy.  ³

Non-Prescription Remedies to Aid Anxiety Include:

• GABA: Produce a calming, relaxed atmosphere.  Induces sleep, muscle relaxation       
• Folate: helps produce dopamine and serotonin which have a calming effect
• Copper: calms feelings of anxiety
• Magnesium: regulates HPA which controls reaction to stress
• Vitamin B6: Assists with the synthesis of GABA

Adrenal Fatigue (Neurasthenia in the 1880s)

Signs:

• Hormonal imbalance
• Depression
• Anxiety
• Weight gain
• Loss of drive & ambition
• Loss of interest in sex
• Decreased sexual performance

Symptoms:

Awaken in AM Fatigued

In Need of Stimulant Mid-morning

In Need of Nap Mid to Late Afternoon

Total Exhaustion by 5-7 PM

Second “Wind,” Does Best Work/Thinking @ 8, 9, 10 PM

Unable to Fall Asleep Naturally

Cycle Repeats

Adrenal Fatigue

Etiology:

                90% of cases from excess cortisol caused  by stress

                10% Split between DMT2, Low Iron

“Traditional” Medicine: Does not exist.

                   Mimics Hypothyroidism.  Fatigue Pattern is Intermittent With Adrenal Exhaustion

                                                        Fatigue Pattern is Continuous with Hypothyroidism

Testing:

Reverse T3 :> 15 pg/ml ((“normal 8.0-24.9 pg/ml)

Cortisol Saliva Test

•                             Test cortisol 4 times throughout the day to evaluate the diurnal rhythm.

Rx: *Lifestyle: Diet, Exercise, Nutrition, Stress, Alcohol and Caffeine consumption, Sleep

        Hormone Replacement

        Adaptogenic Herbs

Adrenal Fatigue

Adrenal Fatigue

Adrenal Rebuilding Program

Lifestyle Changes:

                Stress Reduction, Anti-Inflammatory Diet, Exercise, Meditation, Yoga, Etc.

Sleep Adequacy: 2 Hours Before Bedtime

                                Melatonin 1-3 mg

                                Magnesium Taurate 100 mg 1-2

                                Vitamin D3 5000 IU

                                Magnesium L- Threonate

Increases synapse density,

Improves cognition, learning, memory,

Promotes relaxation and sleep.

                                                                Dose: Magnesium L-Threonate:

                                                                                Magnesium 144 mg

L-Threonate 2000 mg

Adrenal Rebuilding Program

Adaptogenic Herbs

Hydrocortisone or compounded cortisol, if needed

                Starting Dose: 7.5 mg in am, 5 mg. @ noon, 2.5 mg @ 4 PM

                Reduce by 1-2.5 mg every 3 months until D/C

High PM Cortisol-Add Phosphatidylserine 300 mg

Nutrients

•Vitamins B and C                      Selenium

•Calcium                                        Sodium

•Magnesium                                                EPA/DHA Omega 3s

•Manganese                                                Valerian Root

•Copper                                         Adrenal Glandulars

•Zinc

1. https://www.webmd.com/depression/features/depression-and-sex#1
2. Bystritsky A. Treatment-Resistant Anxiety Disorders. Molecular Psychiatry. 2006; 11:805-814
3. Iliades, C.Approaching Treatment-Resistant Anxiety. Psychiatry Advisor.  2014;https://www.psychiatryadvisor.com/home/topics/anxiety/approaching-treatment-resistant-anxiety/3/