Q. I have been taking Paxil 30mg for close to a year. I became impotent some time ago and was prescribed Viagra. This gave me the erection but the sex drive was not there and I'm unable to ejaculate. This is becoming a problem as I now feel" why even start something that I can't finish. could you give any advice on this.

I also have a blood disorder(ITP) could this be creating a problem also?

  A. While Paxil has a great deal of sexual dysfunction-decreased libido, anorgasmia, or both-it may also be that your depression is not fully treated. If the Paxil is the cause, however, you may wish to consider changing to Serzone if you are not obsessive, or Effexor XR if you are. Effexor seems to have less sexual dysfunction as the dosage is increased. Once you libido is down, not much works short of changing to another medication that does not cause decreased libido.

There are some compelling trials using BuSpar as an antidepressant, too. You need a lot of it. 90 or more mg/day. Now that it is generic, it may be affordable to do this. I believe the generic only comes in 7.5 mg tabs, so you would need to use 12 to 16 tablets per day. Once the dosage is this high, there are a lot of side effects (spaciness and dizziness are the two major ones), so it is not as good as the first two choices statistically.

I have also had luck adding on Provigil as 200 in the morning. May be worth a try as you will know in 7 days or so if it reverses the decreased libido.