после СИОЗС и во время их восстанавливают либидо миртазапином
может поможет и тут, его можно одного без других АД
если виноват оланзапин, то он как СИОЗС портит либидо через 5-НТ2A, 5-НТ2C
может даже хуже, ибо он стимулирует их, а СИОЗС поднимает уровень серотонина, который потом их стимулирует
причем 5HT-2A может особо сильно стимулировать 1.32-24.2Ki (nM)
https://en.wikipedia...wiki/Olanzapine
https://www.ncbi.nlm...pubmed/12097814
В доклинических исследованиях установлено сродство оланзапина к серотониновым 5-НТ2A, 5-НТ2C
PHARMACOLOGY OF SEROTONIN AND FEMALE SEXUAL BEHAVIOR
In this review, first a historical perspective of serotonin’s (5-HT) involvement in female sexual behavior is presented. Then an overview of studies implicating 5-HT is presented. The effect of drugs that increase or decrease CNS levels of 5-HT is reviewed. Evidence is presented that drugs which increase 5-HT have negative effects on female sexual behavior while a decrease in 5-HT is associated with facilitation of sexual behavior. Studies with compounds that act on 5-HT1, 5-HT2 or 5-HT3 receptors are discussed. Most evidence indicates that 5-HT1A receptor agonists inhibit sexual behavior while 5-HT2 or 5-HT3 receptors may exert a positive influence. There is substantial evidence to support a role for 5-HT in the modulation of female consummatory sexual behavior, but studies on the role of 5-HT in other elements of female sexual behavior (e.g. desire, motivation, sexual appetite) are few. Future studies should be directed at determining if these additional components of female sexual behavior are also modulated by 5-HT.
Keywords: review, sexual receptivity, proceptivity, SSRIs, sexual motivation, 5-HT receptors
Миансерин, миртазапин являются антагонистами 5-HT2A и 5-HT2С,
должно помочь
1.32–24.2
Mianserin, a 5-HT2a/2c and alpha 2 antagonist, in the treatment of sexual dysfunction induced by serotonin reuptake inhibitors.
Sexual dysfunction is commonly encountered in patients treated with antidepressants. The exact mechanism responsible for the sexual impairment is as yet unclear, although activation of the serotonergic system has been implicated. In the present study, we examined the effect of the 5-HT2a/2c and alpha 2 antagonist mianserin in the treatment of patients with sexual dysfunction induced by serotonin reuptake inhibitors (SRIs). Mianserin 15 mg was coadministered to 15 male subjects with new-onset sexual dysfunction who were under treatment with SRIs. Four major domains of sexual activity-desire, erection, orgasm, and satisfaction-were assessed once weekly for 4 weeks. At the end of the study, 9 of the 15 subjects reported a marked improvement in their sexual functioning, 2 reported partial improvement, and only 4 subjects showed no improvement at all. The beneficial effects were prominent in the areas of orgasm and satisfaction and were usually noted within the first and second week of mianserin treatment. The addition of mianserin to the treatment regimen was not associated with either improvement or worsening of the basic psychiatric clinical status. It appears that the coadministration of low-dose mianserin may be an additional option in the treatment of sexual dysfunction induced by SRIs.