Most cases of Erectile Dysfunction are resultant from an imbalance between Nitric Oxide and Adrenaline. However, the Adrenaline level, receptors, receptor functionality and such are much more important in endothelial function in general. Epinephrine & Norepinephrine (NorAdrenaline) both bind to alpha & beta-receptors, but Epinephrine has a higher affinity for beta-receptors - beta-3’s of which cause Erection in Humans. This suggests its possible that in those with E.D predominant PSSD - that is, in the arousal aspect - that Norepinephrine is not converting into Epinephrine as much - or there are too many alpha-1-receptors - which would be consistent with the Research (https://www.ncbi.nlm.nih.gov/pubmed/2870173) that SSRI’s increase alpha-1-receptor expression - and alpha-1 receptors are the ULTIMATE erection killing receptor (https://www.ncbi.nlm.nih.gov/pubmed/10845765)
SSRI’s also are KNOWN to upregulate the “bad” Beta-receptor; the beta-1-adrenergic Receptor - which is a primary target for antihypertensive drugs and can cause pivotal changes to the Heart Rate (HR) - which may negatively impact Vascular/Endothelial/Cardiovascular Function.
Another supporting study, although perhaps indirect - is that SSRI’s affect gastrointestinal neuronal Physiology including the alpha-1-Receptors.
On the other hand, SSRI’s have some anti-Norepinephrine properties via both PRE and POST synaptic mechanisms!
STUDY --> https://www.ncbi.nlm.nih.gov/pubmed/28216049
SOME People might be a “High Norepinephrine, High Vasoconstriction State”…others with PSSD may be adrenergically-deficient - thus are lacking the normal orgasmic capacity to deficiency of muscular Contractions.
Here is a FULL paper with details on Alpha-1-Receptors, Depression and the antidepressant response!
In a forum topic on ‘AllThingsMale’ - there was a THREAD called “Ultimate Adrenergic Control of Erections”.
This thread proposed various methods of BOTH treating E.D and PREVENTING it.
While it is true that Dopamine agonists can reduce sympathetic tone…they also have effects that desensitize ADRENO-RECEPTORS - leading to reduced Noradrenaline but increased firing of Locus Coroleus neurons [https://www.ncbi.nlm.nih.gov/pubmed/18435418].
The more likely solution for this dysfunction, predominantly erectile dysfunction DURING and AFTER SSRI’s treatment is ELIMINATING the contractile influences almost entirely.
So Doxazosin (4mg) + Yohimbine (7.5mg) + Cialis (20mg) would be a good combo for most people.
I find this combination REVERSES sexual dysfunction from pretty much ANY substance.
credits @JayR from pssdforum