Combating Sexual Dysfunction Caused by Antidepressants
Problems with sexual functioning are common among people who
take antidepressant medication, but experts have devised six
steps to reduce this upsetting side effect.
Sex and satisfaction
with one’s sex life are important
parts of the lives of most adults. But having a satisfying sex
life may be a challenge for some of the 12 to 18 million Americans
who take antidepressant medication. While sexual dysfunction
is a frequent symptom of depression itself and successful treatment
might eliminate it, antidepressant medication may exacerbate
sexual dysfunction or even cause it in people whose sex life
was previously fine. In fact, sexual dysfunction is a common
side effect of all classes of antidepressants.
news is not all bad. Experts have devised six main ways to
address antidepressant-induced sexual dysfunction,
and one or more of these approaches may work for you. For example,
a study published in the Journal of the American Medical Association in January 2003 showed that sildenafil (Viagra) improved symptoms
in more than half of men with antidepressant-induced sexual dysfunction.
Effects of Antidepressants on Sexual Function
can affect almost all aspects of one’s
sex life. First, it can diminish interest in and desire for sex.
In men, it frequently causes erectile dysfunction (an inability
to achieve or sustain an erection), and in women, it may cause
vaginal dryness and decreased sensation in the genitals. Lastly,
in both sexes, antidepressants can result in a difficulty or
inability to achieve orgasm.
Sexual dysfunction caused by any
factor, including antidepressants, can have effects that range
far beyond the bedroom, including
psychological distress and a decrease in self-esteem and overall
quality of life. These effects cause many people to stop taking
their medication: Up to 90% of patients who experience antidepressant-induced
sexual dysfunction stop taking their medication prematurely.
how do you know if your antidepressant medication is causing
sexual problems? Experts say that the trouble is probably the
result of the medication if a person who did not previously have
sexual dysfunction experiences problems within two to three months
of beginning antidepressant treatment.
Who Is at Risk, and From
While anyone taking antidepressant medication
may experience sexual dysfunction, certain people are more susceptible.
include people who are over age 50, married, or smokers; who
don’t have a full-time job or college education; who take
additional medications or a high dosage of antidepressants; who
have another health condition that can cause sexual dysfunction
(for example, diabetes or prostate disease); and who felt that
sexual enjoyment was not important prior to taking antidepressant
Reports show that anywhere from 30% to 70% of people
who take antidepressants experience sexual dysfunction. Because
reports did not all measure sexual dysfunction in the same way,
it has been difficult to compare rates from one report to another.
a study published in the Journal of Clinical Psychiatry in
2002 used a validated questionnaire to survey 6,297 patients
taking a range of antidepressants. Overall, 37% of people taking
antidepressants experienced sexual dysfunction. The lowest rates
occurred with bupropion (Wellbutrin; 22%), bupropion sustained-release
(Wellbutrin SR; 25%), and nefazodone (Serzone; 28%). Citalopram
(Celexa), fluoxetine (Prozac), venlafaxine (Effexor), venlafaxine
extended-release (Effexor XR), and sertraline (Zoloft) caused
moderate rates of sexual dysfunction (between 30% and 40%). The
highest rates of sexual dysfunction occurred with mirtazapine
(Remeron; 41%) and paroxetine (Paxil; 43%).
What To Do
You and your doctor can treat antidepressant-induced
sexual dysfunction in six main ways. However, do not make any
changes in your treatment
regimen without first consulting your physician.
Choose a medication
with a low rate of sexual side effects. If you are sexually active
and have numerous risk factors for antidepressant-induced
sexual dysfunction, your doctor may consider prescribing bupropion
or nefazodone, which have the lowest rates of sexual side effects.
you are already taking an antidepressant, switching to one with
a low rate of sexual side effects may improve these symptoms.
However, switching must be done carefully to minimize the risk
of relapse or a withdrawal reaction from the first drug. Also,
there is a chance that the new medication will be less effective
than the first or will cause other side effects.
Wait to see if
sexual side effects abate. One study found that antidepressant-induced
sexual dysfunction improved somewhat in
about a fifth of patients within six months of beginning treatment.
Antidepressant-induced sexual dysfunction rarely disappears completely
without treatment but may diminish to a point that is acceptable
to the patient.
Change the time you take the medication. If your
symptoms involve a difficulty or inability to achieve orgasm,
taking the medication
after sexual activity may be helpful. For example, if you are
most likely to engage in sexual activity in the evening, take
the medication just before falling asleep. Blood levels of the
drug will be lowest the following night, and the extent of side
effects also should be lowest at this time.
Reduce the dosage. A decrease in
the dosage of medication may allow some people to regain satisfactory
sexual function. However,
lowering the amount of antidepressant taken each day may cause
withdrawal reactions (particularly in people taking paroxetine,
sertraline, and venlafaxine, which are cleared from the body
quickly) or an increase in depressive symptoms. People who use
this approach need to develop a plan with their doctor and should
be monitored closely.
Take drug holidays. A “drug
taking a short break from your medication. Some evidence shows
taking periodic two-day breaks from antidepressant treatment
can lower the rate of sexual side effects during the drug holiday
without increasing the risk of a relapse or recurrence of depressive
symptoms. For example, in one study, taking medication Sunday
through Thursday and skipping Friday and Saturday allowed participants
to have improved sexual functioning 50% of the time on weekends
with no overall worsening of mood. This approach worked with
quick-clearing drugs (sertraline and paroxetine) but not with
fluoxetine, which clears slowly from the body. Potential risks
of drug holidays include relapse and withdrawal reactions.
another medication. Various medications can be added
to your antidepressant regimen to combat sexual dysfunction;
with the best evidence is sildenafil. In the recent Journal
of the American Medical Association study, researchers randomized
90 men with antidepressant-induced sexual dysfunction to take
50 to 100 mg of sildenafil or a placebo before sexual activity.
Significantly more men taking sildenafil than the placebo experienced
meaningful improvements in sexual functioning (55% vs. 4%),
improved arousal, erectile function, orgasm, and overall satisfaction.
Similar research has shown promising results with sildenafil
in a study of 150 women with antidepressant-induced sexual
dysfunction; but, at press time, these data had only been reported
at a medical
conference and have not yet been published in a peer-reviewed
Adding one of the following drugs to antidepressant
treatment may also be helpful, although the evidence for
these is fairly
limited and mainly anecdotal, and they are not approved for
this use by the U.S. Food and Drug Administration: amantadine
bethanechol (Urecholine); bupropion; buspirone (BuSpar);
cyproheptadine (Periactin); dextroamphetamine (Adderall); estrogen
or lubricants (for women in or near menopause); granisetron
hormone replacement therapy (for women in or near menopause);
methylphenidate (Ritalin and other brands); mirtazapine;
nefazodone; pemoline (Cylert); and yohimbine (Aphrodyne). Ask
if one of these drugs may be appropriate for you.
suggest that the herbal extract Ginkgo biloba may be helpful,
but do not take it without consulting your
Ginkgo not only has known side effects, but it may also
have unknown side effects, and the product may be contaminated
or lack potency.
Some of the medications used to combat
sexual dysfunction need to be taken daily, while others only
need to be used
sexual activity. The benefit of adding medication is
that the dosage
of antidepressant medication does not have to be altered.
However, people risk experiencing additional side effects
from the new
drug or from drug-drug interactions. Another drawback
is the increased cost of the additional drug.