Antidepressant Sexual Dysfunction

Here's how to determine if the sexual dysfunction is from the antidepressant medication rather than from depression.

Sexual dysfunction happens too often but is rarely asked or discussed in the doctor's office. Some physicians and patients feel embarrassed about this subject. When you have concerns, be open to your physician. Discuss the possibility of switching medication to an antidepressant (such as bupropion or mirtazapine) that doesn't significantly impair sexual functioning. Also, talk to your doctor about adding another drug such as bupropion, yohimbine, or even mirtazapine to counteract the sexual side effect. ..

How do you know if the sexual dysfunction is from the pill rather than from depression? If the dysfunction persists despite successful remission of depression, then you should consider other causes such as drug-induced dysfunction or other medical causes e.g. diabetes.

Sexual side effects include decreased sexual desire (libido), erectile dysfunction, delayed ejaculation and diminished orgasm. These effects can last throughout treatment. Selective serotonin reuptake inhibitors (SSRIs) are more likely than other antidepressants to cause sexual side effects, particularly delayed orgasm or inability to achieve orgasm (anorgasmia). Tricyclic antidepressants (TCAs) are more likely to cause erectile dysfunction.

Did you know...

More people experience sexual dysfunction (SD) resulting from antidepressant use than previously thought, according to research presented at the May 2001 American Psychiatric Association annual meeting. The researchers questioned nearly 6300 patients at 1101 United States clinics concerning their use of eight newer antidepressants.

The antidepressants studied were:

• buproprion SR (Wellbutrin)
• citalopram (Celexa)
• fluoxetine (Prozac)
• mitrazapine (Remeron)
• nefazodone (Serzone - no longer available)
• paroxetine (Paxil)
• sertraline (Zoloft)
• venlafaxine (Effexor)

Study participants were 18 years old and older, sexually active during the past year, and willing to discuss sexual functioning. Researchers Dr. Anita H. Clayton and Dr. James Pradko note that of all patients asked to participate in the study, 70 percent were willing to do so. Clayton points out that this shows a willingness by patients to discuss sexual functioning with their health providers, if asked. Participants filled out a questionnaire designed by Clayton.

The results of the study showed that nearly 40 percent of people taking these antidepressants experience sexual dysfunction. This number is twice what the researchers had predicted prior to the study. Of the eight antidepressants, , Wellbutrin and Serzone were less likely to cause sexual side effects than Prozac, Paxil, Zoloft and Effexor. Additionally, Wellbutrin was also less likely to cause sexual dysfunction than Celexa and Remeron. Prozac was less likely than Paxil to cause sexual dysfunction. These differences were reported as "statistically significant" by the researchers. According to Clayton, the reason for fewer sexual side effects with Wellbutrin and Serzone is most likely the result of these drugs affecting different receptors in the brain than the other antidepressants.

The researchers also found a number of risk factors which may increase the chance of sexual dysfunction resulting from antidepressant use. The following factors may increase a person's chance of having sexual side effects on these antidepressants:

• increased age
• higher dosage
• being married
• lower education level (less than college)
• lack of full-time employment
• comorbid illness also associated with sexual dysfunction
• other medications
• low interest in sexual functioning
• smoking 6 to 20 cigarettes daily
• history of sexual dysfunction with antidepressants

If you are experiencing sexual dysfunction and are taking an antidepressant, talk with your doctor. Be sure to have a physical in order to rule out other causes. If it is your antidepressant, discuss options with your doctor. If your doctor is not receptive to such discussion, consider seeking another opinion. As seen from this study, Wellbutrin and Serzone cause far fewer side effects than the other antidepressants. These and other antidepressants, as well as various combinations, offer numerous options for people experiencing sexual dysfunction. Also, Viagra currently is being used to treat this side effect.

Coping strategies from the Mayo Clinic

• Talk to your doctor about finding a dose that minimizes sexual side effects but still works for you.
• Consider a drug that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
• Talk to your doctor about adding or switching to an antidepressant that may counteract these effects, such as bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL) or mirtazapine (Remeron, Remeron Soltab).
• Talk to your doctor about taking a medication intended to directly treat sexual dysfunction like Cialis, Levitra, or Viagra.
• Talk to your doctor about a "drug holiday" — stopping the medication for a day or so each week.

next: Guidelines for Treatment Antidepressant Induced Sexual Dysfunction