by Harvey Widroe, M.D.
American Reporter Correspondent
August 15, 2007
SEX AND YOUR ANTIDEPRESSANT
ORINDA, Calif. -- Helen, a 33-year-old mother of two, had been very depressed, at times wishing she were dead. A shaky marriage was part of the problem. Now, with the aid of psychotherapy and an antidepressant, she was much less depressed despite her troubled relationship with her husband. She felt brighter, had more energy, and could function better at her job and at home. She was immensely relieved, and could even smile as she complained, "But sex is lousy!"
She wondered if sex with her husband had ever really been that good. She wasn't sure. Or had a strained marriage made for bad sex all along? When depressed, she didn't even think about sex, except when her husband complained that there wasn't any.
Now that she felt better, sex was a hot issue. Part of it was her husband's nagging, although nagging hardly seemed a romantic come on. Sometimes she bought into his assertion that their problems were really all her fault. She might then try to please him in the vague hope that sexual accommodation would lead to his being less grouchy and critical.
She noticed that she didn't really have any sex drive, and that sex, when it happened, was no fun. Just a blah event. The happy fun of satisfying sex was a distant memory, longed for on an occasional moment. But even the fleeting memory did nothing to rekindle her interest.
Helen, trying to put her life back together, was just happy to be out of the black hole of her depression. So her complaint about "lousy sex" was issued with little force. I wondered whether the complaint had been instigated by her husband. Something like, "Ask the doctor to give you something to make our sex life better."
When first prescribed antidepressants, Helen had been told that sexual dysfunction was a possible, even probable, side effect of the medication I thought would be most helpful for her. But she felt so miserable that she didn't care. At that point sex seemed like frosting on the cake of life, a treat both distant and not all that appealing.
Most (but not all) antidepressants may have a negative effect on your sex life. Sexual dysfunction is usually included amongst a group of probable side effects doctors discuss with their patients. But those suffering from anguish and despair usually couldn't care less.
For women sexual dysfunction typically means lack of desire, decreased pleasurable sensation, or delayed or inability to reach a climax. For men the problem is lack of interest, difficulty getting or maintaining an erection, or delayed or inability to have an orgasm. It is important to remember that these symptoms, when they appear, are not always caused by antidepressant drugs. But if an enjoyable sex life once had been the rule, antidepressant medication, even if not totally responsible for decreased sexual pleasure, may be a significant factor..
The dosage of an antidepressant drug may be a major determinant in the appearance of sexual problems. With lower doses, sexual dysfunction may never occur. But if it does, a lower dosage that does not compromise the antidepressant effect may decrease or even eliminate the problem. A delicate balance between the right dose of the drug needed to achieve or maintain an antidepressant effect may actually avoid sexual dysfunction.
Some antidepressant drugs are more likely to cause sex life problems than others. The drug company info sheets, the tear out information pages from the pharmacy, or your internet research probably won't give you an accurate or complete story. These information sheets are written with primary concern about legal liability. The drug companies fear litigation if someone develops a side effect which has not been previously disclosed.
The companies' lists of possible side effects, usually in barely readable fine print, include almost every symptom that anyone can think of. Side effects are included even if the likelihood of that symptom appearing is one in 10 million. Reading the drug company info sheets shows that all antidepressants may produce sexual dysfunction. But in most cases the info sheet doesn't tell patients the actual likelihood that they will develop sexual problems.
The pharmacy tear out sheets are much shorter and more comprehensible, but these often suffer from insufficient, inadequate or even incorrect information. If one of a particular family of drugs has shown a particular side effect, the tear out sheets brand every other similar drug with the same list of side effects whether they actually occur or not.
Internet research yields a flood of unbalanced information and opinions. Dissatisfied patients are more likely to be motivated to share their experiences than those who have no side effects. So the picture of what a given drug is likely is distorted.
When Zoloft first became available, medical studies told of a 30 percent rate of sexual dysfunction. Although the drug seemed an excellent antidepressant, every single one of my patients who took Zoloft, a whopping 100 percent, complained about sex problems. I wondered why I was seeing so many more patients with sexual dysfunction than the reported figures. It turned out that the 30 percent figure in early drug studies came from patients who had voluntarily complained of sexual dysfunction. But the patients studied hadn't been specifically questioned about their sex lives. The other 70 percent, had they been asked, probably would have acknowledged sexual dysfunction symptoms too.
Zoloft is a member of the extremely popular SSRI family of antidepressant drugs. The vast majority of prescribed antidepressant drugs are in the SSRI group, and all members of this family of drugs are associated with sexual dysfunction. But within this group, some are more likely to adversely impact your sex life than others. Of the SSRI antidepressants, Zoloft and Prozac are the most frequent offenders, closely followed by Paxil and Luvox. Other members of this family, Celexa and Lexapro are less likely to cause significant sexual dysfunction.
Cymbalta and Effexor, while not strictly SSRI antidepressants, have a somewhat lower incidence of sexual impairment.
The tricyclic family of antidepressants are even less likely to produce sexual dysfunction when used in low or moderate dosages. In this group Elavil, Sinequan and Vivactil cause sexual dysfunction more often than Tofranil, Desipramine, Pamelor or Surmontil.
Unlikely to produce sexual dysfunction are Wellbutrin and Serzone, along with the MAOI antidepressants Selegiline, Emsam (the patch form of selegiline), Marplan, Nardil and Parnate. Some of these antidepressants have been reported to actually improve sexual function, especially an increase in sex drive.
It may be tempting for a patient to demand that the doctor change his or her antidepressant to one less likely to cause sexual problems. But the current antidepressant was chosen as the one with the greatest likelihood of providing relief from the misery of depression.
So what can be done about sexual dysfunction, especially if a particular antidepressant is doing the job of improving one's mood and emotional stability? In Part II of this series we will examine strategies that can help.
Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published, "The Smart Dieter's Cheating Guide: Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press).