Sex is still important to depressed people
Practitioners and researchers are beginning to address sexual dysfunctions from antidepressant therapies. Some patients on medication therapy are unpleasantly surprised that they had to trade “relief for grief”. Addressing the sexual dysfunction issue will help improve the patient’s compliance (staying on therapy as instructed by physician) and therefore effectiveness of the therapy.
Sexual dysfunction from antidepressant therapy may include problems such as delayed orgasm, premature ejaculation, and arousal problems including diminished genital sensation or inability to achieve/maintain vaginal lubrication (females). If the patient is involved in an intimate relationship such as marriage, this dysfunction obviously will impact the quality of life for both the patient and the significant other.
Two neurotransmitters implicated in sexual functioning are dopamine and serotonin. Antidepressants known to cause sexual side effects include tricyclics, SSRIs (such as prozac, zoloft, paxil, celexa), and SNRI (effexor). Atypical antidepressants with minimized sexual side effects compared with the previously mentioned ones include serzone, wellbutrin, and remeron. This does NOT mean that tricyclics or SSRIs always cause these problems in everyone, nor does this mean the atypicals never cause sexual problems. These are generalizations based on published clinical studies.
Management of Sexual Dysfunction
The physician can discuss several strategies with the patient when sexual dysfunction arises due to antidepressant therapy. These options include lowering the dose of the antidepressant, taking “drug holidays”, switching to another antidepressant, or using an antidote.
Lowering the dose of an antidepressant and allowing the patient to take a drug holiday (stop taking the medication during the sexually active period) can be risky because the patient may relapse into depression or experience withdrawal. Paroxetine/Paxil and venlafaxine/Effexor are two antidepressants that are often associated with withdrawal syndrome in depressed patients. Therefore, the physician must carefully help the patient monitor for signs of withdrawal during reduced dosing or drug holiday.
Switching to another antidepressant may help with the sexual dysfunction, but the patient may not experience relief from the depression. Also, switching medications can increase the risk of becoming resistant to medication treatment. Again, careful monitoring of symptoms for relapse is critical.
Antidotes for treating sexual dysfunction include buspirone/Buspar, bupropion/Wellbutrin Sustained Release formulation, amantadine, and sildenafil/Viagara-class of medications (used to treat erectile dysfunction). These drugs - including “natural” supplements and herbal remedies - come with risks and side effects, and the physician must be careful about drug interactions. Therefore, if you are self-medicating with supplements for this purpose, please inform your physician and help make sure there are no dangerous drug-drug interactions.
Testosterone replacement therapy was correlated to restoring sexual functioning in both aging men and women, and may have a role in managing sexual dysfunctioning due to antidepressant therapy. However, in a year 2000 study that was presented at the Americal Psychiatry Association annual meeting, use of testosterone to restore sexual function may have serious adverse events because at very high doses (4 to 8 times normal level), patients developed hypomania or psychosis and euphoria. Especially for those suffering from bipolar disorder, please consider these observations before making a decision toward hormone replacement therapy for restoring sexual functioning.