Ever wonder what would happen if an alien's impression of earthlings was shaped solely by TV soap operas? He'd come away with three notions: earthlings change their clothes at least five times a day, the ice cubes in the bucket never melt, and everyone has sex—all the time.
When it comes to sex, our culture is so sexualized that we would believe that everyone in suburbia has sex at least every day, but this couldn't be farther from the truth.
"Most of my patients would be shocked if they knew what happened in other people's bedrooms," says Peter S. Kanaris, PhD, a psychologist and sex therapist with more than 20 years experience. "It comes as a shock to realize that about one-third of the population suffers from sexual dysfunction—and that doesn't include people who are depressed or take antidepressant medications."
Jack Modell, MD, professor of psychiatry at the University of Alabama at Birmingham, says that 25% of women suffer from sexual dysfunction, and 15% of men experience problems—again, discounting those who suffer from depression and take antidepressants.
"That number jumps much higher to about one-half of the population if you start talking about people who have been diagnosed with depression," says Kanaris.In an ironic twist of fate, the very medications that treat depression and give hope back to millions of depressed patients—the popular group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs)—are thought to cause sexual side effects in 40–80% of people taking them.
"This is a staggering number of people, when you think about how many Americans take SSRIs," says Modell.
How Antidepressants Can Cause Sexual Side Effects
Kanaris says that there are two basic sexual side effects that are caused by SSRIs: delayed ejaculation and absent or delayed orgasm.
"It is also very common to hear from patients that desire is affected," he says. "Arousal problems are frequently reported, although an actual drop in libido hasn't been scientifically proven."
"A lot of doctors don't explain to their patients that these are possible side effects," sighs Modell. "These side effects can cause one partner in a relationship to have a complete loss of libido, which then starts them wondering about whether they still love their spouse. They continue to believe there is something wrong with them—[or more importantly, with their relationship]—until their doctor tells them it's a common side effect."
Kanaris agrees. "I usually spend a significant amount of time educating my patients [who take SSRIs] about sexual dysfunction, and emphasize that it is caused by the medication, not any ill will on the part of the person suffering from the symptoms."
Kanaris and Modell agree that sexual dysfunction is a problem that should be treated very seriously by the psychiatrist or physician who prescribes the SSRI.
Treatment Options
Modell, who has studied the sexual side effects caused by SSRIs, first suggests Wellbutrin SR (an antidepressant, but not an SSRI) as an alternate medication for depression. Modell's research has shown that Wellbutrin SR can alleviate the sexual side effects caused by SSRIs, when taken in combination with the SSRI or when used as alternative therapy.
"Patients may find that they can take Wellbutrin SR for a significant amount of their depression treatment, and reduce the amount of the SSRI," he suggests. He points out that Wellbutrin SR is known to enhance arousal and orgasm in both depressed and non-depressed persons.
He emphasizes, however, that the heightened sexual response with Wellbutrin is modest and that the drug has not been tested—nor should it be used—solely for sexual problems.
Modell also points to other antidepressant options:
- Effexor, which is thought to cause sexual side effects in only 20% of patients.
- Remeron, which can cause sleepiness or weight gain, both of which might contribute to sexual dysfunction separately.
- Serzone, which is not thought to cause sexual side effects, but may cause sleepiness or upset stomach.
H. George Nurnberg, MD, professor of psychiatry at the University of New Mexico, reports that small-scale studies show Viagra to be effective at treating sexual dysfunction in both women and men who take antidepressants, although the mechanism for its encouraging results is unknown. He also feels that effective treatments for sexual dysfunction in people who take SSRIs are especially important, because 60% of patients being treated with an SSRI discontinue its use after three to four months because of the sexual side effects.
A "Drug Holiday"
Kanaris suggests other treatment options if the aforementioned medications don't do the trick.
"I advise my patients to wait a while before switching medications. Sometimes a tolerance develops, and the sexual side effects disappear." He also says that a reduced dosage of the SSRI can be effective, or the patient can take a "drug holiday."
Pioneered by Dr. Anthony Rothschild, of the McLean Hospital in Belmont, Massachusetts, a drug holiday typically works as follows: patients stop taking the SSRI on Thursday morning, and resume taking it on Sunday afternoon, hopefully finding themselves without the sexual side effects for the weekend. Kanaris and Rothschild caution, however, that this method can have debilitating side effects if patients forget to resume the medication.
Ongoing Research
Dr. Alan J. Cohen, MD, Assistant Clinical Professor of Psychiatry at the University of California in San Francisco, recently published a study that shows a link between low free testosterone levels and the sexual dysfunction caused by SSRIs. This study was very small, however, and more research needs to be done to determine what role this may play in sexual dysfunction.
Although some studies have shown success using ginkgo extract to relieve sexual side effects, Dr. Modell says, "Ginkgo can cause side effects and drug interactions with medications the patient is already taking, and it can be impure or unreliable. I don't suggest it as a treatment option."What's the bottom line? If you take an SSRI and are suffering from sexual side effects, talk to your doctor immediately. There are options that can reduce or eliminate the side effects and put the spark back in your love life.
Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants
Resources:
The Kinsey Institute for Research in Sex, Gender, and Reproduction
http://www.indiana.edu/
American Association of Sex Educators, Counselors and Therapists (AASECT)
http://www.aasect.org/
American Association for Marital and Family Therapy
http://www.aamft.org/
Sources:
Modell JG, et al. Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clinical Pharmacology Therapy. 1997;61:476-487.
Modell JG, et al. Effect of bupropion-SR on orgasmic dysfunction in nondepressed subjects: a pilot study. Journal of Sex and Marital Therapy. 2000;26:231-240.
Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dys
function: efficacy of a drug holiday. American Journal of Psychiatry. 1995;52:1514-1516.
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