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Sexual Dysfunction Selective serotonin re-uptake inhibitor (SSRI) anti-depressants can cause problems with sexual functioning in both men and women. Most common effects include absent or delayed orgasm and difficulty with ejaculation. Some research suggests that patients can also experience decreased sexual desire. It is difficult to estimate the true incidence of SSRI-related sexual dysfunction. Impaired sexual functioning can be a symptom of depression, and it may be difficult to determine if sexual problems are caused by a patient's drug treatment. Additionally, patients and prescribers may be hesitant to discuss problems with sex, resulting in an under-reporting of sexual difficulty caused by SSRI anti-depressants. As you might imagine, this is a difficult topic for researchers to study. Much of what is known is based on case reports and reviews by clinical experts. It is clear however, that sexual problems are not an uncommon occurrence when patients are treated with SSRI anti-depressants. * Spanish researchers have reported that men are more likely to experience SSRI-related sexual dysfunction than women It was noted, however, that women experience symptoms that are ?more intense? than men. * A comprehensive review by researchers from the University of South Carolina suggests that "SSRI-induced (sexual) dysfunction is a common adverse effect." The authors note that the greater incidence of fluoxetine-related sexual dysfunction may be due to the relative popularity of this agent during the time of study. * One retrospective study reported that "'Female sexual inhibition occurs at a higher rate than what we previously thought," noting that sexual dysfunction was (roughly) equally likely among patients treated with fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft). Are some antidepressants more likely to cause sexual dysfunction? It appears that sexual dysfunction can result from treatment with any of the SSRI-type antidepressants. Some may postulate that fluoxetine (Prozac) is more likely to cause sexual problems because it is metabolized very slowly. However, it may be the dose of the SSRI, not which SSRI prescribed, that is most predictive of the likelihood of sexual problems (2). Patients requiring lower dosages of SSRI anti-depressant may be less likely to develop drug-related sexual difficulties. Some evidence suggests that paroxetine (Paxil) is most likely to cause sexual dysfunction. In one study, paroxetine "provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine, and sertraline." Edwards and Anderson also noted that sexual dysfunction was more likely with paroxetine as compared to citalopram, fluoxetine, fluvoxamine, and sertraline. What can be done about SSRI induced sexual dysfunction? Several strategies exist for managing sexual dysfunction resulting from treatment with SSRI anti-depressants. Of course, it is most important that communication between patient and prescriber be maintained. Discouraged patients may decide to discontinue drug therapy, and thus potentially relapse or remain in a depressed state. Strategies for coping with SSRI-induced sexual dysfunction include: WAIT. In some instances, sexual functioning will improve after a few weeks have passed. This approach is particularly helpful when attempting to determine if sexual problems are caused by the SSRI anti-depressant or associated with a patient?s depressed state. TAKE A DRUG HOLIDAY. Patients prescribed shorter acting SSRIs, such as sertraline, citalopram, and paroxetine, may benefit by skipping doses before engaging in sexual activity. Rothschild reported that some patients who skipped their weekend doses of paroxetine and sertraline experienced improvements in their sexual functioning. Though this approach may help some patients manage sexual side-effects, skipping doses is generally not advised. Confer with your prescriber if you feel that this approach may be helpful in your particular situation. ANECDOTES. As you might speculate, researchers have investigated using Viagra (sildenafil) in the treatment of drug-related sexual dysfunction. Viagra has been shown to induce improvement in sexual functioning in both men and women with sexual problems caused by SSRI anti-depressants. The anti-histaminic agent cyproheptadine has been shown to benefit patients experiencing sexual impairment from SSRI medications. Cyproheptadine may be particularly useful for patients with decreased sexual desire or difficulty achieving orgasm. Other investigational drug treatments for sexual dysfunction include yohimbine, serotonin antagonists such as granisetron, and the herbal product Ginko biloba. Additional evidence regarding the effectiveness of these agents should help in the development of future recommendations. SWITCH MEDICATIONS. Drug therapy is an essential element in maintaining favorable mental health and preventing relapses that can frequently be of greater severity. Compliance with drug therapy can often depend upon the tolerability of a medication. Patients who have considered discontinuing their anti-depressant medication because of side effects should consult with their health care provider. In some cases, different anti-depressant medications may have side-effect profiles that are better suited to individual preferences. The anti-depressants venlafaxine (Effexor) and nefazodone (Serzone) can also cause sexual dysfunction. Tricyclic antidepressants (the 'triptylines') and bupropion (Wellbutrin) generally do not cause sexual dysfunction. |
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