Published: February 01, 2009 11:05 pm         

Side effects blunt antidepressants gains

Anhedonia is a technical term used more frequently by psychiatrists than the rest of us. It refers to the inability to experience pleasure — a core symptom of depression.

A person with anhedonia — and depression — is likely to lose all interest in pleasures such as food, social interaction and sex. One survey found that 40 to 50 percent of both males and females diagnosed with major depression reported decreased sexual interest and reduced levels of arousal.

Fortunately, depression can be treated; unfortunately, nearly all of the medications used to treat depression have side effects that either make sexual dysfunction worse or bring on problems in those who didn’t previously have them.

Although they may not bring up the problem themselves, about 60 percent of patients taking antidepressants medication — when questioned by their doctors admit sexual complaints.

The effects are probably related to the changing balance of neurotransmitters such as serotonin, dopamine and norepinephrine as well as hormones such as testosterone, prolactin and thyroid stimulating hormone.

According to a study published in the Journal of Clinical Psychiatry, the highest rates of sexual dysfunction — well more than 40 percent — occurred with Remeron (mirtazapine) and Paxil (paroxetine).

Rates between 30 and 40 percent occurred with Celexa (citalopram), Prozac (fluoxetine), Effexor (venlafaxine), and Zoloft (sertraline). The lowest rates–between 20 and 30 percent–were with Wellbutrin (buproprion) and Serzone (nefazodone). The latter has been linked to liver problems and is no longer marketed in the United States.

Sexual side effects of older tricyclic antidepressants include decreased desire and libido. The newer SSRIs (selective serotonin reuptake inhibitors) are more likely to have an effect on orgasm. Other sexual side effects for either of these types of antidepressants include erectile dysfunction and ejaculation problems for males and decreased arousal and lubrication for females.

It’s believed that as many as 90 percent of depressed patients stop taking their medication too early because of sexual side effects.

When problems are reported, a doctor may decide first to take a “wait and see” approach. Some problems diminish or fade over time. Or it may help to schedule your dose after sexual activity. A doctor may also lower the dose of the medication or allow you a one- or two-day drug holiday each week.

If the problems persist, your doctor may choose a medication with a low rate of side effects. Wellbutrin (buproprion) is clearly the best choice for persons with a high risk or who are worried about sexual dysfunction. It’s a norepinephrine and dopamine reuptake inhibitor (NDRI), and it is not recommended for persons with seizure disorders, a diagnosis of anorexia or bulimia or those using Zyban, a smoking cessation drug which also contains buproprion. Other drugs with a relatively low rate of sexual side effects include amitriptyline and duloxetine (Cymbalta).

Switching must be done with careful attention to which drug is best suited for the individual’s depression. In some cases, a patient may experience a relapse or a withdrawal reaction that could be dangerous.

Many times, the best course is adding another medication to treat the sexual dysfunction. For men, the natural choice is a PDE5 inhibitor such as Viagra, Cialis or Levitra.

In a randomized, controlled study published in the Journal of the American Medical Association, 55 percent of males taking Viagra (sildenafil) before sexual activity reported meaningful improvement in their antidepressant-related sexual symptoms.

The ED drugs are not approved for female sexual dysfunction, but a study published in the July, 2008 Journal of the American Medical Association concluded that premenopausal women with adverse effects associated with SSRI drugs showed significantly improved sexual function over an eight-week period as a result of taking Viagra one to two hours before sexual activity.

About 72 percent of the women taking Viagra reported meaningful improvement, compared to 27 percent of those taking placebo. None of the subjects experienced a recurrence or relapse of major depression.

Depresion is a life-threatening illness, and complying with your prescription is crucial — even if these drugs cause sexual dysfunction. By the same token, sexual problems cause significiant psychological distress, loss of self-esteem, a diminished quality of life — symptoms of depression.

If your antidepressant medication is keeping you from enjoying all the pleasures of life, it’s time to talk to your doctor.



Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.