Sexual functioning is a complex process involving biological, psychological, emotional, and social factors.
Sexual dysfunction is characterized by a disturbance in the sexual response cycle desire, arousal, excitement, orgasm, and resolution or by pain with sexual intercourse. It is commonly associated with many diseases, such as diabetes and high blood pressure, and drugs, particularly blood pressure medications, anti-ulcer drugs, alcohol, sedative/hypnotics, mood stabilizers, antipsychotics, and antidepressants. Depression itself can cause decreased libido, diminished erectile function, and decreased sexual activity.
All antidepressants can have sexual side effects. First, antidepressants can diminish interest in and desire for sex. In men, they frequently cause erectile dysfunction (an inability to achieve or sustain an erection), and in women, they may cause vaginal dryness and decreased sensation in the genitals. Lastly, in both sexes, antidepressants can result in a difficulty or inability to achieve an orgasm.
Reports show that between 30 and 70 percent of people who take antidepressants experience sexual dysfunction. The mechanism behind antidepressant-induced sexual dysfunction is not completely understood, but is thought to be related to increased levels of the brain chemical serotonin and decreased levels of another neurotransmitter, dopamine level decreases.
The severity of sexual side effects depends on the individual and the type of antidepressant. Wellbutrin, Remeron, and Desyrel are associated with the lowest risk for sexual dysfunction, whereas SSRIs and SNRIs are generally associated with higher rates. In fact, approximately one-third of patients taking SSRIs develop sexual dysfunction. The rates of sexual dysfunction associated with TCAs and MAOIs are more difficult to estimate. Studies indicate moderate rates of sexual dysfunction with these older antidepressants.
Antidepressant-associated sexual dysfunction generally occurs early in treatment and then may improve or persist.Low libido is the most common type of sexual dysfunction and is present in up to three-quarters of depressed patients.
5 Ways to Manage Sexual Side Effects
Sexual dysfunction should be assessed and treated according to individual needs and circumstances. A variety of strategies may help you manage antidepressant-induced sexual dysfunction, including:
- Decreasing the dose: A dose reduction may allow some patients to regain satisfactory sexual function.
- Waiting: One study found that antidepressant-induced sexual dysfunction improved somewhat in about 20 percent of patients within six months of beginning treatment.
- Adding another drug: Various medications (Viagra, Cialis, stimulants, Buspar) can be added to combat sexual dysfunction.
- Switching medications: Switching to an antidepressant (e.g., Wellbutrin) with a low rate of sexual side effects can often alleviate this problem.
- Behavioral strategies: The use of therapy (e.g., psychotherapy) and other types of treatment (e.g., sex therapy) to decrease anxiety associated with sexual performance might be useful.
Work with your doctor to find an effective antidepressant or combination of medications that will keep sexual side effects to a minimum and your depression under control.