Beyond Blue

Beyond Blue


Sex on Antidepressants: No Need For Subtitle

posted by Beyond Blue

r-LOVERS-mediumvariable.jpgAwhile back a reader asked me if I’d cover the topic of intimacy complications with regard to antidepressants.

 

Ah. Yeah. Every time I write about this controversial topic, I usually get hammered by the left, right, and center–this is obviously delicate ground–so let me tread lightly.

In a recent Johns Hopkins Health Alert called “The Challenge of Antidepressant Medication and Intimacy,” I read this:

While sexual dysfunction is a frequent symptom of depression itself (and successful treatment of depression may eliminate it), antidepressant medication can sometimes worsen or even cause sexual problems. In fact, sexual dysfunction is a potential side effect of all classes of antidepressants.

Between 30% and 70% of people who take antidepressant medications experience sexual problems, which can begin within the first week to several months after starting treatment. Antidepressant-related sexual dysfunction can affect almost any aspect of your sex life. In men, it frequently causes erectile dysfunction (the inability to achieve or sustain an erection), and in women, antidepressants may cause vaginal dryness and decreased sensation in the genitals. In both genders, antidepressants can diminish sex drive and make achieving orgasm difficult or impossible.

Sexual dysfunction due to any cause, including antidepressants, can have effects that range far beyond the bedroom, including psychological distress and a decrease in self-esteem and overall quality of life. This causes many people to stop taking their antidepressant medication. Up to 90% of people who experience antidepressant-related sexual dysfunction stop taking their medication prematurely. Fortunately, you can regain your sex life without stopping your medication and risking your symptoms worsening. For example:

From my research on this topic, psychiatrists usually recommend a few things:

* Switching to an antidepressant like Wellbutrin that has a lower rate of sexual side effects. Or adding Wellbutrin to your current antidepressant because recent research says that small doses of Wellbutrin (75 to 150 mg) in combination with another antidepressant can actually be helpful in decreasing the sexual side effects of those antidepressants.

* Another possibility is adding Viagra into the mix. It has been proven to help BOTH men and women with sexual dysfunction.

* Your doctor may experiment with decreasing your antidepressant ever so slightly, to see if that helps with sexual side effects.

* You could change the time you take your medication. For example, if you usually have sex sometime after dinner but before bed, it would be best to take your meds after sex but before bed, because the blood levels of the drug are going to be lowest the next day after dinner (when you typically have sex).

* Dividing your doses is also a possibility.

* And finally, implementing a “drug holiday” might be an option. That is, not taking your meds for two days or so. According to Karen Swartz, M.D. of Johns Hopkins Mood Disorders Center, “evidence shows that periodic two-day breaks from antidepressant therapy can lower the rate of sexual side effects during the drug holiday without increasing the risk of a recurrence of depressive symptoms.”

My plan? To experiment with a few of these when I reach a more stable place.

I’ve been saying that for about three years, because right as I think I’ve hit even ground and can do a drug holiday or try adding Wellbutrin or go to sex school, something happens and the black dog has my ankle again. So for now, I stay a tad challenged in this area.

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  • nillawafer

    those with no insurance can only purchase affordable drugs. the ones that don’t affect sex drive as profoundly tend to be more expensive and free agencies don’t have access to all the different meds. my teen’s three suicide attempts were during a time she forgot or didn’t take her meds for three days. not wise for young people. what do you suggest for people who don’t have access to the mayo clinic or “the best” clinicians?

  • http://www.OptimisticJourney.com Jarrod@ Optimistic Journey

    The unfortunate part to taking most meds is that there are more sideeffects than there are solutions to the problem. It would be one thing if they were minor side-effects but we’re looking at major side-effects such as sexual dysfunction, high cholesterol or high blood pressure. Thanks for providing such food for thought to so many people! :)

  • http://www.OptimisticJourney.com Jarrod@ Optimistic Journey

    The unfortunate part to taking most meds is that there are more side-effects than there are solutions to the problem. It would be one thing if they were minor side-effects but we’re looking at major side-effects such as sexual dysfunction, high cholesterol or high blood pressure. Thanks for providing such food for thought to so many people! :)

  • Tony the cretin

    Sex? What is that? Too frequent bouts of depression don’t allow for any relationships. Been a lonely life.
    One of the unsung symptoms of bipolar disorder is hypersexuality. I had that to where I was seriously aroused by any pretty face and couldn’t stop the ensuing dirty thoughts. When I was depressed, that really fueled the guilt. An antidepressant and an antipsychotic have quelled that. I don’t know if that is a therapeutic effect or a side-effect. For now, it has been a benefit. This is just another perspective on the sex vs. medication dialogue.

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  • MK

    Great article and great suggestions. Just a reminder that some anti-depressants will effect your ability to sleep if taken too close to bed time. I had that problem with Wellbutrin. It’s miserable to not feel rested or have to add ANOTHER pill to the mix just because you’d like to get some rest.

  • Crystal

    I take abilify and it has been a lifesaver in so many ways. I am stable now and able to function instead of staying in bed everyday crying. But it has completely killed my sex life. Fortunately my Husband is very understanding but I really miss what we had together. It has been 3 years since I was able to enjoy sex and now it is just painful to me. Anybody got any suggestions for that? I’ve tried the above with the exception of adding wellbutrin but nothing helps. I think of going off my medication but am scared too. There are other side effects also. If anyone has any advice please list it in your comments here. Thank you very much and thank you Therese on another good article.

  • HereticPrincess2725

    That’s very interesting, luckily I haven’t had any problem really with sexual side effects, but the fact that Seroquel is making me super sick…puts a damper on EVERYTHING! :(

  • Anne

    I’m sure that having any sex at all would increase my sex drive and mood. When I am grumpy at school, my students like to remind me that “I just need to get laid!!! Easier said than done. I like the suggestions about taking a meds break, or wellbutrin. Sometimes I do not like to take it because it makes my anxious. Thank you for sharing your thoughts and experiences. It helps. Anne

  • Michaela

    I had this problem with my first antidepressant (lexepro)!
    i was completely anorgamsic, and sex became and incredibly difficult, and often painful enterprise. My partner felt terrible, and even blamed himself for my problems, feeling like he should be able to ‘overcome’ these side effects. This was shocking, and pained me when I found out he’d felt that way.It was also very difficult as a young couple, who are meant to be in our ‘prime,’ to face the possibility this would be as good as it got. So one thing I think was missing from this article, and the comments, was make sure there is a loving, open communication with your partner, or it can cause problems.
    I was able to overcome this however, in two ways.
    Firstly, by a change of antidepressant. This was difficult to explain to friends and family, why I was going through the fairly traumatic process of changing a medication that seemed to be outwardly working, as I was not comfortable telling most of them the real reason. And while my partner was 100% behind me staying on the original medication, I felt this was something it was important to try to improve, for both our sakes.
    For me, it just so happened another common form of antidepressant (Luvox) was as useful for me depressionwise, and did not have those side effects to nearly such an extent. This got me to a place where I could have enjoyable sex, and yet my sex drive was not where it used to be, and it would still take me quite a while to ‘warm up’ to the idea, eradicating the possibility of any ‘spontaneity.’
    However, once I got my excercise routine in shape, that was what really kicked me back up a notch. After facing the prospect of needing to move up a dose, I decided to finally take the time to really plan and maximising my exercise routine to see if it would help. I bought a cross-trainer, and it has just changed my world! from someone who was very anti-cardio, after two weeks of making myself, the switch just flipped and the benefits of the workout were compelling enough to make me happy to get out of bed and work out for 40 minutes a day. the most amazing thing I found though, was other than elevating my mood and acting as the perfect helper to my medication, my sex drive returned with a vengeance :)
    So I would definitely recommend trying other medications if the sexual side-effects are debilitating. Just make sure, as always, to have a good support network around and time it well. And if you have not already made a consistent excercise plan, do so and then stick to it. There will come a time when you won’t be able to go without it, and the benefits will be found in so many areas.

  • Teresa

    I am on Wellbutrin, and I used to have an incredible sex life. I have not had a sex drive in probably 3 or 4 years. My psychiatrist has changed my meds several times, adding Wellbutrin…dropping other antidepressants…increasing Wellbutrin…Nothing has helped! The only suggestion in the blog that I haven’t tried is adding Viagra. Who can afford that?? My depression seems to have gotten better since the last increase in Wellbutrin, but my lack of sex drive is causing my husband to need an increase in HIS antidepressants! I am at the end of my rope.

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