Sex Rx: Paxil and Your Sex Life
Paroxetine (Paxil) is widely used in the United States. It is most often prescribed for depression, obsessive-compulsive disorders, panic disorder, premenstrual syndrome, and anger management. While Paxil is effective in treating these disorders, it has been associated with sexual problems.
How Paroxetine Works:
Paroxetine is one of a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These medications work blocking the reuptake of the brain chemical serotonin, which helps regulate mood.
Other Drugs of This Class (SSRIs):
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
***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 is 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.
Possible Sexual Side Effects Associated With Paroxetine:
- Decreased sexual desire
- Difficulty reaching orgasm, especially in women
- Erection impairment in men
- Loss of lubrication in women
How It Causes Sexual Problems:
It is not yet clear how SSRIs affect sexual function. The effects are believed to be related to the increased level of serotonin, which may affect sexual reflex centers.
There are a number of alternative treatment options available if you are dissatisfied with your sexual functioning while taking Paroxetine. But it is important to talk with your doctor about your concerns first. Although it can be very difficult and embarrassing to discuss your sexual functioning, it’s crucial that you communicate with your doctor about your sexual functioning. Never make any changes to your medication regimen or start taking new medications or herbal supplements without your doctor’s knowledge and approval. Here are some possibilities that you and your doctor may decide to have you try:
Wait it out
As you adjust to your new medication, the sexual side effects may go away.
Decrease the dosage
This tactic will work occasionally, but carries the risk of a relapse of the depression or disorder. Never change your dosage without checking with your physician first.
Since the medical response to SSRIs and other drugs to treat these disorders can vary among people, a physician will consider the severity of your depression or disorder as well as your response to the drug before switching to another. When switching is appropriate, your three main options are:
Bupropion (Wellbutrin)—This medication does not affect serotonin. It is unlikely to cause sexual dysfunction and may actually have prosexual effects. However, it is not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorders.
Nefazodone (Serzone)—This is an SSRI, but it blocks only one of the serotonin receptors, whereas other SSRIs block several. It can be used to treat each of the disorders paroxetine is indicated for and has been found to cause fewer sexual side effects.
Mirtazapine (Remeron)—This drug is similar to nefazodone, but without as much scientific proof behind it.
Try an antidote
This involves maintaining your current level of paroxetine, while adding a second medication to offset the sexual side effects. However, except for drugs in the Viagra family, there are no proven antidotes. Furthermore, these medications can also cause side effects. The four drugs most commonly recommended as antidotes are:
Bupropion (Wellbutrin)—This is the most commonly used and most effective antidote. However, there is only minimal evidence that it is effective, and some evidence that it is not. Bupropion is not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorders. Side effects include anxiety, delirium, myoclonus (irregular involuntary contraction of a muscle), uncontrolled hypertension, nausea, headache, dizziness, fatigue, constipation, diarrhea, drowsiness, and hypotension. Combined use of bupropion and SSRI antidepressants can also increase risk of seizures.
Buspirone (BuSpar)—The use of buspar as an antidote for the sexual side effects of SSRIs is based entirely on unreliable anecdotes. This drug should not be taken in doses exceeding 30 mg/day. Buspirone is generally safe, although the potential side effects include: sedation, akathisia (uncontrollable motor restlessness), dizziness, insomnia, nervousness, GI disturbance, nausea, and headache.
Sildenafil (Viagra) and related drugs—Medications in the Viagra family are believed to be helpful for the male sexual side effects of SSRIs. There is no evidence, however, that these medications help sexual dysfunction in women, and some evidence that they do not help.
Amantadine (Symmetrel)—Several case reports indicate that amantadine is an effective antidote for SSRI-related sexual dysfunction, however these amount to little more than testimonials, and are not reliable at all (see discussion of ginkgo below).
Take a drug holiday
This involves taking your usual Thursday morning dose and then nothing again until noon on Sunday. This tactic is unlikely to work with fluoxetine (Prozac) because it takes much longer to make its way out of your body than other SSRIs.
There is also a risk with this technique that you may feel well enough during the short drug holiday to discontinue your medication all together, which can lead to a relapse. Furthermore, short-acting SSRIs like Paxil can produce severe withdrawal symptoms in some people unless they are slowly tapered. Again, discuss this option with your physician before trying it.
Consider herbal supplements
The efficacy of herbal supplements to treat the sexual side effects of SSRIs is not clear. Numerous case reports and uncontrolled studies seemed to show that the herb ginkgo was dramatically effective for both men and women, but when proper double-blind studies were performed, these dramatic cures proved to be no more than a placebo effect.
American Psychological Association
Food and Drug Adminisstration
Canadian Psychiatric Association
Canadian Pharmacists Association
DeBattista C, Solvason B, Poirier J et al. A placebo-controlled, randomized, double-blind study of adjunctive bupropion sustained release in the treatment of SSRI-induced sexual dysfunction. J Clin Psychiatry. 2005;66:844-8.
Last reviewed May 2008 by Rosalyn Carson-DeWitt, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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