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Antidepressants and Sexual Dysfunction

One of the great ironies of depression treatment is that while depression can rob you of your desire for sex, the drugs that treat it can be much worse, causing not only low libido, but also erectile dysfunction and difficulties with orgasm. The following are some tips that you may wish to discuss with your doctor that can help restore you sex life.

1. Reduce Your Dose
Under the supervision of a physician, it may be possible to lower your dose enough to reduce sexual side effects while still obtaining depression relief. For example, it has been shown that for some people 5-10 mg of Prozac may be just as effective as the standard 20 mg dose.

2. Schedule Your Dose Right After Sexual Acitvity
With certain drugs, such as sertraline and clomipramine (brand names Zoloft and Anafranil), it may be possible to schedule your daily dose right after the time you would normally expect to engage in sexual activity, when the drug's level in your body would be at its lowest. For example, if you normally have sex at night, schedule your daily dose near that time and take it just after sex.

3. Augment With a Drug That May Reduce Dysfunction
Case reports and small clinical studies have found the following to be potentially helpful in counteracting sexual dysfunction: Amantadine, Bupropion, Buspirone, Cyproheptadine, Dextroamphetamine, Pemoline and Yohimbine. Your doctor may suggest taking the drug prior to sexual activity or may put you on a daily regimen.

4. Take a Drug That Treats Sexual Dysfunction
Drugs targeted at erectile dysfunction, such as Viagra, may help some patients.

5. Take a "Drug Holiday"
With the drugs sertraline and paroxetine (brand names Zoloft and Paxil) it may be possible to schedule a two day drug holiday each week in order to restore sexual function without losing the efficacy of the antidepressant.

6. Switch to an Antidepressant That Causes Fewer Side-Effects
Nefazodone and bupropion (brand names Serzone and Wellbutrin) have been shown in double-blind studies to have less effect on sexual function than SSRIs. If either of these have an adequate antidepressant effect for an individual patient they may be a viable treatment alternative to reduce sexual side effects.

Sources:

Ashton AK, Rosen RC: Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual function. J Clin Psychiatry 59:112, 1998

Bartlik B, Kaplan P, Kaplan HS: Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin reuptake inhibitors. J Sex Marital Ther 21:264, 1995

Gitlin MJ: Treatment of sexual side effects with dopaminergic agents [Letter]. J Clin Psychiatry 56:124, 1995

Labbate LA et al: Sexual dysfunction induced by

 

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