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Monday, August 14, 2006

Part 2: SSRI Antidepressants

This is the second in a series of “Ten Reasons Why Women May Lack Sexual Desire.”

The topic of this entry is truly one of the most common causes of lack of sexual desire for women. I encounter it with great frequency in the questions posted on the message board and in my therapy practice as well. It pits some women against some very tough questions: Lose my depression and possibly my sexuality? Or, keep my depression and maintain my sexual desire and function?

Of course, there are some women who have little interest in sex because they are depressed. That is an entirely different situation for them to unravel. It often can require the help of a mental health professional (preferably a sex therapist) to evaluate her situation and create the best path for her to take.

Women who use an antidepressant in the SSRI category (selective serotonin reuptake inhibitor) may sometimes find that their interest in sex (solitary or partnered) has decreased. In addition, there may also be negative impact upon their ability to get aroused or to reach orgasm. Not everyone experiences these difficulties, but enough do that whenever a women presents to me in my therapy practice with lowered sexual desire, I always ask about their use of antidepressant medication.

Sexual researchers are working on this very common problem. There is no ideal solution that works for most people (male or female).

Some women have had some success with using Viagra at the time they intend to be sexual in addition to their other medications. It works for some — for reasons that we do not yet fully comprehend — and not for others. Cialis and Levitra have not been explored as often in this manner, but my hunch is that they might offer a similar level of assistance.

If Wellbutrin (bupropion) has not been tried, it might be good to consider it either as a replacement to the SSRI or addition to it. It is a dopamine agonist and that has been found to be somewhat successful in treating women with sexual side effects due to antidepressants. Typically about 100 mg per day is used if it is added on. The woman’s prescribing physician would have to be consulted in order to do this. There is good evidence based, scientifically reviewed research on Wellbutrin use for this purpose.

Dostinex (cabergoline), also a dopamine agonist, has also been used, but I have less anecdotal evidence upon which to rely and no scientific research as yet.

In addition to those approaches, a woman with this difficulty (lowered sexual interest and the need to stay on the antidepressant) could speak to her prescribing physician. Robert Taylor Segraves and Richard Balon offer a number of SSRI “antidotes” that have some anecdotal support in “Sexual Pharmacology Fast Facts.” Among their suggestions are: Symmetrel (amantadine), Urecholine (bethanechol), bromocriptine, Periactin, (cyproheptadine), Kytril (granisetron), Claritin (loratadine), Prostigmin (neostigmine), phentolamine, Aphrodyne (yohimbine), and Ritalin (methylphenidate).

These antidepressants have a reportedly lower frequency of sexual dysfunction: Bupropion, Mirtazapine, Nefazodone, and Reboxetine. The SSRI antidepressants include: Celexa (citalopram), Lexapro (escitalopram), Prozac and Sarafem (fluoxetine), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline).

There are several management strategies that can be tried, but each of these approaches has its limitations.

1. Waiting for spontaneous remission of symptoms or accommodation of symptoms.
2. Reducing the dose to the minimal that is effective.
3. Scheduling sexual activity around the dose.
4. Switching to another antidepressant with a lower frequency of sexual dysfunction.
5. Using other medications such as Viagra (sildenafil).
6. Take drug holidays with a doctor’s permission.
7. Addition of the mentioned “antidotes.”

As you can see, we are still very much in the try-and-see world with this problem. Pharmaceutical companies are well aware of these issues and will likely be tackling their own type of “solution,” so — stay tuned.


Related Topics:
Human Pheromones: Our Love Scents, Married with Kids: Is Libido Lower for Women?

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