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Antidotes to Antidepressant Sexual Side Effects

While at the ISSWSH conference in San Diego, Anita Clayton, MD of Charlottesville, VA, presented research that will prove very interesting to me and to many of the clients in my therapy practice. She reviewed ways to reverse the negative sexual side effects of SSRI type antidepressants.

First, the ways that work for only a few people.

A small number of people who take an SSRI will simply acclimate to the medication and find that they develop a type of tolerance that allows them to function sexually while still getting the benefit of combating their depression. This can take four to six months to occur (if at all) and it works for only about 5% of patients.

Some people will try changing to another SSRI, but this, according to Dr. Clayton, only works with about 10% of patients. In addition, many people worry that if they change from the medication that is working for their depression they will wind up sacrificing the gain against their depression for the possibility (and it’s a slight one) of restoring their sexual function. If a patient is willing to risk that situation and make a change, there are also non-SSRI medications that may offer relief from the depression with less likelihood of sexual difficulties: Bupropion (Wellbutrin), and Mirtazapine (Remeron).

Some research on Bupropion has included placebo-controlled trials. This means that these studies involved some patients taking a pill that looked identical to the real medication but did not contain that medication. To get an antidote effect to an SSRI, doses of 300 to 400 mgs. of Bupropion are typically used. Typically, a dose can begin with 150 mgs for one week. Then, 300 mgs. for three weeks and ultimately 400 mgs if needed to get the desired effect. In some cases, the dose of the SSRI can also be lowered when Bupropion is added on.

Buspirone (Buspar) may be selected to treat what is called anxious depression. This type of depression has a restless quality. It can also be added to an SSRI (30 to 60 mgs) to alleviate negative sexual side effects.

SSRIs tend to decrease testosterone levels in both men and women, so some supplementation of testosterone can help — particularly with issues of sexual desire and sometimes with arousal during sexual activity. Also adequate levels of testosterone are needed for PDE5 inhibitors (Viagra, Cialis, and Levitra) to work.

Cyproheptadine has been studied as an antidote, but it seems to have an effect that is often too sedating for patients. And, on the other end of the spectrum is the use of psychostimulants such as methylphenidate (Ritalin). About 10 mgs per day is often used, but not with patients who are bipolar or possibly psychotic.

Pharmaceutical companies realize the downside of the current batch of antidepressants. No doubt, they are working to develop other medications that don’t solve one problem while creating another. Until then, these are some coping strategies that are worth trying for people interested in treating their depression and maintaining their sexual interest and abilities.

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