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), Mirtazapine (Remeron), and Nefazodone (Serzone).
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.
Related Topics:
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), Mirtazapine (Remeron), and Nefazodone (Serzone).
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.
Related Topics:
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7 Comments:
I have completely taken myself off of anitdepressants. One of the reasons was due to the sexual side effects. I had been on some type of antidepressant since my son was killed 10 years ago. I slowly weaned myself off of the med, the last one I took was Effexor. I had also been on Prozac, Zoloft, I can't say if any of them worked, but I'm still here on the planet so maybe they have. Anyway, I slowly got off of the Effexor, and it took about 5-6 weeks to get rid of the terrible physical withdrawl symptoms. I still experience that "shocking" feeling, where I get bursts of shocks, that is the only way I can describe it, I feel like I'm being 'Zapped" by these surges of tingling energy. Sounds goofy, but I can't put it into any other words. That has been the worst side effect for me. I still get these bursts, but not so bad. I also noticed that things that used to be so important in my life now are back, such as my love for music, playing the violin, sex, and laughing. I feel re-born, re-newed. I'm sure sex would be great once again, but since I've been off the antidepressants, my love and I have split up, not because of getting off the meds. It's been a long time coming. I do cry more often and I noticed that the crying is now related to happy things, I'm emotional anyway, but I cry now because I'm happy about things, I know that sounds crazy, but really it's good crying. I have more energy, feel life and now see the light at the end of the tunnel.My family says I even sound better. Can you imagine, I even sound better to my family. I don't know if it is because I got off the meds or if I just mentally changed my attitude. I have not done anything different. I had gone thru counseling, and I have not started again. Prior to leaving his office my doctor gave me yet another prescription for another antidepressant. He was not too keen on my stopping them in the first place. I have the Rx, just in case. I recommend to others ask your Dr. first before you decide to discontinue taking your antidepressants. There are ways to help with the sexual side effects of antidepressants, and using them helps. I have used marijuana (I'm not recommending it, just sharing) Trying to be more intune with your body, letting your partner know of the side effects, that is an important one, then your partner can help even more in other ways.
I have a question for you.I am 29 years old. I had sex for the first time with my boyfriend. I am bleeding that means I lost my virginity. Is it normal that I get cramps and my stomach hurts a little bit? What are the side effects of losing your virginity?
I'm not quite sure this blog is describing antidotes to the sexual side effects caused by the antidepressant. At least not for me. About the only thing I really saw was to supplement with testosterone, but I heard that if there's a high incidence of prostate cancer in the family that taking testosterone could significantly increase the risk of the cancer.
So how do I resolve this issue?
Thank you so much for posting this information. I am going to print it out and bring it to my doctor for my next visit. I am taking Cymbalta for depression/anxiety/chronic back pain and it has taken a serious toll on my sex life. I have trouble becoming aroused now and I cannot reach climax without a GREAT deal of effort. This is very frustrating and depressing in itself!
I am wondering if I need a testosterone supplement. Is there a way to tell if your testosterone levels are low (blood test, for example)? I had no idea that anti-depressants affected a man's testosterone level before reading this article.
The sexual side effects of anti depressants, the SSRI's in particular can be dose related, there are a few anti depresants with a much lower incidence of sexual related side effects too. such as Wellbutrin and Mirtazapine.
Sometimes the timing of your dose...there are multiple variables and it is trial and error.
Yohimbe and ginsing are options yet they can cause side effects and should be researched before trying as they are drugs just not regulated by the fda.
Always discuss with your health care provider..as sexual dysfunction can only add to a persons depression. and there are multiple alternatives one should consider before considering testosterone.
I AM CURRENTLY USING WELLBUTRIN XL, AND ZOLOFT. IT REALLY DOES WORK. PLUS WELLBUTRIN HELPED ME STOP SMOKING. I REALLY BELIEVE FROM EXPERIENCE THAT SEEING A PSYCHIATRIST IS FAR BETTER FOR YOU THAN SPEAKING TO YOUR FAMILY DOCTOR,LOT'S OF LUCK,AND LOT'S OF LOVING.
I am one of those people who have experienced the negative side effects and am leary of changing meds. I was prescribed Zoloft so many years ago I cannot remember the year! It was like a light switch was turned on for me. Gone was the anger, being constantly irritated by everyone and everything, and I found a very pleasant life. What I did not realize, until about 6 months ago, was the toll taken on both my sex drive and ability to reach climax. I took myself off of my meds for about 3 months (yes this is a VERY stupid thing to do). I rediscovered the anger, paranoia, irritation, etc. But I discovered a healthy sex drive and orgasms that didn't take a marathon session to achieve!
To be honest, the trade off wasn't worth it. I went back on meds, found the happier me, but no libido.
After reading this article I will speak with my doc about steps to take to combat the sexual side effects. I do not want to feel the way I do when I am off my meds (and again - don't be as dumb as I was - don't self-medicate), but now I can speak with my doc. Thanks for the article.
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