- With Mayo Clinic psychiatrist
Daniel K. Hall-Flavin, M.D.
read biographyclose windowBiography of
Daniel K. Hall-Flavin, M.D.
Daniel K. Hall-Flavin, M.D.
Dr. Daniel Hall-Flavin, board certified in general psychiatry and addiction psychiatry, is a St. Louis native looking to the Internet as a way to help people improve their health and be more active participants in their own health care by learning from Mayo Clinic's experts.
Dr. Hall-Flavin has been a member of the faculties of Cornell University Medical College, New York Medical College, and The George Washington University Medical School before joining the Mayo Clinic staff in 1996. He has special interests in adult psychiatry, addiction psychiatry, and psychogenomics. He has served as medical director of the National Council on Alcoholism and Drug Dependence from 1986 to 1999.
"With the advent of the genomics and proteomics revolution and the pace of advances in medicine, informed collaborative relationships between knowledgeable, capable health professionals and informed, proactive individuals and their families are more vital than ever," he said.
"I'm optimistic that our Internet health education activities will contribute to ever-improving health outcomes for all who participate and apply what is learned."
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Complications (1)
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Question
Antidepressants: Which cause the fewest sexual side effects?
My psychiatrist is recommending that I take an antidepressant for my depression. But I'm worried about the sexual side effects. What can be done to prevent or minimize such side effects?
Answer
from Daniel K. Hall-Flavin, M.D.
Sexual dysfunction is a frequent side effect of antidepressants. So your concern is understandable. The risk and severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. Common sexual side effects include reduced sexual desire, erectile dysfunction, and difficulty achieving orgasm or ejaculation.
According to a 2007 overview of research, the antidepressants with the lowest rate of sexual side effects include:
- Bupropion (Wellbutrin), a norepinephrine and dopamine reuptake inhibitor (NDRI)
- Nefazodone, a combined reuptake inhibitor and receptor blocker
- Mirtazapine (Remeron), a tetracyclic antidepressant
- Duloxetine (Cymbalta), a serotonin and norepinephrine reuptake inhibitor (SNRI)
Selective serotonin reuptake inhibitors (SSRIs) — such as fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) — all have a high rate of sexual side effects. But some research suggests that Paxil is more likely to cause sexual dysfunction than are other SSRIs.
Tricyclic antidepressants — such as amitriptyline, clomipramine (Anafranil), amoxapine and desipramine (Norpramin) — have a lower rate of sexual dysfunction than do SSRIs. However, some research suggests that clomipramine and amoxapine have a higher rate of sexual side effects than do other tricyclic antidepressants.
Exactly how antidepressants interfere with sexual desire and function remains the subject of ongoing debate and investigation. Unproven theories abound. For example, some blame the sedating effect of certain antidepressants for dampening sexual desire. Others speculate that antidepressants cause chemical changes in the parts of the brain that regulate sexual desire and function. Complicating all of this is the effect of depression itself in decreasing sexual desire and function.
It's impossible to predict which individuals are most likely to develop sexual side effects while taking an antidepressant. In some cases, sexual side effects may improve once your body adjusts to the medication. But in others, sexual side effects may last for the duration of treatment. If you experience sexual side effects while taking an antidepressant, consider these strategies:
- Talk to your doctor about the possibility of changing your dose.
- Consider taking a medication that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
- Talk to your doctor about adding or switching to an antidepressant that may counteract sexual side effects, such as bupropion (Wellbutrin) or mirtazapine (Remeron). The anti-anxiety drug buspirone (BuSpar) also may reverse antidepressant-induced sexual dysfunction.
- Talk to your doctor about taking a medication intended to directly treat sexual dysfunction.
How well these strategies might work depends on the specific drug and your individual circumstances. If sexual side effects are troublesome, talk to your doctor before discontinuing your medication or trying unproven remedies.
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