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With Mayo Clinic psychiatrist Gabrielle J. Melin, M.D.

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July 31, 2008

Sexual dysfunction and antidepressants

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By Gabrielle J. Melin, M.D.

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Sexual functioning can be affected by many things. Some of these factors include: past sexual experiences, religious beliefs, upbringing, self-esteem, medications (both psychiatric and non-psychiatric, such as some blood pressure medications), depression, and medical conditions such as diabetes or sleep apnea. Please don't stop any of your medications without talking with your doctor. There may be alternative medications you can use. This is by no means an exhaustive list, so talk with your doctor.

People can have difficulty with one or more of the phases of sexual functioning: desire, arousal and orgasm. Libido, or sex drive, may be reduced during a depressive episode. People describe not having interest in sex and in addition may not be able to have an orgasm. In order to achieve orgasm, arousal must occur. Some people can have low sex drive but are still able to become aroused and achieve orgasm.

A study just published this month in the "Journal of the American Medical Association" (JAMA) claims successful treatment of arousal and orgasm. This study was done on women only.

The study, an 8 week trial, included 98 women currently taking a serotonin reuptake inhibitor (SRI) anti-depressant medication. One-half took Viagra and the other half took a placebo. It showed that Viagra improved orgasm delay but not sexual desire, so will not help everyone. Viagra does have side effects, some of which can be very serious. No study is without bias. The number of women included is not a large number, so it is difficult to apply the results to the general population.

Also, the women's depression had to be in remission to be included in the study. So, was their sexual functioning improved because their depression was treated or was it because of the Viagra? Viagra needs to be taken one hour before sexual activity, so some feel that it reduces spontaneity.

As always, talk with your doctor about options if you have sexual dysfunction. Wellbutrin has a low incidence of sexual dysfunction as does Remeron. These both have potential side effects with Wellbutrin sometimes worsening anxiety and Remeron causing weight gain. Some people have sexual dysfunction with antidepressants such as Prozac, Paxil, Effexor, Cymbalta, Zoloft or Celexa, and some do not. We cannot predict who will have what side effect and to what degree at this time. We are learning more all the time, so stay tuned!

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13 comments posted

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November 6, 2008 3:03 p.m.

Viagra is not available in a Generic form at this time. Regarding Viagra or any other medications, including generic equivalents, please consult with your health care provider. All medications are monitored and approved by the FDA. They must all have the active drug in order for them to be given to patients for use. We do not recommend purchasing medications that are meant to be prescribed by a physician over the internet. These may not be regulated and may claim to be something they are not.

- MC.Com Staff

September 8, 2008 6:31 a.m.

When you gain 30 lbs. in less than a month and you can no longer have an orgasm. How am I to feel better? I tried accupunture and there are no side effects except feeling GOOD. Try it.

- Lynn Luddington

September 2, 2008 9:44 p.m.

i have been on every antidep.for the last 12yrs,gained60pounds,have NO SEX DRIVE,and i'm still depressed,recently my new dr got me dwn to klonipin and cymbalta.the cymbalta worked maybe?for the 1st few weeks ,then the irratability,crankiness,and just nasty set in.now i am only on klonipin i have severe fatigue,lethargy,aches all over,and gained15 lbs. in the last month.can somebody help me?

- stephanie

September 2, 2008 4:46 p.m.

Untreated depression by itself can lower sex drive. Other medications, medical conditions and personal habits such as smoking, alcohol and nicotine can negatively impact sexual functioning. Viagra is just one option-talk with your physician for options if on nitroglycerin or nitrates for cardiac disease.

- Mayo Clinic.com Staff

August 25, 2008 8:15 a.m.

I am on zoloft, and I feel like a zombie. At first, it was great. I felt so much better. Now my depression has returned and my sex drive is gone. I have been on zoloft for about 4 years. I wonder what's wrong with me that I can't be happy. To top it all off, I've started to gain weight. I've always been slim. Is it midlife weight? Or is ti something else? And can anyone suggest anything to fix any of this?

- Susan@42

August 14, 2008 7:50 a.m.

im on paxil and nitroglycer i cant take viagra is there any thing i can take im very depess bad now

- curt

August 14, 2008 12:27 a.m.

I have been on Paxil for years and it has definitely reduced my desire for sex. I want to go off of it and have tried...very slowly but I guess not slowly enough because my nightmares became so bad I was afraid to go to sleep! It is an awful merry-go-round.

- No Name

August 13, 2008 1:09 p.m.

I have been taking Zoloft/Sertraline for several years. Prior to that I took Paxil, which for all intents and purposes made me impotent. Not exactly a cure for depression. Zoloft was much better, but still had similar effects. While achieving and maintaining an erection is better with Zoloft, I will sometimes use a non-perscribed source of Viagra. However, even with the Viagra and no chance of losing my erection reaching orgasm is nearly impossible. So another non-perscribed cure I use is Dostinex/ Cabergoline. It works! Plus the rebound period for another erection and orgasm is sometimes only minutes. It's worth some research for those that are interestes.

- Meathead

August 12, 2008 2:25 p.m.

I have been on Tranxene since 1979 (15MG/Day. A few months ago swithched to klonopin (2 Mg/Day). I also take Deseryl and Effexor XR. Effexor is the very best for me and I have tried almost every other med. The problem with Effexor is I can't reach an orgasm. If I go off Effexor for 3/4 Days I can have an orgasm and great sex with my wife however I can't sleep and I feel terible. I thought a man should have a say. I hate this situation!!!!!!!!!!!

- Don

August 9, 2008 4:06 p.m.

I've been on venlafaxine 9 years, and I am sick and tired of being anorgasmic! I'm happily married... and this is really a downer. I tried Wellbutrin, but broke out in big spots. My doctor's attitude is that I should be glad I am less depressed. Well, I don't want to live without good sex. My husband is older, and when he dies, what will I have to look back on: years and years of no sexual satisfaction? What kind of life is that? I tried prozac, but it didn't work well. Besides, it is $12 a pill and the insurance won't cover it. Well, darn it, it's not like I'm a fat, old man who didn't take care of himself and now can't get it up! It's caused by the medicine! I'm giving it til April, when I plan to dump the venlafaxine. That'll be 10 years on it.... and that's long enough!!

- shindigz