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  • July 31, 2008

    Sexual dysfunction and antidepressants

    By David Mrazek, M.D.

48 comments posted

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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!

48 comments posted

blog index
  • January 11, 2012 7:31 p.m.

    Hi, I've been blessed with depression and anxiety for years. Recently taken off paxil which I was on for 14 years!!! It did help though. I am currently suffering with fibromyalgia and some arthritis in hands.Yes this is all very painful,being even more so being 37!!! I'm very sexual and it's not that I don't want sex it's I can't achieve an orgasam!!! My doc has put me on 30mg of cymbalta for both depression and to help ease some of the pain,plus lyrica. This has helped but??? any suggestions on what to do? considering stopping the cymbalta,and trying well butrin but that will not help aid the pain along with the depression and anxiety from the Fibromyalgia??? Please anyone with info please help!!!!!

    - marie

  • November 26, 2011 2:15 p.m.

    how about testosterone supplement even though man has wnl level, for sexual dysfunction. Is this reasonably safe and are there positive results improving errections and "don't feel anything"" complaint. Assume there is no underlying concurrent condition. current meds are venlafaxine and wellbutrin which combination very satisfactory effect for depression and social anxiety disorder.

    - Michael

  • October 10, 2011 11:41 a.m.

    I see some drug companies are now offering to pay the patient's deductable, while the patient's insurance picks up the rest. I'd like to see a list of drug companies who offer this. Thanks.

    - Tom

  • September 28, 2011 11:01 p.m.

    For those of you who have dealt with ongoing severe depression without getting relief from a list of meds. you have been prescribed, please ask your doctor about E.C.T After months of chronic depression my treatment team suggested E.C.T which was very positive for me.In a matter of a week,I felt like I was back in the world,University Hospitals usually jave this program and i wonder about how different my life would have been if we knew to ask about E.C.T. It saved my life.

    - Nancy

  • August 6, 2011 5:44 p.m.

    Depression/anxiety are one in the same. The meds that are often prescribed unfortunately blunt sex drive. I have been taking 100mg of Zoloft for 10 years. It works very well for my anxiety/social anxiety. I have had no sexual problems with taking this drug. One of the main causes of ED(men)is uncontrolled Type 2 Diabetes. Many people have Type 2 Diabetes and do not know it. You can develop neuropathy (nerve problems, blood flow) if left untreated and undetected. Also, ED can be a warning that you MAY have underlying heart/circulation problems. The thought here is if you are having blood flow problems with your penis, it also could be developing elsewhere. Men who go to their doctor and discuss this openly are now automatically treated as heart patients, initially until proven otherwise. I do not know how or if Type 2 Diabetes would or could affect women's sex drives, but men, before plying yourselves with herbal stimulants or pharma pills--go to your doctor and be open about it without shame or fear. You may have this issue due to some other factors that may in fact save your life.

    - Eddie

  • June 25, 2011 4:45 a.m.

    Ive come to the conlusion that anxiety and depression are just 2 sides of the same coin. When i do things that cause me to have a low energy level i feel depressed. When i excercise etc so that i feel energetic i dont feel depressed but i feel extremly anxious. Ive been exercising and taking good care of myself and i feel the best ive felt in my entire life, right up to the point where the increased anxiety made me have a panic attack. All in all being full of energy and anxious is a lot better than being lethargic and depressed.

    - Scott

  • June 7, 2011 12:52 p.m.

    I'm on Zoloft 50mg for 3 months for PMDD. My anxiety was huge as depression. This med really helped me, but since i started it my sex drive is low, but the real problem is that I can't reach orgasm and it is very frustrating for me. I'm 30 and my husband 36, no kids, and having no orgasm is something very bad for me. My sex drive is low but only to initiate the sex, if my husband has the iniciative, it makes me want... I've been always too skynny and I wantted to gain a few pounds and I got it with the Zoloft. I have heard that Wellbutrin is better for who has sexual dysfunction with SSRIs but makes you lose weight what I don't want. Does someone know what I should do?

    - Marcy

  • November 15, 2010 12:17 p.m.

    59-yr-old; active, professional, volunteer, female & mother: taken various antidepressants & combos since age 40. Depression (D) since adolescence, not diagnosed til mid-life. prozac, wellbutrin, zoloft, cymbalta, etc., regimes provided blessed relief (after 40-d wait) and worked fairly well for a year or two when drug's or drug combo's effectiveness ended with horrifying suddenness. QUESTION: why has medical research community failed to establish effective long-term treatment guidelines for D after decades of anti-D drug usage and patient histories?

    - Sue

  • October 22, 2010 6:38 a.m.

    is these penis enlargement solutions really helps to get the permanent result

    - james

  • October 1, 2010 1:34 p.m.

    I did have my low libido and it's quite boring, sad and feeling alone. I can't play with fire and I can't even play mine. How could this happen to me, do I made a mistake? They said take a pill but I can't because I am afraid of pills maybe they have side effects to my health.

    - Akatsuki

  • September 12, 2010 2:06 a.m.

    I can't believe some of these peoples comments. Is sex the only thing holding your relationship together? So its better to have a dead partner than a dead sex drive? Instead of you people being happy your partner is still alive, functioning normally, being happier and more excited to be active, spend more time with the family etc, you're only happy if your partner impresses well in bed? Aren't people who are less depressed are the ones that are more motivated to spend time with their families and isn't their medication controlling these people from losing their tempers towards their loved ones? I know people who have families, still happily married and take meds that contribute to loss of sex drive and have loss of sex drive, infact in many cases, these meds have actually improved and saved their relationships and marriages! Blood pressure meds can also cause sexual dysfunction, and how common is blood pressure problems? ADD/ADHD meds can also cause sexual side effects, things in nature can cause sexual problems! Stop focussing on the negatives such as the sexual side effects like I used to do and as I said the sexual problems are actually not that bad and are temporary. Periactin can increase sexual desire, zinc can too among many other things. Its because of reading your descriptions of how the sex effects ur relationships in the first place I felt suicidal, I went through all that to find it was an exaggerated load of sh*t!

    - Not as bad as I thought

  • September 12, 2010 1:28 a.m.

    As I was saying and would like to add, (not all of my comment seemed to have been fully displayed on Sept 12, 2010 1:07pm) I stopped the meds after being on them for many years and my sex drive, arousal returned to normal just like all the other side effects which were worse than the sexual side effects. There is no shame in taking meds

    - Not as bad as I thought

  • September 12, 2010 1:07 a.m.

    I have been on antidepressants for years, one of them being zoloft with great success. I did get some side effects including sexual problems. I was nervous at first thinking it can't do more harm than just impotence or just an inability to get an erection but after reading sexual problems means loss of sex drive as well I got really paranoid about it with these what if thoughts "what if I'm unable to even feel any sexual attraction towards the opposite sex, how can I get a partner without the chemistry? I will have no future because a married life would be meaningless if I don't have that chemistry towards my partner". After taking the zoloft only for 2 days and then reading more into it finding out it can also include loss of sex drive, I thought there was no turning back, I might have already starting getting that side effect and it may never ever go away, I even thought I was tricked into taking the medication so that I completely lose my ability to have a sexual relationship. After continually taking the med with the help of an antipsychotic to calm down my paranoid thoughts I started to get this "sexual side effect." This side effect actually didn't effect me the way I thought it would at all. Yes, there was loss of interest in sex, but not in the opposite sex. Members of the opposite sex still caught my eye just as much as they always did. It really just dampened or froze my sexual activity or arousal while taking them. Stopped meds, sex driv

    - Not as bad as I thought

  • June 26, 2010 1:55 p.m.

    I am in the middle of a divorce where my husband was sexually abusive to me during the marriage and now am dealing with post traumatic stress, hard to deal with work and my day to day life, and depression and my psycologist feels that I need to begin taking antidepressants. For the first time in my life I am striving for a healthy and satisfying sexual relationship and I am reading that anti-depressants can cause problems in this area and this is understandably causing me great concern. What would be the first possible medications to start with for a otherwise healthy woman 56 years old?

    - Ann

  • May 31, 2010 3:25 p.m.

    I have been on effexor 150mgs. valume and 5mg of abilify, and ambien. Ok I am married with children. I am 32 years old....my husband is 23. Well ever since the meds. I can barely orgasm, i know its not him because It was great b4 the meds. I never want to have sex, i pretend to want to, and I often fake orgasms. He is currently deployed for 7 months. I think its the Effexor.

    - Jennifer

  • April 7, 2010 3:42 a.m.

    hi, i love sex, but i found out that i ejaculate too soon and it spoils my fun, what can i do to prolong the ejaculation, I'm afraid of using drugs because of side effect. I'm 33, married with a kid. please advice me

    - ak

  • February 9, 2010 7:26 p.m.

    I have been on Ativan 2.5mg for over 25 years for anxiety and stress. In the last 6 years I have felt a gradual decrease in my libido and creeping ED. To make it worse now it is a real struggle to reach an orgasm. Where to go from here?

    - Luc

  • January 24, 2010 10:43 p.m.

    I wanted to give a suggestion to women who are looking for a good anti depressant combination that doesn't kill your sex drive. I was having issues with my sex drive and lubrication/sensation issues as well. I periodically go through depression episodes and have to be on an anti depresant right now, but it was horrible for my sex life. The best anti-d. for my mood issues is Effexor, but it killed my sex life in more ways then one. But my psychiatrist suggested I offset the effexor with wellbutrin to help with the sexual side effects while keeping me on a high enough dose of anti-depressant. It has worked wonders for me. I now have a great level for my anti-depressants and my sex drive and other issues have improved greatly. I also wanted to say for someone on here who mentioned Cymbalta, be carefule with that, I was put on it to help with my horrible headaches and it made me very sleepy and I started falling asleep while driving and it became very dangerous. Try it when you don't have to drive or do anything very important until you know who it will affect you. -Summer

    - Summer

  • January 18, 2010 5:10 a.m.

    if a women take maximor pills will it cancel her birth control pills. She did take it in the morning before intercourse.

    - jones

  • December 4, 2009 11:56 a.m.

    After years of suffering from depression and anxiety, I have just begun to research serotonin management techniques. Apparently your diet and regular exercise (which both should be no brainers) can really help manage serotonin levels. Eating complex carbohydrates and foods high in omega-3's can be very helpful. Why, may I ask, over years of treatment, numerous drugs, and many doctors, including psychiatrists, hasn't ONE SINGLE DOCTOR EVEN MENTIONED THIS!!?? I had to do my own investigation because nothing seems to work well enough or long enough without the various aweful side effects! Thank you to whom ever suggested acupuncture, I am going to include it in my research. Doctors are so eager to push pills. The first med. I was ever put on in my early twenties nearly made me commit suicide and the roller coaster of side effects I went though to find the right medicine was almost worse than the actual depression and anxiety itself. I am now on 40 mg. of Celexa and Xanax. Sigh. It also doesn't help that one of the doctors I went to would want me to switch meds just because they were 'popular' at the time, when I've run the gauntlet, I know what works for me. Also, not to mention, I haven't heard much about sexual disfunction, which also explains a whole lot!! Frustrated with western medicine.

    - Marie

  • November 3, 2009 9:43 p.m.

    I'm sorry but I am not impressed with this article. For Suzie: Nefazadone and it's relative Remaron has minimal sexual dysfunction effects. Some will tell you that Nefazadone causes severe liver problems, but I suspect that is very, very overblown and I'm not sure that it was the Nefazadone or perhaps a contaminant. I find it very useful. While it is true that Remaron can lead to weight gain, aerobics and working on not "pigging out" can prevent that. To equate "worsening anxiety" with Remeron a relative to the benzodiazapines I think is frankly odd. Sure all of these can cause paradoxical effect (increased anxiety) but for every increased anxiety there will be 500 with markedly decreased anxiety. And I am truly sorry see any mention of Viagra. Does the write suggest using aspirin for joint pain, ignoring ibuprofin or naprosyn? Viagra is ancient and its effects are "shotgun-like." I call it the "three-step" med. First take an acid reducer for the intense indigestion you will get. Then snort some 12 hour nasal decongestant to combat the nasal stuffiness you will get, and then take two Ibuprofin and two Tylenol for the intense headache. And after all that it last for a few hours. If you want to look at erectcile dysfunction drugs for males or females at least look at Cialis, whose effects are more like a rifle--and whose side effects for most are a small fraction of those experienced on Viagra, and the erectile (penis or c

    - Steve

  • October 19, 2009 7:58 a.m.

    it has been so hard! my husband was on effexor and had no sexual desire, now he is on prozac and he is unable. I am 50 and do want to give it up, yet I want him happy...any suggestions?

    - suzie

  • October 6, 2009 10:15 p.m.

    Hi, I am 27 and married and I am currently taking wellbutrin. I like this medicine and it seems to have helped me, but my Dr. just prescribed another med. My prob. is that I have absolutely NO sex drive. I have recently been trying to get into nursing school and have had an extremely hard time, so that has not helped. we also have a 2 yr. old daughter. I need to understand if its the medicine or me. My dr. says its b/c I am tired and depressed. but I dont know, I feel that at 27 we should be having sex and I feel guilty. Please help, I really need advice.

    - Natalie

  • October 4, 2009 8:12 a.m.

    i need help please tell me what i can do to help my son. he is 18 i found out over a year ago from going on his computer and reading his text that he pays girls to kick him in his balls. i had him see a phyc for over 6 months. i thought it helped. but i wanted to see if he would do it again so i set up a facebook acct. and started talking to him as if i was someone else and he offed me money if i would do it to him. after that i had told him it was me .and that he needs help .he said that he talks about doing it with girls but he doesent go though with it .i dont buy that . i need help what should i do .thank you

    - lynn

  • September 21, 2009 2:17 a.m.

    I was on paxil for 6 yrs,it did help with depression & anxiety,but took away my desire for sex.......this is depressing too!! I'm happily married and it's the pits,plus i gained allot of weight.I weaned myself off the drug,lost weight, had a sex drive again,but the depression & anxiety returned.I take Xanax for my anxiety.My Dr wants me to take Cymbalta,but I'm not doing it.I've decided to see a phyc Dr. maybe a low dose of Remeron would help me.I too have tried so many anti-depressants and it's frustrating.They need to make better meds with less side effects.

    - gepe

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