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David Mrazek, M.D.
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David Mrazek, M.D.
David Mrazek, M.D.
Dr. David A. Mrazek is chair of the Department of Psychiatry and Psychology at Mayo Clinic, Rochester, Minn., and a professor of psychiatry at College of Medicine, Mayo Clinic. Dr. Mrazek has developed a federally funded psychiatric pharmacogenomics research program and implemented clinical psychiatric pharmacogenomics services at Mayo Clinic.
He has received numerous awards including the Award for Creativity in Psychiatric Education from the American College of Psychiatrists and the Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry from the American Psychiatric Association. He currently serves as chairman of the board of the American Board of Psychiatry and Neurology.
Dr. Mrazek has focused his current efforts on using pharmacogenomics testing to improve clinical care. One of his specific goals is to decrease the risks of taking psychiatric medications.
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Depression blog
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July 31, 2008
Sexual dysfunction and antidepressants
By David Mrazek, 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!
48 comments posted
September 20, 2009 12:45 p.m.
I am not depressed and never have been-thank goodness, but I have no sex drive at all, and I'm 69 years old. Is that a normal thing? I have had my tyroid taken out, and I'm also on blood pressure medicine. Any comment?
- marie
August 10, 2009 5:50 p.m.
I've found that the combination of 40mg. of Celexa along with Wellbutrin work best for me. SSRI's alone never worked alone..and Abilify is not yet a generic and therefore very expensive. I have had substance abuse problems along with depression. I was using prescribed opiates and went on Methadone to detox. (Actually, methadone was the best anti-depressant I ever used..but the hassle of going everyday, and now is often not paid by the public..it cost me nearly $400 a month..yuk!) But Wellbutrin works on the dopamine nerve transmission as do opiates. So I asked my physician for the combo. It works!! I sleep well...very sexy for a 62 year old man. Better yet than all of the above is EXERCISE!! One hour a day of good strength training 3 days a week and 2 days of cardio...I'm 6'1'' and weigh 170..all muscle. So before trying any antidepressant go for the exercise first! It's certainly better than any drug (see WEB MD under Zoloft compared to exercise...exercise works better.
- Roger
April 22, 2009 4:11 p.m.
We would never recommend quitting any medication cold turkey. Please discuss your concerns with your health care provider. Tapers should be done(if appropriate) with your Physician in a planned manner. If you quit "cold turkey" you could have flu like symptoms mild to severe, worsening depression and/or anxiety. Rarely, but possible would be seizures. Depending on the medications, other severe symptoms could emerge. Please do not stop without talking with your doctor.
- Mayo Clinic. Com Staff
April 22, 2009 10:43 a.m.
In 2006 my doctor recommended that I take all of my Prozac for the week (6 capsules) all at once for the purpose of lessening the ED side effect that I was experiencing. Five hours after taking this advice, I suffered a serious stroke and will never be the same.
- Don
April 19, 2009 2:26 p.m.
I have taken about every antidepressant that has shown its face, starting with triavil (a form of elavil) in 1970. I have had ect and it seemed to help. Everything seems to help at first, it is so hard to determine because the effect is so slow. I am on a combination of cymbalta and wellbutrin with a bunch of other stuff for arthritis, anxiety sleep. acid reflux etc.I have no idea at this point what is working and what might be making me worse. I very much to quit it all cold turkey. What would happen? Is there such a thing as detox for this. I would really like a professional answer to all this!!
- anita
March 25, 2009 6:02 p.m.
A thorough checkup is in order for everyone before taking antidepressants. Low ferritin levels which are your iron stores can feel just like depression. Checking hemoglobin levels is not enough. one can have normal hemoglobin and still have depleted iron stores. Thyroid,calcitonon levels electrolytes and even cortisol levels should be checked. Be persistent with your doctor about getting these labs done. Don't be afraid to change doctors. I know this from personal experience. I am also a registered nurse.
- julia
March 19, 2009 6:57 p.m.
I have dealt with depression/anxiety quietly for many years before i finally could not take it any more and asked for help....I originally started taking Lexapro and had good results but had to take half the lowest dose, but then i noticed i was unable to reach orgasim and that was never a problem before, then i was switched to Wellbutrin XL and just felt like i was worse; the anxiety was absolutely aweful! Im now trying Pristiq and am feeling better but once again am having a HUGE problem.....NO orgasims once again! I enjoy sex, have the drive and never had problems before even with the depression! Is something like viagra an option for me? HELP! I dont want to choose between taking the medication and sex.
- Mrs. Smith
March 10, 2009 4:21 p.m.
I have been on Prozac and Wellbutrin for over 2 years, and I also go in for once a month ECT maintenance treatments. Which would be the big culprit for my inability to get excited about sex? I have difficutly also trying to excite myself. I wish there was a magic pill for depression and sexual disfuntion.
- bunalee
February 17, 2009 7:39 a.m.
I have been on Tranxene since 1986, I had anxiety-panic attacks everyday before that. It helps me function normally. Now I take Tranxene and Cymbalta due to a sudden depression 4 years ago. I have no sex drive what so ever, no men or (women) attracks me. How can I go off the Tranxene and Cymbalta since I feel that I am no longer depressed or fear of a relapse regarding my anxiety-panic attacks. When I reduced my Tranxene intake by 1 per day, I felt a little funny inside, like needles into my body for seconds at the time. Is it normal?
- Maria
January 3, 2009 10:51 p.m.
I found this article to be very vague and opinionated. It was of no help at all!
- ms. cleo
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
August 7, 2008 1:06 p.m.
Since being diagnosed with coranory artery disease, I look back and realize that probably it was the CAD that caused me to be tired and depressed for two years. Have been on Zocor which has helped the depression. Am now in cardiac rehab.
- maggie
August 7, 2008 9:14 a.m.
are there any proven effective natural treatment such as diet, exercise and vitamin supplements to treat depression.
- lisastand
August 6, 2008 5:19 p.m.
I am currently taking two kinds of antidepressants - Seroquel and Lexapro. My doctor prescribed Viagra for sexual disfunction several years ago. It works quite well for me as long as I take it at least an hour before I need it. For that reason I prefer Levitra as it lasts for up to 36 hours. I have had no problems with either.
- anxious
48 comments posted