Many antidepressants, if not most of them, can cause poor libido, inability to have an orgasm, erectile dysfunction in men, etc. When antidepressants increase serotonin in the brain to help depression and anxiety, they also increase serotonin in the spinal cord which may disrupt sexual functioning at the same time. This serotonin over-activity may cause sexual problems. Unfortunately, it is very clear that stopping an antidepressant too quickly will often result in the major depression symptoms coming right back.
Below are some ideas about how to avoid sexual side effects or treat them if they happen to you.
1) Use psychotherapy to treat your depression or anxiety. Psychotherapy has no sexual side effects and in many studies is shown to be as effective as medications in helping depression or anxiety. Consider a bona fide course of psychotherapy such as cognitive behavioral psychotherapy, interpersonal psychotherapy, or psychodynamic psychotherapy as these specific types of psychotherapy have well documented outcomes in the treatment of depression and anxiety
2) Ask your doctor to choose an antidepressant with less sexual side effect risk. Bupropion (Wellbutrin) antidepressant products do not manipulate serotonin at all and are considered to be sexual side effect free by many doctors. Trazodone (Desyrel, Oleptro) products manipulate serotonin mildly and through a different mechanism and appear to have less sexual side effect problems as well. In treating certain forms of anxiety, buspirone (BuSpar) also is known for producing fewer sexual side effects.
3) If you have to be on a serotonergic antidepressant and develop sexual problems, consider asking your doctor for an antidote. Almost none of these medications are FDA approved for improving sexual functioning, however many psychiatrists use them in order to lower sexual side effects while keeping their patient on an effective serotonin antidepressant. Patients will have to take two medications at the same time but often two medications may improve depression more substantially and also lower sexual side effects at the same time. Erectile dysfunction medications (sildenafil — Viagra — etc. ) may specifically help men and they can be used as well.
4) Just bite the bullet. Sometimes, patients cannot avoid being on serotonin-based antidepressants. These antidotes may not be safe for the individual patient or may not work for the patient. In this case, patients will have to decide to have continued good antidepressant effect but suffer sexual side effects or risk discontinuing the antidepressant and a possible relapse into major depression. Often times, depression is treated from six months to a year with good antidepressant treatment. Giving up sexual functioning for a year might be worth keeping the depression away.
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