Common Anti-depressants and Female Sexual Dysfunction
The most commonly used class of antidepressants called selective serotonin re-uptake inhibitors (SSRIs) have quickly risen to the top of the charts for their effective ability to treat depression (see bottom of page for list of names). However, there is one big problem: SSRIs have a negative effect on a womans normal sexual functioning. In fact, many women experience these negative effects to such a severe extent that it results in them ending treatment altogether. Luckily, this negative side effect has been recognized and a variety of options have been developed to deal with this problem.
Some may be worse than others, but maybe not for women
All SSRIs seem to cause sexual dysfunction, yet there is some variation within this class of drugs. Prozac is the worst SSRI for libido, decreasing it in 11% of its patients. Following behind are Paxil (3.3%), Luvox (2%), and Zoloft (1.7%). But, in one study using only women, there was no difference between the major brands in womens sexual dysfunction. It is not clear if this finding should be taken at face value, though. (See Gender Differences below)
The Problem is Much Worse Than the FDA Implies
Many studies find rates of sexual dysfunction dramatically higher than the official FDA statistics. It is likely that the FDA, when preparing its list of adverse reactions to a certain drug, requires patients to spontaneously report any symptoms or side effects (as opposed to directly asking them if they are experiencing a certain side effect). This means that many cases of sexual dysfunction may go unreported, as people may be hesitant to report it or do not think of it.
In fact, one particular study found that only 14% of patients spontaneously reported SSRI-dependant sexual dysfunction. However, when the doctor asked about it specifically, sexual dysfunction was actually found in 58%. Also, one study on Paxil showed that 50% of patients were affected by decreased libido! This same problem may be behind the failure to document the full range of sexual dysfunctions by the FDA that are found in many other studies. These include decreased libido (desire), arousal, intensity of orgasm and other symptoms.
Gender Differences In The Drugs Or Gender Bias In The Research?
One particular study showed that men display more symptoms of sexual dysfunction, while women experience their symptoms more intensely. And as mentioned, another found no difference in rates of dysfunction with different drugs in women, unlike men. This may not be true.
It is very possible that the results reflect survey questions are geared towards men. These studies often look at aspects of sexual dysfunction that are uniquely male (delayed ejaculation, inability to ejaculate, and impotence), in addition to ones that are gender non-specific. The more symptoms a person is asked about, the more likely they are to say yes to at least one of them. No studies were found that surveyed decreases or failure to have multiple orgasms or any other female-specific sexual side effects.
It could be that womens dysfunction is not picked up on these surveys until it is very severe. Overlooking the mild to moderate womens symptoms would give the false appearance that womens dysfunction is less but more intense. Women are slower to orgasm than men in the first place, so perhaps orgasmic delay is missed when studying women.
What To Do
If an SSRI is only being taken for acute treatment and the only problem with it is that it causes a decrease in libido, the best thing to do might be to just deal with it during these short time-spans. However, if the drug is being used chronically, the woman will probably want to do something to get rid of this negative side effect. Sometimes, after the body gets used to the drug, a side effect can simply go away. If this does not happen (or if the patient just does not want to wait), here are some other options to consider:
a. Reduce the dosage: Side effects (including loss of libido) are dosage-dependant. Therefore, it is possible to reduce the dosage enough so that the patients libido will be restored while still maintaining the anti-depressive benefits. Unfortunately, one study showed that 81.4% of patients suffering from SSRI-dependant sexual dysfunction had no improvement even after 6 months.
b. Take a drug holiday: This involves taking some time off from the drug in order to revive the patients libido for a short period of time. However, this cannot be done with all of the SSRIs; a drug holiday can only be taken from those with a short half-life, which refers to the amount of time a drug will remain in the body before it is eliminated. Prozac is the only SSRI that cannot have a holiday, since its half-life is so long that, even upon stopping the drug; it will remain in the bodys system for weeks. Fortunately, a holiday can be taken from Zoloft, Paxil, and Luvox, as their half-lives are all short enough that the body can eliminate the drug fairly quickly (26, 21, and 15.6 hours respectively).
c. Typically, the patient takes the pill on Thursday. Libido resumes on Friday and then its off you go for the second honeymoon weekend. The next pill is taken Monday. Most patients dont get a noticeable return of depression. A woman should never spontaneously take a drug holiday, though; be sure to consult a doctor first on how to do it.
d.Switch antidepressants: There are some antidepressants that dont have such a negative impact on a patients libido. Consider ending the use of the SSRI, allowing the body to wash it all out of its system, and then starting up again on a different drug such as Wellbutrin or Manerix. Many studies have shown the positive effects of Wellbutrin on libido. In one study, 81% of patients who had switched from Prozac to Wellbutrin experienced a significant increase in libido. The only problem with Wellbutrin is that it cannot be used for the treatment of obsessive-compulsive disorder. Therefore, those taking Prozac for this reason cannot make this switch. Manerix also has a positive effect on libido; in one study that involved switching from Prozac to Manerix, all of the patients reported resolution of their sexual dysfunction. Remeron and Serzone also have been recommended.
e. Use antidotes: These are drugs that contain 5-HT2, alpha2 adrenergic receptor antagonists, and dopamine receptor agonists.
f.Increase clitoral stimulation: If the woman is having trouble with her orgasms, it may not be due to the medication at all. A majority of the traditional sexual positions to not supply the woman with enough clitoral stimulation for her to orgasm. The woman should try informing her partner of this and see if it helps.
Before messing with the drug, all patients should be aware that depression and sexual dysfunction often go hand-in-hand. Therefore, loss of libido in someone who suffers from depression may not be due to the SSRI alone. The cause of this loss of libido should be determined before deciding upon a course of action to treat it.
If A Male Partner Is On SSRIs
There is in fact at least one benefit of the sexual side effects that SSRIs cause. Studies have shown that the use of an SSRI has a positive impact on men suffering from premature ejaculation, as the SSRI can cause delayed ejaculation. With this side effect, a womans sexual satisfaction can be greatly enhanced.
Here is a list of the most commonly used SSRIs:
a. Prozac (fluoxetine)
b. Paxil (paroxetine)
c. Zoloft (sertraline)
d. Luvox (fluvoxamine)