Gettysburg Medical Center
The Clinical View
by P.E. Hoffsten, MD
26 September 2007

SEXUAL SIDE EFFECTS OF ANTIDEPRESSANTS

            There probably isn’t a topic of human behavior more sensitive or controversial or diverse than sexuality.  You could always tell when Mom or whoever she was talking to were discussing sex because their voices went down to a whisper and they got this funny kind of guilty look on their face.  It isn’t a whole lot different today when patients come to the doctor and want to talk about sexual problems.  I recently was struck by three patients in one week who came with the same problem.  It seemed a reasonable topic for a column.

            As an example, one of these individuals with this concern had been coming to me for several years because of depression problems.  He was 44-years-old and worked in a local firm with a responsible job. Although his life had been going very well, he had become depressed.  Note that depression ran in his family and he was aware of the issue by the time I first saw him.  After a long discussion, he was started on a product called Zoloft several years ago.  This is a so called serotonin re-uptake inhibitor of which Prozac, Paxil, Celexa, and Lexapro, are all members.  The medication had worked very well for him.  After about six months, the medication was discontinued as perhaps no longer necessary.  However, over the next several months he relapsed and the medication was restarted.  It has been continued ever since at his request.  But on this occasion, he came to the clinic with his wife and after discussion of several other medical considerations, he and his wife sort of looked at each other anticipating.  Just like my mom, their voices went down an octave and they got a kind of funny guilty look on their face and she said she wanted to talk about his antidepressant.  She had read that it decreases sexual function.  Without delving into details, I acknowledged that was a side effect that some individuals experienced.  Then they both wondered if there wasn’t some other antidepressant that they might use.  They also wondered how and why the Zoloft acted as it did and would other antidepressants have the same side effect. 

            I explained to them that anxiety and depression both have their roots in the same ground.  Depression basically comes when a person cares intensely about some or all aspects of life.  But for some reason, they feel unable to deal with these aspects of life.  Anxiety results from the same problem of caring too much and being afraid of what the future holds.  The SSRI group of antidepressants basically works by turning down how much a patient cares.  When the person cares less intensively, their concern about the future lessens and the depression and the anxiety get better.  Please note that anxiety and depression are real and legitimate emotions under the right circumstance.  But in some situations such as this gentleman above, he freely acknowledged that he did not have major concerns about his future and yet he was depressed anyway.  Thus, if use of a medication allows him to become more functional, it is a legitimate use. 

            But with the decreased caring about the problems of the world, comes a decreased caring about a number of aspects of life.  Sexuality can be one of these.  It doesn’t happen to everyone who uses an SSRI but it is an important side effect in some individuals.  The side effect is not necessarily a decreased ability to have sexual activity but rather a decreased desire in seeking sexual activity.  As a side note, it might be said that some spouses welcome this side effect in their mate but that was not the case with this couple.

            I indicated to this couple that there were other antidepressants that might be tried and were less likely to cause this side effect.  Specifically, Wellbutrin (bupropion) works better for some individuals.  This couple inquired as to whether a testosterone supplement or the use of a product such as Viagra might be helpful for them.  After discussion, it appeared that their basic problem was one of interest, not capability and thus testosterone or Viagra probably would not be useful for them. 

            I have never really understood why sexuality is such a sensitive topic.  But problems such as this are certainly reasonable points to bring up with a physician or a healthcare provider.  Since the Viagra ads have come out on TV, the erectile dysfunction problems are much more commonly discussed than they used to be and also much more effectively dealt with.  Invariably when a gentleman comes to the clinic because of an erectile dysfunction problem, he first thinks that it is one of his medications causing the problem.  With the competitiveness of today’s pharmaceutical industry, most of the medications that might be causing erectile dysfunction have long since left the market.  The unfortunate truth is often that the person is drinking excessively or smoking cigarettes both of which are the leading most common cause of erectile dysfunction.  The next most common problems causing erectile dysfunction are diabetic nerve disease, heart failure, deconditioning, and then finally medication side effects.  The health care providers at your local clinics are able to help with these problems or refer a person for specialty care when needed. 

This and other columns available at www.macpierre.com.