Sign Up Now For
HEALTHbeat
Our FREE E-mail Newsletter

In each issue of HEALTHbeat:

  • Get trusted advice from the doctors at Harvard Medical School
  • Learn tips for living a healthy lifestyle
  • Stay up-to-date on the latest developments in health
  • Receive special offers on health books and reports
  • Plus, receive your FREE Bonus Report, Living to 100: What's the secret?

[ Maybe Later ] [ No Thanks ]

Check out these newly released Special Health Reports from Harvard Medical School
Learn How

New Releases

You can't buy good health but you can buy good health information. Check out these newly released Special Health Reports from Harvard Medical School:

Dealing with sexual side effects

MAY 2008

Did you know?

You can get instant online access to all of the articles from the May 2008 issue of Harvard Mental Health Letter for only $5.

Already a subscriber? Login for complete instant access.

If you want a button/link to remove the box (not sure if you do or not...), it would look like this: Cancel

 

Options for people with depression and other psychiatric disorders.

Some psychiatric disorders — or the medications that treat them — impair sexual functioning. Most research has focused on depression and antidepressants, but sexual dysfunction also affects people with anxiety disorders, bipolar and other mood disorders, and schizophrenia. Coexisting disorders, such as heart disease, diabetes, arthritis, or cancer, may further impair sexual function.

Studies have found that about 35% to 50% of people with untreated major depression experience some type of sexual dysfunction. Yet antidepressants may also impair sexual function. For example, selective serotonin reuptake inhibitors (SSRIs) prevent or delay orgasm in 30% to 40% of patients, decrease libido in about 20%, and impair erectile function in about 10% of men.

Fortunately, there are steps people with depression and other psychiatric disorders can take to improve sexual functioning. Although this article focuses mostly on depression, the advice may also apply to other psychiatric disorders.

Impact of medications on sexual functioning

Drug class

More sexual side effects

Fewer sexual side effects

Antidepressants

citalopram (Celexa)

fluoxetine (Prozac)

paroxetine (Paxil)

sertraline (Zoloft)

bupropion (Wellbutrin)

duloxetine (Cymbalta)

mirtazapine (Remeron)

Antipsychotics

clozapine (Clozaril)

risperidone (Risperdal)

aripiprazole (Abilify)

olanzapine (Zyprexa)

quetiapine (Seroquel)

Sedatives

diazepam (Valium)

thioridazine (Mellaril)

buspirone (BuSpar)

 

Medication options

Some of the following options work better than others, but all are worth considering.

Wait it out. If the medication causing sexual side effects has just been prescribed, wait a while to see if the problems diminish.

Lower the dose. A lower dose of a psychiatric medication may reduce its sexual side effects. However, it may be difficult to do this while still remaining in the therapeutic range necessary to avoid relapse.

Schedule sex. If a patient finds that the medication produces more pronounced side effects at particular times of the day, it may be possible to schedule sexual activity for the time when side effects are least bothersome — or to take the drug at a different time.

Switch psychiatric medications. Some psychiatric medications are less likely than others to cause sexual side effects (see table). Different people also react differently to various medications. Switching to another medication might help. Just be aware that this may only trade a sexual problem for some other side effect, such as weight gain or dry mouth. Although clinicians usually recommend switching medications only when symptoms of the psychiatric disorder have not responded to an initial medication, an intolerable side effect is also a legitimate reason to switch. If you had enjoyed some relief of psychiatric symptoms with a medication, it's important to make a slow transition to a new drug to minimize the risk of a relapse.

Add a drug. The most common solution to alleviating sexual problems caused by psychiatric medications is to start taking an additional drug that specifically targets sexual dysfunction. Studies have found that sildenafil (Viagra) and tadalafil (Cialis) may improve SSRI-induced erectile dysfunction. A study involving men who experienced SSRI-related sexual impairment, for example, found that almost 55% reported that their sexual function was much or very much improved after taking sildenafil, compared with 4% of those taking placebo. For women, however, the results have been relatively disappointing.

Other drug options include bupropion (Wellbutrin), which may counter SSRI-induced sexual dysfunction or even boost sexual response. One double-blind placebo-controlled study found that bupropion increased sexual desire in women with low libidos. Still another option is buspirone (BuSpar), which may restore the ability to have an orgasm and increase libido.

 

Psychotherapy

Sex therapists have specialized training to address sexual problems, but often this degree of expertise is not necessary. A mental health professional with general training can also be helpful. The role of therapy is to help people explore their sexual concerns, better communicate their needs, and expand their repertoire of sexual and sensual activities.

Finding the right mix of medication and psychotherapy may take some time, but it is possible to enjoy a satisfying sex life even while keeping psychiatric symptoms under control.

Segraves RT. "Sexual Dysfunction Associated with Antidepressant Therapy," Urologic Clinics of North America (Nov. 2007): Vol. 34, No. 4, pp. 575–79.

For more references, please see www.health.harvard.edu/mentalextra.