Lacking Libido? Are Antidepressants to Blame?
Men at their sexual prime who take antidepressant medicine are commonly faced with the embarrassment of loss of libido and ]]>erectile difficulties]]>. These side effects may be so upsetting that they choose to stop taking their antidepressant medicine. The result could be deadly.
In the general male population, 16% of all men have a decreased libido and 6%-10% have erectile difficulties. These percentages increase dramatically in men as they age and in men with untreated ]]>high blood pressure]]> or untreated major ]]>depression]]> . When antidepressant medicine is used to treat depression, it causes sexual dysfunction in at least 30%-60% of the men and women who take it. In many, the primary sexual dysfunction is delay of orgasm, but a variety of other side effects may occur.
The Biology of Sexual Function
Your sexual response consists of four phases:
- Sexual desire (libido) is dependent on hormonal factors and mental stimuli involving all your senses: touch, sight, taste, smell, and sound.
- Sexual excitement or arousal is characterized by penile erection and vaginal lubrication. These are the result of an increase in blood flow to the area and an alteration in your brain chemicals.
- Orgasm is the climax of sexual pleasure and is in response to hormones and brain chemicals.
- Resolution involves the release of sexual tension; you know it better as "afterglow."
Your Brain Has Control
Brain chemicals control your sexual response, so any drugs or conditions that alter your brain chemistry can alter your sexual response. Dopamine is a type of brain chemical known as a neurotransmitter. Dopamine is very important for pleasure and reward, and an increase in dopamine activity may enhance the sexual response. Conversely, blocking dopamine may compromise the response.
Serotonin is a neurotransmitter present in significant quantities in areas of the brain responsible for feelings and emotion. Low serotonin levels can lead to depression and other conditions. The idea behind widely prescribed medicines, such as ]]>fluoxetine]]> (Prozac), ]]>paroxetine]]> (Paxil), and ]]>sertraline]]> (Zoloft), is to keep levels of serotonin circulating longer by preventing its uptake and breakdown. But at the same time that these drugs are increasing serotonin activity and relieving depression, sexual response may be diminished.
You Are Not Alone
Sexual function is an important component for quality of life and is often affected by antidepressant treatment. In fact, over 50% of the men who take antidepressant medicines, such as Prozac and Zoloft, experience sexual dysfunction. Many men are embarrassed and don't tell their doctors, but this is a mistake. You should report changes in sexual functioning to your doctor because he can help treat the problem. It is important that you do not stop taking your medicine.
Sexual dysfunction may not be a huge issue for patients receiving short-term antidepressant treatment. However, inadequate sexual functioning can offset the antidepressive benefits of long-term treatment. Sexual difficulties could theoretically cause patients to stop treatment and relapse into a deep depression.
There are numerous treatment options if your medicine does cause sexual dysfunction. They include decreasing the dosage, taking drug "holidays," adding another drug to counteract the problem, or switching to another drug. However, all of these changes should be prescribed and supervised by a doctor. Unfortunately, none of these options have been successful in treating antidepressant-induced sexual dysfunction in all individuals.
There are some antidepressant medicines that provide short and long-term medical benefits that do not have sexual side effects. These include:
The use of ]]>Ginkgo biloba]]> for the treatment of antidepressant-induced sexual dysfunction was discovered purely by chance. A 65-year-old man was taking an antidepressant drug, which increased his serotonin levels. As a result, he experienced a loss of libido and erectile difficulties. While on vacation, he met numerous senior citizens that were taking ginkgo for memory enhancement. After consulting with his doctor, the man began taking ginkgo. To his delight, after four weeks of taking ginkgo, his libido and erections improved. While still taking the antidepressant medicine, he stopped taking the ginkgo, and his sexual problems returned. His sexual problems diminished when he resumed taking the ginkgo along with the antidepressant medicine.
For a drug effect to be real, it must occur in more than just one person. To raise the ante, so to speak, Drs. Alan J. Cohen and Barbara Bartlick conducted a clinical trial that included 63 men and women taking antidepressant medicine and suffering from antidepressant-related sexual side effects. The results were published in the 1998 issue of Journal of Sex and Marital Therapy . The participants were given up to 120 milligrams of ginkgo extract twice a day along with their regular antidepressant medicine. Sexual dysfunction was tested before and after four weeks of ginkgo treatment.
In 84% of the patients, ginkgo alleviated antidepressant-induced sexual dysfunction. The patients reported an improvement of all four phases of the sexual response cycle: desire, excitement (erection and lubrication), orgasm, and resolution (afterglow). Of the patients who experienced an improvement, all were satisfied with the results and requested to continue taking ginkgo. No adverse side effects were reported, indicating that ginkgo is compatible with antidepressant medicines.
In this study, everyone received ginkgo. Therefore, we don't know whether the improvement on sexual performance was a placebo effect (everyone thinks there is a benefit, but in reality there is no change) or a real finding. Researchers have addressed this issue by conducting ]]>double-blind studies]]>, where neither the patients nor the administrators know which group gets the treatment and which group gets the placebo. These more recent, double-blind studies have found that ginkgo was no more effective than placebo.
If you are interested in learning about other natural and alternative treatments for depression, ]]>click here]]>.
Safety Issues With Herbs and Supplements
There is a common misconception that herbal remedies are safe because they are natural. This is not necessarily true. Herbal remedies can produce adverse drug reactions similar to typically prescribed drugs. Any adverse drug reactions to an herbal remedy, such as ginkgo, should be reported to your doctor.
It is also important to remember that in the US herbal remedies are classified as dietary supplements. And because of this, they are not subject to review or regulation by the Food and Drug Administration. In fact, different companies have been known to use different plants or parts of plants, but the labels may seem to indicate that they are the same product.
Side effects associated with ginkgo include: stomach and intestinal upset, headache, dizziness, and allergic skin reactions. More serious, potential side effects include the risk of internal bleeding; the herb should not be used if you are going to have surgery or if you have a bleeding problem. Ginkgo may also interact with blood-thinning medicine, like ]]>warfarin]]> (Coumadin). In addition, the American Herbal Products Association states that ginkgo may increase the activity of monoamine oxidase inhibiting drugs (MAOIs) and a number of anti-tuberculosis drugs.
Before taking any herb or supplement, talk to you doctor. There could be side effects if you are taking other medicines or if you have a condition.
What Should You Do?
Above all, discuss your symptoms with your doctor. It may seem embarrassing to talk about sexual problems, but doctors recognize that antidepressants commonly affect sexual health. And your doctor will likely be receptive to talking about this sensitive topic.
Canadian Network for Mood and Anxiety Treatment
Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J of Sex and Marital Therapy . 1998;(24):139-143.
Ginkgo. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated April 2009. Accessed May 5, 2009.
Kang BJ, Lee SJ, Kim MD, Cho MJ. A placebo-controlled, double-blind trial of Ginkgo biloba for antidepressant-induced sexual dysfunction. Hum Psychopharmacol. 2002;17(6):279-84.
Nikles CJ, Clavarino AM, Del Mar CB. Using n-of-1 trials as a clinical tool to improve prescribing. Br J Gen Pract. 2005;55(512):175-180.
Wheatley D. Triple-blind, placebo-controlled trial of Ginkgo biloba in sexual dysfunction due to antidepressant drugs. Hum Psychopharmacol. 2004;19(8):545-548.
Last reviewed January 2009 by ]]> Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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