Sex Rx: Paxil and Your Sex Life
]]>Paroxetine]]> (Paxil) is widely used in the United States. It is most often prescribed for ]]>anxiety]]> and ]]>panic disorder]]>, ]]>depression]]> , ]]>obsessive-compulsive disorders]]>, ]]>premenstrual mood disorder]]>, among other conditions. While Paxil is effective in treating these disorders, it has been associated with sexual problems.
How Paroxetine Works
Paroxetine is one of a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These medicines work by blocking the reuptake of the brain chemical serotonin, which helps regulate mood.
Other Drugs of This Class (SSRIs)
Possible Sexual Side Effects Associated With Paroxetine
- Decreased sexual desire
- Difficulty reaching orgasm, especially in women
- Erection impairment in men
How It Causes Sexual Problems
It is not yet clear how SSRIs affect sexual function. The effects are believed to be related to the increased level of serotonin, which may affect sexual reflex centers.
There are a number of alternative treatment options available if you are dissatisfied with your sexual functioning while taking paroxetine. But, it is important to talk with your doctor about your concerns first. Although it can be very difficult and embarrassing to discuss your sexual functioning, it is crucial that you communicate with your doctor about your sexual functioning. Never make any changes to your medicine regimen or start taking new medicines or herbal supplements without your doctor’s knowledge and approval. Here are some possibilities that you and your doctor may decide to have you try:
Wait It Out
As you adjust to your new medicine, the sexual side effects may go away.
Decrease the Dosage
This tactic will work occasionally, but carries the risk of a relapse of the depression or disorder. Never change your dosage without checking with your doctor first.
Since the medical response to SSRIs and other drugs to treat these disorders can vary among people, a doctor will consider the severity of your depression or disorder, as well as your response to the drug before switching to another medicine. When switching is appropriate, some options include:
- ]]>Bupropion]]> (Wellbutrin) —This antidepressant medicine does not affect serotonin. It is less likely than the commonly used SSRIs to cause sexual dysfunction. and may actually have prosexual effects. Bupropion is used to treat a number of conditions, such as major depressive disorder, seasonal affective disorder, and depression with bipolar disorder. It is not recommended for people with eating disorders or ]]>seizure disorders]]>.
- ]]>Nefazodone]]> (Serzone)—This drug does affect serotonin, but not in the same way as SSRIs. It can be used to treat depression and cause fewer sexual side effects. One of its more troublesome adverse effects is sedation.
- ]]>Mirtazapine]]> (Remeron)—This drug is similar to nefazodone in its effect on depression and sexual function. It can also cause sedation.
Try an Antidote
This involves maintaining your current level of paroxetine, while adding a second medicine to offset the sexual side effects. This option is generally less desirable since antidotes frequently have their own side effects and may adversely interact with the primary medicine you are taking. Drugs that may be used as antidotes are:
- Bupropion (Wellbutrin)—This medicine is not recommended for people with eating disorders or seizure disorders.
- Sildenafil (Viagra) and related drugs—may be helpful for the male sexual side effects of SSRIs
- ]]>Amantadine]]> (Symmetrel) —This is an antiviral medicine that has also been studied as an antidote for SSRI-related sexual problems. More studies are needed, though to prove that is actually works.
Take a Drug Holiday
This involves taking your usual Thursday morning dose and then nothing again until noon on Sunday, when you resume your previous schedule.
There is also a risk with this technique that you may feel well enough during the short drug holiday to discontinue your medicine all together, which can lead to a relapse. Furthermore, short-acting SSRIs like Paxil can produce severe withdrawal symptoms in some people unless they are slowly tapered. Again, discuss this option with your doctor before trying it.
Consider Herbal Supplements
The efficacy of herbal supplements to treat the sexual side effects of SSRIs is not clear. Care should also be taken with herbal products because they are not strictly regulated, as drugs are. One herb commonly used to resolve the sexual dysfunction associated with SSRIs is Yohimbine. More studies are needed to determine the effectiveness and safety of these remedies. Be sure that you talk to your doctor before taking any herbs or supplements. They could react with medicines that you are currently taking.
American Psychological Association
Food and Drug Administration
Canadian Psychiatric Association
Canadian Pharmacists Association
DeBattista C, Solvason B, Poirier J, et al. A placebo-controlled, randomized, double-blind study of adjunctive bupropion sustained release in the treatment of SSRI-induced sexual dysfunction. J Clin Psychiatry. 2005;66:844-8.
Ginkgo. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated September 2009. Accessed May 6, 2010.
Mirtazapine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 2010. Accessed May 6, 2010.
Nefazodone. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 2010. Accessed May 6, 2010.
Paroxetine. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated December 2009. Accessed May 6, 2010.
Last reviewed May 2010 by ]]>Brian Randall, 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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