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.
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.
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:
As you adjust to your new medicine, the sexual side effects may go away.
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:
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:
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.
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.
RESOURCES:
American Psychological Association
http://www.apa.org/
Food and Drug Administration
http://www.fda.gov/
CANADIAN RESOURCES:
Canadian Psychiatric Association
http://www.cpa-apc.org/
Canadian Pharmacists Association
http://www.pharmacists.ca/
References:
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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