About 1 in 8 Americans — or 13 percent — take an antidepressant, based on the latest data from the National Center for Health Statistics.
Commonly used to treat depression as well as anxiety, the drugs are prescribed for a range of disorders and medical conditions, from post-traumatic stress disorder to chronic pain. Women, who are about twice as likely to be diagnosed with depression as men, are also about twice as likely to report taking an antidepressant, according to an NCHS report released last year.
While effectiveness varies by the individual, clinicians say antidepressants are often a useful tool, and in some cases — when a patient is suffering from severe depression — may be a lifesaver. But from nausea, insomnia and irritability to constipation, the drugs can also cause unpleasant side effects. Among those, many who take antidepressants struggle with another common and particularly bothersome concern that’s often not discussed between doctor and patient: sexual dysfunction.
Experts say all antidepressants can potentially cause sexual side effects, though some more than others, like the class of antidepressants that’s most prescribed today. “The selective serotonin reuptake inhibitors — the SSRIs — are the most common,” says Dr. Nolan Williams, an instructor of psychiatry and behavioral sciences at Stanford University. “And that’s the one that is the most problematic for these sort of side effects.” About one third to one half of those who take SSRIs will experience sexual side effects, he says.
[See: 8 Medications That Treat Multiple Conditions.]
That can run the gamut in the bedroom, touching all aspects or phases of sexual function. “It can affect desire, arousal and orgasm,” says Dr. David Hellerstein, a professor of clinical psychiatry at Columbia University Medical Center. “The thing that people most often complain about first is if it’s a problem with orgasm, because they will be very frustrated with that. But then they may mention those other two areas as well.”
Many taking antidepressants experience reduced sexual interest or low libido; and men may suffer from erectile dysfunction.
What’s tricky is that conditions treated with antidepressants, like depression, also tend to cause sexual issues; and by treating depressive symptoms, as well as other conditions that can interfere with intimacy, sometimes antidepressants can improve a person’s sex life. So it can often be difficult to determine whether it was the underlying condition or an antidepressant (or both) that may contribute to sexual dysfunction. However, experts say it’s important that clinicians address these issues with patients, since sexual problems can strain relationships and undermine quality of life and throw a wrench in treatment — or halt it all together if a patient stops taking an antidepressant as a result.
Yet commonly patients never broach the subject and doctors never ask what sexual side effects patients may be experiencing. “Despite the fact that most doctors know that these are an issue, very rarely do they assess for sexual side effects,” says Tierney Lorenz, an assistant professor of psychology at the University of North Carolina–Charlotte, “and if they do, most often they kind of take a wait–and–see approach — which is sometimes useful, but often demoralizing for these patients.” Lorenz was the lead author of a review of medical research evaluating antidepressant-induced sexual dysfunction in women. The review for clinicians, published in the journal Mayo Clinic Proceedings in 2016, laid out studied options for addressing these issues.
For women and men who experience sexual dysfunction while taking an antidepressant, experts emphasize it’s key not to wait to speak up about concern, and to expect the doctor to be proactive in working with you to help manage sexual side effects. “It’s not an inevitable thing that someone just has to live with,” Hellerstein says. “There’s ways to manage the problem.”
As with some other drug side effects, sometimes sexual dysfunction can be transient — after a patient adjusts to the medication, they’re able to enjoy sex again. But often that isn’t the case, and taking too much of a wait-and-see approach puts those taking antidepressants in a difficult position. Research shows sexual side effects tend to begin in the first weeks of treatment, frustratingly, even before medication effects, like improvement in mood, kick in. “Helping patients navigate this critical window can considerably improve long-term treatment adherence and prevent premature discontinuation of medication,” Lorenz and her co-authors wrote in the Mayo Clinic Proceedings review.
[See: These Medicines May Cause Bone Loss.]
Among many options that may be advised to manage sexual side effects is switching antidepressants. “There are some antidepressants that have a lower — not zero, but lower — incidence of sexual side effects,” Hellerstein says. For example, a doctor might suggest replacing an SSRI with a medication from a different drug class, like the antidepressant Wellbutrin, or bupropion. Of course, some medications work better — or are less effective — than others for different individuals; and if a patient is responding well to an antidepressant, switching drugs may not be a viable option, clinicians say. The same is true for changing drug dosing, which is sometimes done to reduce side effects, but often is inappropriate because a lower dose wouldn’t be adequate for treatment. In such cases, Wellbutrin or other medications may be prescribed in addition to the antidepressant the patient is already taking in an effort to offset sexual side effects.
Adjusting the timing for taking an antidepressant on a given day is another strategy. So if a person took the antidepressant in the morning the day before and waited until that evening to take it again, that could provide a window of opportunity for presumably better sex (or having sex at all if a couple hasn’t been) when the blood level of a drug is lower. “That requires people to be less spontaneous,” Hellerstein says. “So a lot of people are not thrilled with that. But for some people who don’t want to add a second medicine and can’t switch — that can work for them.”
Another move is something called a “drug holiday,” Williams noted, whereby a person would come off of an antidepressant for say a day or even the weekend. But experts emphasize that’s something patients should discuss with a doctor first and that factors such as severity of a patient’s depression would need to be taken into account. And the Mayo Clinic Proceedings review cautioned against it: “A drug holiday (e.g. temporarily discontinuing the drug on weekends) is not recommended because it may induce withdrawal symptoms related to discontinuation, particularly with shorter-acting antidepressants. Additionally, this practice may lead to medication nonadherence and relapse in patients who fail to restart the medication.”
Less controversially, behavioral changes can also help, like getting your blood pumping before sex. Research finds that just as exercise can reduce symptoms of depression, it may help squelch antidepressant sexual side effects. Men and women may benefit; but speaking specifically about its impact on women, Lorenz says, “scheduling exercise to happen immediately prior to sexual activity appears to boost the underlying nervous system activity that’s necessary to support sexual arousal.”.
Changing things up in bed may also make a difference. “For women experiencing arousal and orgasm adverse effects, more intense stimulation with the use of a vibrator may help counter decreased tactile sensitivity related to an antidepressant,” Lorenz and co-authors noted in Mayo Clinic Proceedings.
Therapy may also help in talking through concerns related to sexual issues. Often the recommended treatment for many mental health disorders that antidepressants are prescribed to treat is medications and therapy; and it may be that therapy alone is sufficient.
[See: 5 Questions to Ask Your Doctor Before You Fill That Prescription.]
Finally, for those whose doctors recommend continuing on antidepressants, it’s key not to expect that sexual side effects will just go away, experts say — even with strategies to reduce them. Instead the focus should be on managing those, Lorenz notes, to have “a happy, healthy sexual life — however the patient defines it.”
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How to Deal With Sexual Side Effects From Antidepressants originally appeared on usnews.com
