Did you know that over the past two decades the rate of antidepressant use has increased nearly 400%? It is estimated that approximately 11% of all Americans aged 12 and older are now taking some form of anti-depressant medication. According to the US National Health and Nutrition Examination which analyzed data from 2005-2008, antidepressants are now the third most common prescription drug taken by Americans of all ages and most frequently used by those aged 18 – 44 (1).
Unfortunately, depression itself can shoot down your libido and anti-depressant medications don’t usually help matters much within the sexual arena. Anti-depressants allow you to stay on course and enjoy life, but some antidepressants may further lower desire and block the ability to achieve sexual satisfaction estimated affecting 30-50% of individuals taking these medications. Researchers reported that women are 2.5 times more likely to take anti-depressants than men and 23 percent of women aged 40-59 take antidepressants, more than in any other age/sex group (1).
What are anti-depressants and how do they work?
There are many forms of anti-depressants now available on the market and generally work by increasing the amount of neurotransmitters in the brain. In order to synthesize and simplify this huge amount data, I have broken these drugs into 3 main categories and the essential neurotransmitters associated with each of them. Neurotransmitters are chemicals used in the brain to transmit signals between neurons. Serotonin, norepinephrine and dopamine are three of the most critical neurotransmitters involved with depression and anxiety.
1) SSRI’s: Selective Serotonin Reuptake Inhibitors : These work by preventing the reuptake of serotonin ( also known as 5-hydroxytryptamine, or 5-HT) in the brain. This class of drugs include Prozac, Celexa, Lexapro, Paxil, Zoloft and Luvox.
2) SSNRI’s: Selective Serotonin/Norepinephrine Reuptake Inhibitors : work on both norepinephrine and serotonin, allowing for larger concentrations of these neurotransmitters in the brain. Examples of these include Pristiq, Cymbalta, and Effexor.
3) Norepinephrine-dopamine reuptake inhibitors: inhibit neuronal reuptake of dopamine and norepinephrine. Most common drug in this class is Wellbutrin. This medication often causes a moderate increased in sexual drive due to its increased dopamine activity and leads to the least sexual side effects.
The most common side effects of these drugs are nausea, diarrhea, agitation and headaches. Sexual side effects are also very common and include loss of sexual desire, failure to reach orgasm and erectile dysfunction. These are most likely caused by increased serotonin, decreased dopamine, decreased norepinephrine, inhibition of nitric oxide synthetase and elevation of prolactin levels.(2)
According to Dr. Helen Fisher, an anthropologist from Rutger’s University, SSRI’s alter the perception of some emotions related to love, desire and arousal. “There’s every reason to think SSRI”s blunt your ability to fall and stay in love”. During sex, a cocktail of hormones, is released which plays an important role in forming romantic attachment within the brain. Dopamine appears to be the central neurotransmitter affecting romantic love and attachment. Dr. Fisher believes that SSRI’s may also suppress romance.
Given all of this information regarding anti-depressants and potential negative sexual side effects, how can we stir up the flames of sexual desire? Before embarking on any of the following, it is critical that you disclose any side effects with your physician and have a lengthy consultation prior to making any changes.
4 Ways to Light a Fire Under Your Libido:
1) Take a drug holiday : Again, with the advice from your doctor, stop taking the medication for a short period of time. For instance, a “weekend holiday” would involve stopping the medication after the Thursday morning dose and resuming the next dose on Sunday. This “holiday” will lead to decreased levels of medication in your body with the goal of increasing your level of desire.
2) Change the medication: Some of these medications have fewer sexual side effects than others and so discussing possibly changing the type of medication may reduce the negative effect on sexual desire.
3) Change the dose of medication: Lowering the dose of an anti-depressant may decrease the negative impact on sexual desire without changing the benefit in treatment of depression.
4) Consider herbal remedies: Many herbs can effectively battle depression without unwanted side effects and include maca root, saw palmetto, passion flower and ginseng. Speak with your health care provider before starting any herbal remedy.
A new medication now claims to have no sexual side effects – no negative impact on sexual desire or function. Can this really be true?
The newest class of anti-depressants is called indolealkylamines. The indolealkylamines combine the properties of SSRI’s and 5-hydroxytryptamine-1-A (5-HT1A), with the most recent released medication called Vilazodone ( Viibryd) . It works by enhancing serotonin activity in the central nervous system through the selective inhibition of serotonin reuptake and has partial agonist activity at the serotonergic 5-HT1A receptors. Clinical trials with Viibryd have shown no sexual side effects and even a slight improvement in sexual function in men and women. (3) The most common side effects were diarrhea, nausea and headache. (4)
Before you start changing your prescription to Viibryd, it is imperative to note that in the past, many other anti-depressants have made claims of very low rates of sexual dysfunction. Only later, in post-marketing data, did this prove hold true.
Overall, balance again comes into play – balancing the benefit of treatment of depression/anxiety and the potential side effects. By having more knowledge regarding the different types of anti-depressants, their mechanism of action and side effects, you and your doctor can determine the best regimen for you…in and out of the bedroom!
1. National Center for Health Statistics. Health, United States, 2010: With special feature on death and dying. Table 95. Hyattsville, MD. 2011.
2. Keltner, NL et al. (2002). “Mechanisms and treatments of SSRI-induced sexual dysfunction”. Perspectives in Psychiatric Care, 38 (3): 111-6.
3. Rickels, K et al. (2009): Evidence for the efficacy and tolerability of vilazodone in the treatment of major depressive disorder: a randomized, double-blind, placebo-controlled trial. J. Clin Psychiatry ;70(3): 326-333.
4. Khan, A. et al. Efficacy and tolerability of vilazodone, a dual-acting serotonergic antidepressant, in the treatment of patients with major depressive disorder (MDD). Poster presented at American Psychiatric Association, May 22-26, 2010, New Orleans, LA.