Antidepressants And Sexual Side-Effects

As if battling depression is not enough many antidepressants also causes sexual side effects in the patients. Some antidepressants may cause sexual dysfunction to less intensity as compared to others.

Antidepressant Related Side Effects In Men And Women

A wide range of undesirable effects may occur while taking antidepressants. These effects may range from anxiety to issues related to gut. Given below are the sexual side effects that this class of drugs causes:

• Diminished libido
• Lack of sexual excitement
• Improper orgasm
• Lack of sensation
• Persistent genital arousal
• Compromised erection
• Painful erection
• Painful ejaculation in men
• Lactation in women (regardless of breastfeeding or pregnancy)
• Numbness in the nipples and vagina

The mechanism behind such side effects, after taking antidepressants is not clearly understood. Sometimes sexual side effects may occur from depression itself. Putting the finger on the cause may be difficult at times.

Since the antidepressant class of drugs is further divided into subclasses, therefore each subclass has its own mode of action, like SSRIs (selective serotonin reuptake inhibitors) elevate the serotonin levels within the brain. Serotonin uplifts the mood and alleviates depressive symptoms however too much of it can adversely affect the sex drive.

As serotonin and dopamine have an inverse relation so when serotonin goes up, dopamine, responsible for stimulation, goes down. This may contribute to a lack of sexual excitement.

Antidepressants And Associated Sexual Adverse Effects

• SSRIs: SSRIs usually cause a lot of sexual side effects. These drugs include Prozac, Zoloft and Paxil.
• TCAs (Tricyclic antidepressants): 7.7-10 % of the depressed people may experience sexual side effects after initiating treatment with Amitryptyline. Therefore, in many of the patients, it is a safer option in contrast to SSRIs.
• 5-HT2 blockers: The risk of sexual dysfunction is less with the use of 5HT2 blockers compared to SSRIs. Mirtazapine causes sexual dysfunction in 24% of the patients whereas nefazodone causes sexual side effects only in 8% of the patients. The figures are still very down than those of SSRIs.
• MAOIs (monoamine oxidase inhibitors): The risk of sexual dysfunction depends upon the category of MAOIs like phenelzine can cause sexual side effects in almost 40% of the patients.
• Reversible inhibitor or monoamine oxidase A (RIMA): Meclobemide, (drug belongs to a subclass of antidepressants), has comparatively lower incidence of causing sexual dysfunction or related side effects. Only 4% of patients experience sexual side effects from this drug.

How To Manage The Side Effects Associated With Antidepressants?

Side effects can also be dealt with proper management and various approaches. Given below are the ways to manage sexual side effects of antidepressants:

• Alternative medication: Per your doctor’s recommendation, medication may be switched or an alternative may be used to prevent persistent, severe and undesirable sexual side effects.
• Adjusting the dose: Dose dependent side effects are very common with antidepressants. So the treatment usually begins with the smallest effective dose and may be increased up to the desired level. Upon experiencing side effects, the dose should be monitored on the routine basis.
• Self-approach: To come back in the game, foreplay and other such intimating acts may be used to ignite the fire. Easing the mind may help in naturally picking up the libido.

References:

• Clayton, A. H., Croft, H. A., & Handiwala, L. (2014). Antidepressants and sexual dysfunction: mechanisms and clinical implications. Postgraduate medicine, 126(2), 91-99.
• Reichenpfader, U., Gartlehner, G., Morgan, L. C., Greenblatt, A., Nussbaumer, B., Hansen, R. A., ... & Gaynes, B. N. (2014). Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug safety, 37(1), 19-31.