A new category of medication has revolutionized the treatment of depression during the past few years. Called selective serotonin reuptake inhibitors, or SSRIs, this class of antidepressants includes such drugs as Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).
These medications have helped many people overcome feelings of depression and allowed them to get on with their lives. Thus, SSRIs have been rightfully dubbed a major advance in medicine. With simple once-a-day dosing and fewer side effects than older drugs, they've been embraced by physicians and patients alike -- so much so that some mental health experts complain that these "fashionable" drugs are sometimes given to people who don't really need them.
By Kimberly Goad
As Amanda Clark, 33, a caterer from Boston, walked down the aisle toward her fiancé, wearing a $15,000 gown and a 7-carat ring, she felt nothing but dread. I don't want to go through with this, she thought, with each step toward the altar.
Just two hours before the ceremony, Clark had gone for a dip in the ocean with her two sisters. When it was time to get ready, Clark wouldn't budge. "I couldn't get out of the water," she says. "It was like knowing you have a work meeting...
But even when SSRIs are prescribed to appropriate patients, they are not perfect. Recently, researchers have found that adverse sexual side effects may be much more common with these medicines than originally believed. So, if you're on an SSRI and you're suddenly having sex life problems -- an inability to get aroused or difficulty reaching orgasm, for instance -- the medicine might be to blame. And it's time to talk to your doctor about it.
Old Studies Versus Newer Studies
Some of the first studies of the SSRIs found that adverse sexual side effects (such as orgasm problems) occur in less than 10% of patients, according to Lawrence Labbate, M.D., Associate Professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, Charleston. But, he points out, those studies relied on unprompted reporting -- patients who spoke up during a doctor visit or called their doctor on the phone when they noticed the sexual problems, so the number of people experiencing such problems was underrepresented.
In more recent studies, doctors specifically asked patients about libido or orgasmic difficulties, and found that they are present in nearly half of patients on an SSRI. Labbate reported this finding in the October 1999 issue of Psychiatric Annals.
Depression or Drugs to Blame?
Exactly how these drugs interfere with sexual desire isn't known. And depression itself, long considered a common cause of sexual dysfunction, may play a role, doctors concede.
Many physicians fail to mention the potential side effect of diminished desire while on SSRIs to their patients. Perhaps this is because they are not aware of recent studies, don't want to scare patients, or are simply short on time. Unfortunately, according to Richard Balon, M.D., Professor of Psychiatry at Wayne State University School of Medicine in Detroit and recent guest editor of the October 1999 issue of Psychiatric Annals, many practitioners don't have the time to inform patients about all of the possible medication side effects.
Without being warned about the potential side effect of loss of sexual desire, a patient may have no idea that his or her sex-life problems could be related to the medicine they are taking.