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When Good Drugs Lead to Bad Sex

Lost That Lovin' Feeling? It Could Be Your Medicine.

Lowering pressure continued...


For instance, he says, ACE inhibitors, shown in some studies to be less likely to cause sexual problems, are also more expensive.


Not all of the studies paint a bleak picture of the old standby drugs, however. For instance, a study published in the same issue of American Journal of Medicine that carried Rudd's editorial found no difference in sexual function between 312 men and women randomly placed on either the beta-blocker Inderal or an inactive placebo drug.


It's difficult to predict who will and won't notice an effect on sexual functioning after beginning blood pressure-lowering drugs, Rudd says. But one study published in the May 1999 issue of Pharmacotherapy found that nearly every first-line antihypertensive treatment (which includes diuretics and beta-blockers) has been reported to cause some degree of erectile dysfunction. But sexual problems can also increase with age and as other diseases set in, so it's even more difficult to pinpoint exactly what percent of problems can be blamed on the drugs.


A physician should mention the possibility of side effects when prescribing a blood pressure-lowering drug, Rudd says, but encourage a patient to try it before dismissing it because of potential effects. "The only way to be sure," he tells patients, "is to take a trial of it."


If sex life is affected, doctors can consider many options: reduce the dose, switch to another drug, or suggest lifestyle modifications such as exercise, which could help lower blood pressure and reduce the need for medication.

Lifting mood

For physicians, treating patients with depression and sexual problems can be frustrating. For one thing, sexual problems can be both a symptom of the depression and a side effect of the medication that treats the depression, according to James M. Ferguson, MD, a psychiatrist who is founder and director of the Pharmacology Research Clinic in Salt Lake City and clinical professor of psychiatry at the University of Utah School of Medicine.


Most people suffering from depression would like to be sexually active, but about half experience a decrease in desire or performance, he writes in a review of the topic in the March 2001 issue of the Journal of Clinical Psychiatry. Antidepressants often interfere with several parts of the sexual response, he says, including an inability to achieve orgasm.


With the introduction of a new class of antidepressant medicine called selective serotonin reuptake inhibitors or SSRIs (including Prozac, Zoloft, and Paxil), many doctors thought they were associated with less impact on sexual function. But as the drugs began to be prescribed in greater numbers, reports found that nearly half of patients on SSRIs had libido or orgasm problems.


The side effects vary in terms of severity, Ferguson tells WebMD. In the review article he notes that the greatest negative effects on sex lives have been reported with Paxil and the least with Prozac -- but this comes from anecdotal reports, not careful, scientific studies, he says.


But even if an antidepressant that is associated with sexual side effects is deemed the best course of treatment, there are ways to cope, Ferguson says. For instance, a patient on Zoloft, under his doctor's supervision, might skip a dose or two before a romantic evening. Because this drug stays active for a relatively short time, this may be enough to restore normal sexual function, he says.

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