When Good Drugs Lead to Bad Sex
Lost That Lovin' Feeling? It Could Be Your Medicine.
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
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.
Physicians who treat hypertension and depression say they don't
rule out the use of Viagra for all patients on blood pressure-lowering or
antidepressant drugs. But they do select these patients very carefully and rule
out certain patients. Those taking nitrate drugs, for instance, such as
nitroglycerine (such as Nitrol or Nitro-Bid) for chest pain, are warned by the
manufacturer, Pfizer, not to take Viagra. Others are cautioned to tell their
physician about other drugs they are taking.