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    When Good Drugs Lead to Bad Sex

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

    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.

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    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.

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    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.

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    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.

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    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.

    Other considerations

    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.

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