Psychiatric Drugs and Sexual Dysfunction
Antidepressants and Antipsychotics Can Cause Problems with Sex
Mar 20, 2009
Antidepressants, especially the selective serotonin reuptake inhibitor (SSRI) drugs like fluoxetine (Prozac) are notorious for causing sexual dysfunction, including problems with achieving erection, delayed orgasm and loss of libido. The sexual dysfunction may even be permanent, though fortunately this is extremely rare.
In men, delayed ejaculation may not pose a problem and may even be desirable. Several European countries have approved the SSRI drug dapoxetine (Priligy) for the treatment of premature ejaculation. Dapoxetine is not used as an antidepressant, only for this indication. It is quickly absorbed and has a short half-life. It is taken as needed, 1-3 hours before planned intercourse.
Antidepressants Unlikely to Cause Sexual Dysfunction
Bupropion (Wellbutrin, Zyban), buspirone (BuSpar), trazodone (Desyrel), moclobemide (Manerix) and mirtazapine (Remeron) are antidepressants that do not usually cause sexual dysfunction (buspirone is generally considered an anti-anxiety drug, but it can also be used as an antidepressant). Bupropion and buspirone have even been used to reduce sexual dysfunction caused by SSRIs, but studies do not support their efficacy in this use.
Tianeptine (Stablon), a selective serotonin reuptake enhancer (SSRE) is an antidepressant sometimes used in the treatment of sexual dysfunction. Unfortunately its availability is very limited and it is not available in the United States, Canada or the UK.
Antipsychotic Drugs and Sexual Funtion
Antipsychotic drugs, also called neuroleptics, are used in the treatment of schizophrenia, other psychoses and bipolar disorder, sometimes also for depression and other ailments. They work by reducing the levels of dopamine in the brain, which also increases the levels of the hormone prolactin. This can lead to reduced libido, but also the decreased pleasure derived from sex.
Switching to aripriprazole (Abilify) might help, as it does not so strongly reduce dopamine levels in all parts of the brain compared to other antipsychotic drugs and does not increase prolactin levels. However, the effects of medications always depend on the individual and not everyone can tolerate Abilify. Ziprasidone (Geodon) and quetiapine (Seroquel) may also be good choices.
Besides dopamine antagonism antipsychotic drugs also have other modes of action. Many of them block alpha adrenergic receptors. This does not usually affect libido (though it can cause tiredness and lassitude and thus indirectly affect sexual feelings), but it can lead to erectile dysfunction and problems with ejaculation. Different antipsychotic drugs do this to a different extent, so a change of drug may solve the problem.
Other Treatment Options
"Drug holidays" are sometimes used with SSRIs - skipping the drug before planned intercourse. This has several problems though: it cannot be done frequently (or it might affect the efficacy of the drug), the intercourse has to be planned in advance, and it cannot be done at all with fluoxetine, which has a half-life of up to several weeks.
Sildenafil (Viagra) has been used to treat sexual dysfunction caused by antidepressants and seems to work in both men and women for this purpose. Some small trials have supported its efficacy in treating erectile dysfunction caused by antipsychotic drugs. Horny goat weed is a herb with a mode of action similar to Viagra.
Dopamine agonists like pramipexole (Mirapex) are sometimes prescribed to alleviate sexual dysfunction caused by SSRIs. Cyproheptadine and amantadine have been used as well, but there is little evidence to support their use. One preliminary study found the over-the-counter antihistamine loratadine useful for erectile dysfunction caused by SSRIs.
References
Gopalakrishnan R, Jacob KS, Kuruvilla A, et al. Sildenafil in the treatment of antipsychotic-induced erectile dysfunction: a randomized, double-blind, placebo-controlled, flexible-dose, two-way crossover trial. Am J Psychiatry. 2006 Mar;163(3):494-9.
Aukst-Margetic B, Margetic B. An open-label series using loratadine for the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors. Prog Neuropsychopharmacol Biol Psychiatry. 2005 Jun;29(5):754-6.
See Also
Antipsychotic Drugs for Fibromyalgia Treatment
Different Types of Antidepressants
