SexRx: Monoamine oxidase inhibitors and your sex life

What These Medications Are Most Often Prescribed For

• Depression
• Panic disorders and phobias
• Eating disorders, especially bulimia (rare)

How These Medications Works

Possible Sexual Side Effects

• Decreased sexual desire
• Impotence in men
• Difficulty reaching orgasm, in both men and women

How They Cause Sexual Problems

Treatment Options

Wait it out

As you adjust to your new medication, the sexual side effects may go away.

Decrease the dosage

This tactic will work occasionally, but carries the risk of a relapse of the depression or disorder. Never change your dosage without checking with your doctor first.

Switch medications

Depending on your condition, there may be other medications that can manage your medical symptoms without affecting sexual function. Some of these drugs have been associated with sexual dysfunction as well, but people respond to drugs differently. Due to their side effect potential, MAOIs are rarely the first, or even second, drug of choice for depression. Since you will probably have tried other antidepressants before taking MAOIs, there may be fewer antidepressants available for you to switch to. If switching is appropriate for you, your options include:

• Another MAOI - Tranylcypromine has been reported to cause less sexual dysfunction than phenelzine.
• Bupropion (Wellbutrin) – This antidepressant medication does not affect serotonin. It is less likely than commonly used antidepressants to cause sexual dysfunction and may actually have prosexual effects. However, it is not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorder.
• Selective serotonin reuptake inhibitors (SSRIs) – This class of antidepressants includes citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). These drugs raise serotonin levels, and have been reported to cause sexual dysfunction in some people.
• Nefazodone (Serzone) – This antidepressant also affects serotonin levels in the brain but does not have as great a potential to inhibit sexual function as other antidepressants.
• Mirtazapine (Remeron) – An antidepressant with actions similar to nefazodone, but without as much scientific evidence about its affects on sexual function.
• Alprazolam (Xanax) – A benzodiazepine, which is used to treat panic disorders. Drugs in this class can have prosexual effects when given in low doses, but have also been associated with negative sexual effects at higher doses.

Note: Do not take these medications concurrently with MAOIs.

Try an antidote

This involves maintaining your current level of MAOI, while adding a second medication to offset the sexual side effects. Keep in mind that these antidotes can also cause side effects. MAOIs adversely interact with multiple drugs, so it essential to discuss the other drugs you are taking with your doctor. The drugs that have shown the most promise as antidotes are:

• Amantadine (Symmetrel) – Several case reports have shown amantadine to be an effective antidote for medication-related sexual dysfunction, however it has not yet been proven effective in a double-blind clinical study, which is the gold standard for drug efficacy.
• Sildenafil (Viagra) – Commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, the expense of this drug may prohibit many patients from using it.

Consider herbal supplements

The efficacy of herbal supplements in treating sexual side effects of various medications is not clear. There have not been any double-blind clinical studies, only case reports, some of which have shown positive effects and others that have shown no effects. Care should also be taken with herbal products because they are not strictly regulated, as drugs are, and may interact negatively with certain medications. Ask your doctor about these two herbs commonly used to treat sexual dysfunction associated with medications:

• Yohimbine
• Ginkgo