Sun
19
Apr

Sex Rx: Paxil and your sex life

by Karen Schroeder, MS, RD

Medication:

Paroxetine

Commonly used brand name:

Paxil

What it is most often prescribed for:

  • Depression
  • Obsessive-compulsive disorder
  • Panic disorder
  • Premenstual syndrome
  • Anger management

How it works:

Paroxetine is one of a class of drugs called selective serotonin reuptake inhibitors or SSRIs. These medications work blocking the reuptake of the brain chemical serotonin, which helps regulate mood.

Other drugs of this class (SSRIs):

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Fluvoxamine (Luvox)
  • Citalopram (Celexa)

Possible sexual side effects:

  • Decreased sexual desire
  • Difficulty reaching orgasm
  • Erection impairment in men
  • Loss of lubrication in women

How it causes sexual problems:

It is not yet clear how SSRIs affect sexual function. The effects are believed to be related to the increased level of serotonin, which travels down the spinal cord and may affect sexual reflex centers.

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 physician first.

Switch medications
Since the medical response to SSRIs and other drugs to treat these disorders can vary among people, a physician will consider the severity of your depression or disorder as well as your response to the drug before switching to another. When switching is appropriate, your three main options are:

Bupropion (Wellbutrin) – this medication does not affect serotonin. It is less likely than the commonly used SSRIs 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 disorders.

Nefazodone (Serzone) – this is an SSRI, but it blocks only one of the serotonin receptors, whereas other SSRIs block several. It can be used to treat each of the disorders paroxetine is indicated for and has been found to cause fewer sexual side effects.

Mirtazapine (Remeron) – similar to nefazodone, but without as much scientific proof behind it.

Try an antidote
This involves maintaining your current level of paroxetine, while adding a second medication to offset the sexual side effects. Keep in mind that these antidotes can also cause side effects. The three drugs that have shown the most promise as antidotes are:

Bupropion (Wellbutrin) – this is the most commonly used and most effective antidote. However, bupropion is not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorders. Side effects include anxiety, delirium, myoclonus (irregular involuntary contraction of a muscle), uncontrolled hypertension, nausea, headache, dizziness, fatigue, constipation, diarrhea, drowsiness, and hypotension.

Buspirone (BuSpar) – this drug should not be taken in doses exceeding 30 mg/day. BuSpar is generally safe, although the potential side effects include: sedation, akathisia (uncontrollable motor restlessness), dizziness, insomnia, nervousness, GI disturbance, nausea, and headache.

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.

Amantadine (Symmetrel) – several case reports have shown amantadine to be an effective antidote for SSRI-related sexual dysfunction, however it has not yet been proven effective in a double-blind clinical study, the gold standard for drug efficacy.

Take a drug holiday
This involves taking your usual Thursday morning dose and then nothing again until noon on Sunday. This tactic is less likely to work with fluoxetine (Prozac) because it takes much longer to make its way through your body than other SSRIs.

There is also a risk with this technique that you may feel well enough during the short drug holiday to discontinue your medication all together, which can lead to a relapse. Again, discuss this option with your physician before trying it.

Consider herbal supplements
The efficacy of herbal supplements to treat the sexual side effects of SSRIs 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. Two herbs commonly used to resolve the sexual dysfunction associated with SSRIs are:

  • Yohimbine
  • Ginkgo