SexRx: Prozac and your sex life

Medication:

Commonly used brand name:

What it is most often prescribed for:

• Depression
• Obsessive-compulsive disorder
• Bulimia
• Premenstrual syndrome
• Anger management

How it works:

Other drugs of this class (SSRIs):

• Sertraline (Zoloft)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)
• Paroxetine (Paxil)

Possible sexual side effects:

• Decreased sexual desire
• Difficulty reaching orgasm
• Impotence in men

How it causes 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 physician first.

Switch medications

Since the medical response to SSRIs and other drugs to treat these disorders can vary, 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 antidepressant 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 fluoxetine is indicated for and has been found to cause fewer sexual side effects.
• Mirtazapine (Remeron) – similar to nefazodone, but without as much scientific evidence supporting it.

Try an antidote

This involves maintaining your current level of fluoxetine, while adding a second medication to offset the sexual side effects. Keep in mind that these antidotes can also cause side effects. The 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 low blood pressure.
• 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, which is the gold standard for drug efficacy.

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