Depressing libidos?

One category of medication has revolutionised the treatment of depression during the last 20 years. A class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs.  

These medications have helped many people overcome feelings of depression and allowed them to get on with their lives. Thus, SSRIs have been dubbed a major advance in medicine. With simple once-a-day dosing and fewer side effects than older medicines, they have been embraced by doctors and patients alike -- so much so that some mental health experts complain that these "fashionable" pills are sometimes given to people who do not really need them.

However, even when SSRIs are prescribed appropriately, they are not perfect. Recently, researchers have found that adverse sexual side effects may be much more common with these medicines than originally believed. If you are taking an SSRI and find that you are suddenly having problems with your sex life -- an inability to get aroused or difficulty reaching orgasm, for instance -- the medicine might be to blame. If you suspect this could be the case, it’s important to talk to your doctor about it.

Old studies versus newer studies

Some of the first studies of SSRIs found that adverse sexual side effects (such as orgasm problems) occur in less than 10% of patients, according to Dr Lawrence Labbate, an associate professor of psychiatry and behavioural sciences. However, he points out, those studies relied on unprompted reporting -- patients who spoke up during a visit to their doctor or called their doctor on the phone when they noticed the sexual problems, so the number of people experiencing such problems was underrepresented.

In subsequent studies, doctors specifically asked patients about libido or orgasm difficulties, and found that they are present in nearly half of patients on an SSRI. Labbate reported this finding in the October 1999 issue of Psychiatric Annals.

Depression or medication to blame?

Exactly how these medications interfere with sexual desire is not known.  Depression itself, long considered a common cause of sexual dysfunction, may play a role, doctors say.

Some doctors may not adequately stress the potential side effect of diminished desire while on SSRIs to their patients. Perhaps this is because they do not want to scare patients, or are simply short of time. Unfortunately, according to Dr 

Richard Balon, a professor of psychiatry, many practitioners simply do not have the time to inform patients about all of the possible side effects of different medication.

Without being warned about the potential side effect of loss of sexual desire, a patient may have no idea that his or her sex-life problems could be related to the medicine they are taking.

What can be done?

On the brighter side, Labbate says, awareness is increasing among patients and doctors about the potential for sexual side effects while on SSRIs. Plus, there are solutions. Stopping the medicine usually solves the sexual problem, but for safety this should only be done under a doctor's close supervision. A doctor who suspects SSRI-related sexual dysfunction may also consider lowering the dose, switching to a non-SSRI antidepressant, or suggesting the patient take a break from the medicine.

How well these strategies work depends on the specific antidepressant and the individual patient. Complicating the doctor's decision about what to do is the possibility that the depression itself might be causing the sexual problems. In addition, there is lack of agreement among doctors about how to best treat SSRI-related sexual dysfunction, because the problem is newly recognised.

The bottom line, for anyone on an SSRI, is that no one should sacrifice sexual satisfaction for psychological health without first exploring all the alternatives. Hopefully, you can have both a good sex life and psychological well being even if it requires effort, including some honest communication between you and your doctor.