This side effect is just as depressing, if not more so, than getting fat. It’s most associated with SSRIs. The worst offenders are Paxil (paroxetine) and Prozac (fluoxetine). Lexapro (escitalopram oxalate) sucks the least in this department. Celexa (citalopram hydrobromide), Luvox (fluvoxamine maleate) and Zoloft (sertraline) all have their share of issues when it comes to losing sexual desire. But the SSRIs aren’t the only ones that prevent you from getting it up or getting wet. Effexor (venlafaxine) can also makes you limp and/or frigid, which is just one more reason it’s the drug everyone loves to hate. Anticonvulsants, especially the valproates (Depakote (divalproex sodium), Depakene (valproic acid) and whatever they call valproate sodium where you live) and the enzyme inducing anticonvulsants, notably Tegretol (carbamazepine), have been shown to mess with testosterone. Many other anti-epileptic medications (a.k.a. mood stabilizers) mess with estrogen, especially Tegretol (carbamazepine), Trileptal (oxcarbazepine) and Topamax (topiramate). As a result they mess with sexual desire and response in both men and women. See the anticonvulsants page for more information on how they mess with our hormones.
There is one very important thing to keep in mind if you’re bipolar and/or epileptic – what is a normal level of sexuality? How often should you want to be doing it every day? Hypersexuality is often a problem in these spectra, and while it may have been normal for you to want to make love five or six times a day (or more) before you were medicated, that’s really not typical for most people in their thirties. So if you’re reduced to wanting to do it only once or twice a day, that’s not because the meds have messed with your hormones, it’s more because the meds are keeping your brain from burning out. Live with that and you’ll live longer. And probably get in a lot less trouble.
For everyone else who isn’t up for daily nookie, there is hope. You might be able to do something about it. As usual it all depends on the med and the disorder involved.
If you’re taking an SSRI, see if you can switch to Lexapro (escitalopram oxalate). I’ve found one reference to a single case study where someone overcame the sexual side effects of Prozac (fluoxetine hydrochloride) by switching to Lexapro (escitalopram oxalate). Many people have reported that the sexual side effects, along with all of the common SSRI side effects in general, are just less harsh with Lexapro (escitalopram oxalate). The downside is that the most common sexual side effect with Lexapro (escitalopram oxalate) is anorgasmia – you can’t cum no matter what.
Dr. Amen describes Wellbutrin (bupropion) as having “prosexual effects.” A placebo-controlled trial testing it for SSRI-induced sexual dysfunction found that frequency of sexual activity and desire were increased, but that was about it. Orgasms weren’t any better and their partners didn’t seem more interesting nor did the participants find themselves any sexier. But they still managed to have more sex and/or wanted it more often on 300mg a day of Wellbutrin (bupropion). And earlier, open-label study had better results, thus showing the placebo effect in full force. Or the other study just didn’t look at everything when they meant “all sexual side effects.” If you have a seizure disorder Wellbutrin (bupropion) is out of the question. If you’re bipolar it’s iffy.
I’m getting a bunch of e-mail from women telling me that Strattera (atomoxetine) is not only increasing their sexual desire, but giving them better orgasms as well. Nothing about using it in conjunction with SSRIs but this has been reported (to me) when used along with anticonvulsants. Obviously more studies are required. Ladies – Eli Lilly does want to hear from you, so give them a call at 1-800-545-5979 and tell them that Crazy Meds sent you. I did find one study where women taking the similarly-acting drug reboxetine were more likely to achieve orgasm after taking the drug.
The few reports that have come in from men have been that it’s been neutral or has contributed to sexual dysfunctions of various flavors, usually of the short-term variety. My sex drive is still fairly high, although it has mellowed out somewhat with age and mental stability. I have no idea if the Strattera (atomoxetine) was contributing to keeping me horny or not. Discontinuation made no difference, so I guess it was neutral for me. Strattera (atomoxetine), officially approved for ADD/ADHD is not a stimulant, so it can be evaluated by just about anyone reading this.
Viagra (sildenafil citrate) and Levitra (vardenafil). Guys, if you want to do it but just can’t get it up, these drugs do work. Viagra (sildenafil citrate) does come with a stroke risk, and since you’re already taking meds that mess with your brain you really need to take that into account. Levitra (vardenafil) is just too new for me to have any good data about, other than a threat of priapism that rivals that of Desyrel (trazodone). Viagra (sildenafil citrate) has been tested on both men and women to treat SSRI-induced sexual dysfunction. And while more trials are done on men, the anecdotal evidence coming in is that it, in this case, it works better for women. Even though it recently failed approval as a medication to treat women’s sexual problems in general. Maybe the anecdotal evidence is wrong, or maybe Viagra (sildenafil citrate) really does help women with SSRI-induced sexual dysfunction. Additionally Viagra (sildenafil citrate)has been tested on men for antipsychotic-induced sexual dysfunction and found to be moderately effective.
A new medication, PT-141, is currently in phase 2 trials, so there’s no idea as to when, let alone if, it will become available. It’s being tested as a drug for sexual dysfunction. It will also help you lose weight. And it’ll make you tan. Hence the references to it as “The Barbie drug.”
I had some hope for ginkgo biloba for antidepressant-induced sexual dysfunction, but a double-blind study found that it made no difference after eight weeks. Sorry. A smaller study held some promise for it. Placebo effect or does it actually work sometimes? Unfortunately there can be some real problems with it. One guy died from the drug-herb interaction with ginkgo biloba, as ginkgo induces both CYP2C19 activity (used by valproates and Dilantin) as well as seizure activity. So it should be avoided by the epileptic and people taking medications metabolized by CYP2C19.
On the other hand, the amino acid l-arginine, with or without other supplements, has been shown to be effective for men and women, although for guys it takes a lot to work.
BuSpar (buspirone) has some mixed results. I’ve found one study indicating it might help reverse the problems with SSRI-induced sexual dysfunctions, especially in women. Plus when you mix BuSpar (buspirone) with an antidepressant you often get a boost to the med, most likely from a minor inhibition of liver enzymes as much as anything else.
Periactin (cyproheptadine hydrochloride) – this is an old antihistamine that is also an antiserotonergic. The theory is if you’re getting too much serotonin reuptake, or getting it in the wrong place in your brain, that’s why you can’t get it on. Hey, it worked for one guy taking Celexa (citalopram hydrobromide). I can find a few case studies, one person here, one there, where it worked with old meds like TCAs and MAOIs. The anecdotal evidence is piling up for this old-fashioned remedy.
Lamictal (lamotrigine) turns out to improve sexual function. At least it did for these three guys. It reversed the sexual problems of antiepileptic medications they were taking. With all the focus on the sexual problems inherent with antidepressants, those of us with epilepsy and/or bipolar are kind of left in the cold. However, while Lamictal is officially a med with no incidence of sexual dysfunction, there are reports that it can hit a guy’s plumbing, and hard, just like any other anticonvulsant.
For the bipolar, schizophrenia and panic/anxiety communities there’s been some research involving antipsychotics. A large Spanish study has Risperdal (risperidone), Haldol (haloperidol) and Zyprexa (olanzapine) the worst offenders. They all seem to be dosage-related, and I’ll go along with that, as a low dosage of Risperdal (risperidone) wasn’t reigning me in. From the number of studies I’ve seen Risperdal (risperidone) is by far the worst of the lot. Other than taking Viagra (sildenafil citrate), your options are lower your dosage or switching to another med, such as Abilify (aripiprazole) or Geodon (ziprasidone HCl). Those may or may not be appropriate, of course.
Finally, let’s not forget regular exercise. Really, it looks like doing anything helps!