Johns Hopkins Health Alerts | Depression and Anxiety | Antidepressant-Induced Sexual Dysfunction

What should you do if your antidepressant medication causes decreased libido? Karen L. Swartz, M.D., Director of Clinical Programs at the Johns Hopkins Mood Disorders Center, weighs in on this common problem.

Unfortunately, sexual dysfunction is a common side effect of all classes of antidepressant medications. Sexual dysfunction includes diminished libido, inability to orgasm, decreased sensation in the genitals, vaginal dryness (in women), and erectile dysfunction (in men).

The first thing your doctor will do if you report sexual dysfunction is a thorough medical workup to rule out any possible physical problems. Hypertension, diabetes, urological problems, and neurological problems can all cause sexual dysfunction.

If antidepressants are the likely cause, there are several possible remedies. First, you and your doctor may consider switching to an antidepressant with a low rate of sexual side effects, such as Wellbutrin (bupropion). This must be done carefully to minimize the risk of a relapse of depression. As an alternative, your doctor may suggest adding Wellbutrin to your current antidepressant regimen. Research indicates that small doses of Wellbutrin (75–150 mg daily) in combination with other antidepressants can be helpful in alleviating the sexual side effects of those antidepressants. Here are some other remedies you might try:

• Add Viagra (sildenafil), which is potentially effective for combating antidepressant-induced sexual dysfunction in both men and women.
• Decrease your antidepressant dose slightly. If you want to try this approach, however, it’s important to develop a plan with your doctor to decrease the antidepressant dose slowly and in small increments to avoid a recurrence of depressive symptoms.
• Change the time you take your antidepressant medication. If your symptoms involve difficulty achieving orgasm, taking the antidepressant after sexual activity often proves helpful. For example, if you are most likely to engage in sexual activity in the evening, take the antidepressant medication just before falling asleep. Blood levels of the drug will be lowest the following night, so the extent of side effects will also be lowest at that time.
• Divide medication doses. Rather than taking the full dose once a day, some people find that taking half the dose twice a day helps diminish side effects.
• Try a “drug holiday.” This involves taking a short respite from your medication. Evidence shows that periodic two-day breaks from antidepressant therapy can lower the rate of sexual side effects during the “drug holiday,” without increasing the risk of a recurrence of depressive symptoms. For example, in one study, taking medication Sunday through Thursday and skipping it Friday and Saturday allowed participants to enjoy improved sexual functioning 50% of the time on weekends, with no overall worsening of mood. This approach works with quick-clearing drugs, such as Zoloft (sertraline) and Paxil (paroxetine), but not with Prozac (fluoxetine), which has a longer half-life and therefore clears more slowly from the body. One potential risk with taking a “drug holiday” from antidepressants that have very short half-lives, such as Zoloft and Paxil, is the onset of withdrawal symptoms.

All the remedies discussed above should be implemented only with physician support and supervision to prevent relapse of depressive symptoms and drug withdrawal reactions.

For more Alerts and Special Reports, please visit the Depression and Anxiety Topic page.

Johns Hopkins Health Alerts | Depression and Anxiety | Antidepressant-Induced Sexual Dysfunction