Antidepressants That Don T Affect Libido
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Antidepressants That Don T Affect Libido
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Significantly Different Adverse Sexual Effects Caused by Various Antidepressants
FROM THE FAMILY PRACTICE INQUIRIES NETWORK
JOHN SMUCNY, M.D., AND MICHAEL S. PARK, Department of Family Medicine State University of New York Upstate Medical University Syracuse, N.Y.
Am Fam Physician. 2004;69(10):2419-2420
In patients being treated for depression, which antidepressants have a low risk of sexual side effects?
Bupropion (Wellbutrin), nefazodone (Serzone), amitriptyline (Elavil), and moclobemide (Manerix, a reversible inhibitor of monoamine oxidase type A not available in the United States) have been shown to cause less sexual dysfunction than selective serotonin reuptake inhibitors (SSRIs). [Strength of recommendation: B, based on individual randomized controlled trials (RCTs)] Among SSRIs, fluvoxamine (Luvox) may cause less sexual dysfunction than sertraline (Zoloft). [Strength of recommendation: B, single RCT] No other differences between or within classes of antidepressants have been demonstrated in RCTs.
> = “ is associated with a greater incidence of the measured outcome than”; SSRI = selective serotonin reuptake inhibitor .
*— Not available in the United States .
note : No significant difference was found for the following: sertraline vs. citalopram (Celexa); paroxetine (Paxil) vs. fluvoxamine or fluoxetine; amitriptyline vs. amoxapine (Asendin) or mirtazapine (Remeron); clomipramine (Anafranil) vs. fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram; phenelzine (Nardil) vs. imipramine (Tofranil) .
Information from references 1 through 4 .
The incidence of sexual side effects between different antidepressants in adults with depressive or anxiety disorders has been reported by 25 RCTs, most of which were included in two recent descriptive systematic reviews. 1 , 2 [References 1 and 2—Evidence level 1A] Bupropion led to less sexual dysfunction (or to more sexual satisfaction) than sertraline or fluoxetine in four trials. The number needed to harm (NNH), that is, the number of patients who have to take the drug for one patient to experience sexual dysfunction, ranged from two to 17, depending on the type of dysfunction. 1 , 2 Nefazodone led to less sexual dysfunction (or to more sexual satisfaction) than sertraline in two trials (NNH: two to seven). 1 – 3 [Reference 3—Evidence level 1B] Moclobemide led to less sexual dysfunction than four SSRIs in one trial (NNH: five) and to greater sexual desire than doxepin (Adapin) in one trial (number needed to treat: eight). 2 – 4 [Reference 4—Evidence level 1B] The acompanying table 1 – 4 summarizes the different adverse sexual effects and the agents that cause them.
There were no other consistent differences between classes of antidepressants. One trial reported less sexual dysfunction resulting from amitriptyline than from sertraline (NNH: seven), but numerous trials have not shown differences between clomipramine (Anafranil) and other SSRIs. 1 , 2 One trial showed less sexual dysfunction resulting from fluvoxamine than from sertraline (NNH: six), but no differences between other SSRIs have been demonstrated. 1 , 2 Limitations to many of the published studies include small sample sizes, failure to control for baseline differences in sexual function between groups of patients, and lack of uniform means of inquiring into sexual adverse effects.
Guidelines issued by the American Psychiatric Association 5 (APA) and the American College of Physicians–American Society of Internal Medicine 6 (ACP–ASIM) do not provide specific recommendations regarding which antidepressant to prescribe to minimize sexual dysfunction. [References 5 and 6—Evidence level 1A] The APA notes that SSRIs can carry a risk of sexual side effects, whereas the ACP–ASIM states that the data are insufficient to estimate incidence rates, thus making quantitative comparisons among antidepressants impossible.
Bupropion appears to be the best antidepressant for use in patients who are concerned about drug-related sexual dysfunction. Amitriptyline may be a less expensive and suitable alternative, but it has other worrisome adverse effects. Nefazodone may have a low incidence of sexual dysfunction, but it has been associated with hepatotoxicity and was withdrawn from the Canadian and European markets. Moclobemide is not available in the United States.
JOHN SMUCNY, M.D., MICHAEL S. PARK,
State University of New York Upstate Medical University Syracuse, N.Y.
Address correspondence by e-mail to John Smucny, M.D., smucnyj@upstate.edu . Reprints are not available from the authors .
Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:1577-89.
Montgomery SA, Baldwin DS, Riley A. Antidepressant medications: a review of the evidence for drug-induced sexual dysfunction. J Affect Disord. 2002;69:119-40.
Ferguson JM, Shrivastava RK, Stahl SM, Hartford JT, Borian F, Ieni J, et al. Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline. J Clin Psychiatry. 2001;62:24-9.
Philipp M, Tiller JW, Baier D, Kohnen R. Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults. The Australian and German Study Groups. Eur Neuropsychopharmacol. 2000;10:305-14.
American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry. 2000;157(4 suppl):1-45.
Snow V, Lascher S, Mottur-Pilson C. Pharmacologic treatment of acute major depression and dysthymia. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 2000;132:738-42.
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Moclobemide* (Manerix) doxepin (Adapin)
Fluoxetine (Prozac) >bupropion (Wellbutrin); sertraline (Zoloft) >nefazodone (Serzone)
Sertraline, fluoxetine >bupropion; sertraline >nefazodone
Sertraline >fluvoxamine (Luvox), nefazodone; SSRI >moclobemide
Published October 26, 2015 6:32pm EDT
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It’s hard to feel sexy when you don’t feel happy. If that unhappiness is rooted in clinical depression, your health care provider may recommend an antidepressant.
But it’s vital that you know all of the possible side effects before you sign on – because like most other medications, not all of them are created equal.
In fact, antidepressants in the SSRI family (selective serotonin reuptake inhibitors) are known to cause low libido. Prozac, Zoloft , Celexa and Paxil are all SSRIs and all have been documented as having sexual side effects.
Dr. Chad Collom, a doctor of nursing practice and board-certified family psychiatric mental health nurse practitioner at Solace Counseling in Dallas, Texas, explains why.
“SSRIs stimulate certain serotonin receptors that can cause a decrease in dopamine and norepinephrine in an area of the brain, which can have an effect on libido,” Collom said. “Older classes of antidepressants that are not used as much anymore, like monoamine oxidase (MAOIs) and tricyclics antidepressants (TCAs), can have the same libido depressing effect.”
Of course, depression itself can cause low libido. In fact, it’s very common in people battling depression – and this presents a bit of a Catch-22.
“The risks versus benefits should be weighed,” Collom explained. “If depression is causing significant impairment in one's life, then treatment may be necessary. This should be determined with your health care professional.”
So, is there anything you can do to combat the low libido caused by antidepressants?
“For men, some medications such as Levitra, Viagra , and Cialis can be of some benefit,” Collum said.“Men should also get testosterone levels checked. Though (it’s) not indicated for women, some studies using Viagra in women have shown positive results with sexual side effects. Women should always get hormone levels checked.”
There’s another option as well, Collom noted.
“Changing to Wellbutrin (another antidepressant that works only on dopamine and norepinephrine receptors) or adding it to an SSRI can help counteract sexual side effects,” he said.
In other words, not all antidepressants have sexual side effects.
“Wellbutrin has been shown to have no sexual side effects due to its mechanism of action,” Collom said. In fact, “Wellbutrin can actually increase one’s sex drive.”
According to Collom, the key to dealing with antidepressants and the risk of sexual side effects is to “Always consult with your health care provider to get treatment options that will be the best fit for your symptoms of depression. Giving your provider a detailed history is essential in order to give him or her a clear and accurate picture leading to a treatment plan that’s right for you.”
Symptoms of depression are not something that should be ignored. So, don’t let this information keep you from seeking help from your health care professional. Instead, use it to prepare yourself when you do seek help. The more you know, the better.
A happy and healthy sex life starts with being informed and seeking professional care when you need it.
And don’t ever be afraid to ask questions. Your health care professional is there for you.”
Jenny Block is a freelance writer based in Dallas, Texas. She is the author of " Open: Love, Sex, and Life in an Open Marriage ." Her work also appears in " One Big Happy Family " edited by Rebecca Walker and " It’s a Girl: Women Writers on Raising Daughters " edited by Andrea Buchanan. Visit her Web site at www.jennyonthepage.com.
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