Your Sanity or Your Sex Life: Coping with Sexual Side Effects

If you're like the estimated 27 million Americans who take antidepressant drugs, you're faced with a dilemma every time you open the prescription bottle: The medication has helped you stay out of the dark shadow of depression, but it's having some less than positive effects on your sex life. As a psychiatrist and contributor to Good in Bed, I help patients manage these side effects. From decreased libido to increased time reaching orgasm, sexual issues are all too common consequences of antidepressants and other psychiatric drugs. In fact, research suggests that 37 percent of people who take antidepressants experience sexual dysfunction -- almost twice the number estimated by physicians who prescribe these drugs.

For some people, sexual effects can be a welcome change. Take men with premature ejaculation, for example: What some guys dread -- delayed ejaculation -- can be a boon to those who typically climax too soon. In general, though, I'm often asked about how to avoid the sexual side effects of such medications. Here's what I tell my patients.

Change your perspective. Think about the time before you took this drug. Did you feel sexy and energetic? Probably not. But now, after addressing your depression, anxiety or other mental health concern, you're interested in sex again -- enough to worry about how the medication is affecting your sex life. You may be bothered by what you think is a lower sex drive, but consider how you felt before. In a way, your libido has actually increased!

Likewise, if you're dealing with delayed orgasm, ask yourself if your worries outweigh the reality. I've had female patients who come to me after starting an antidepressant, complaining that the drug is preventing them from climaxing. But when we start pulling apart the issue in more detail, it often turns out that they haven't lost their orgasm. It's simply taking them a little longer and they're concerned that they eventually won't be able to climax. Try timing yourself while masturbating: Does it take you 10 minutes now instead of five? Yes, that's an increase, but you can work with it.

Be proactive. Communicate your concerns to your partner. Chances are he or she is happy you're feeling well mentally and is less concerned than you about potential side effects. Work together to cope with any changes. Remember, you don't necessarily need to experience desire to be physically aroused. Make a commitment to sometimes have sex even when you think you aren't in the mood. Let the sex itself turn you on. Because sex usually begets sex, you may even find you start wanting it more often.

Talk with your doctor. Selective serotonin reuptake inhibitors are the most popular types of antidepressants and also the ones most associated with sexual side effects. However, there's a range of SSRIs, and some are less problematic. Tell your doctor about your concerns; he may be able to switch you to a similar medication with fewer side effects, such as changing from Prozac to Zoloft or from Celexa to Lexapro Your doctor may also try lowering the dose of your medication, scheduling the time you take the drug around sex or adding another drug to counteract side effects. You can also simply wait to see what happens -- sexual concerns, like other drug side effects, can ebb over time.

Some other ideas might include:

• Dose reduction -- sometimes a patient can still have the wanted benefits of medication treatment at a lower dose that may not induce the same degree of sexual dysfunction as the higher dose. A patient may have significantly less sexual side effects with Prozac 40 mg than Prozac 80 mg.
• Patience and medication acclimation -- over time this side effect may subside, just as other common drug side effects do.
• Timing -- sexual dysfunction may be significantly less two hours before the next scheduled dose and the highest two hours after the scheduled dose. There are also times during the 24-hour day when we may be more excited for coitus, such as early morning (related to testosterone secretion).
• Changing medications -- switching to another medication in a similar class may have a different effect on a person's sexual function (such as switching from Paxil to Zoloft or Celexa to Lexapro). FDA-approved transcranial magnetic stimulation), a novel nonmedication treatment of depression, can be used by people who do not want to endure any medication systemic side effects.
• Adding a medication that can reverse the sexual side effect -- some medications can undo what the antidepressant did to cause the sexual side effect.
• Adding a sexual enhancer -- this is typically done by medications that either improve excitement via either desire (dopamine mediated) or blood flow (if the sexual dysfunction is ED). In complex cases, these agents can be combined in many creative ways; however, it is important to remember that adding additional medications or supplements has its own risks and side effects that can and do complicate this treatment.
• Sexual warm-up -- this is a technique of arousal generation that intentionally does not lead to climax or ejaculation. The idea is that the process of getting aroused will increase the person's ability to generate more testosterone later in the day or later in the week.

For more tips to dealing with sexual side effects of medications, visit me at goodinbed.com, where I'll be answering your questions all week.

Dr. Edward Ratush is a psychiatrist specializing in the treatment of addictive disorders, treatment resistant depression, adult ADHD, and male sexual health and dysfunction. He is an expert in minimizing or eliminating sexual side effects commonly encountered in psychiatric treatment. In his private practice in New York, he offers individual and group psychotherapy, medication management and transcranial magnetic stimulation (a safe, noninvasive depression treatment without any sexual side effects). For more, reach Ratush at goodinbed.com.