From low libido to erectile dysfunction, some people report suffering from enduring sexual problems.
Antidepressants are widely prescribed, commonly used for depression and recommended to treat a range of other issues, from anxiety disorders to pain. But the medications aren’t without risk – and some potentially serious side effects start, or continue, after a person has stopped taking them.
These effects vary by the individual and the drug, but for the most commonly prescribed antidepressants – selective serotonin reuptake inhibitors, or SSRIs, and serotonin-norepinephrine reuptake inhibitors, or SSNIs – side effects, or adverse events reported by patients, range from headache, nausea and fatigue to paresthesia, or an abnormal sensation that can feel, to some, like electrical shocks, to insomnia to seizures. And though less widely recognized, some patients also report another enduring effect of SSRIs and SSNIs: sexual dysfunction.
To be sure, sexual side effects ranging from lower libido to erectile dysfunction are known and detailed in drug labeling information. But though online support groups have cropped up for people who experience persistent sexual dysfunction after going off antidepressants – post-SSRI sexual dysfunction, or PSSD – it’s not clear how common the concern is.
However, one recent paper co-authored by researchers linked with an independent drug safety website RxISK.org that collects reports of side effects – including after people stop medications – recently reported on 300 cases of enduring sexual dysfunction. These were reported by people from around the world who were taking SSRIs, SSNIs and tricyclic antidepressants, as well as drugs called 5α-reductase inhibitors and isotretinoin. which are used to treat male hair loss (baldness) and benign (non-cancerous) prostate enlargement, and acne respectively. Reports by patients who’d taken 5α-reductase inhibitors and isotretinoin to RxISK of enduring problems with sexual function after stopping these medications appeared to have similar characteristics to those related to antidepressants, notes co-author Dr. Dee Mangin, the David Braley and Nancy Gordon Chair in Family Medicine at McMaster University in Hamilton, Ontario, and chief medical officer for RxISK.org.
“We were really looking at sexual dysfunction both on and after taking medication, because some of the reports we were getting were suggesting that sexual dysfunction, which is a known side effect of a number of drugs, seemed to be persisting once the drugs were stopped,” Mangin says.
As noted in the paper published in the International Journal of Risk & Safety in Medicine, there have been limited references to the potential for such issues to occur after patients stopped antidepressants. In the U.S., the product information for Prozac (fluoxetine) – the oldest of the SSRIs – was updated in 2011 to warn, “Symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment.” What’s more, the authors noted, “The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, states that ‘In some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.'”
But the authors go further in detailing reports of enduring sexual dysfunction such as the onset of premature ejaculation and persistent genital arousal disorder (whereby a person becomes aroused without any stimulation) as well as losing genital sensation, or genital anaesthesia, pleasureless or weak orgasm, loss of libido and impotence. “Secondary consequences included relationship breakdown and impaired quality of life,” the authors note.
The individuals weren’t independently evaluated before, during or after taking the medication, and more study is needed. Still, Mangin asserts, “The study provides the strong signal that there is a group of people who seem to experience enduring side effects that affect their sexual function after they’ve stopped taking the drug.”
Experts say just as patients should never stop antidepressants abruptly, or without consulting with their provider – since doing so is known to increase side effect risk and worsen those effects – patient and provider should discuss any adverse effects that start or continue after stopping a medication.
Dr. Eliza Menninger, who directs a behavioral health program at McLean Hospital in Boston, says she hasn’t heard from patients voicing serious concerns about sexual side effects after stopping their medication. For the most part, sexual side effects seem to go away after patients stop taking the medication, Menninger says. “Some will indicate it’s still an issue, but they don’t seem as bothered by it – and I don’t know if it’s as bad an issue as when they were on the SSRI,” she says.
However, clinicians say, it would be helpful to have more clarity on the issue – including how likely it may be that patients could experience enduring sexual side effects. In part due to the sensitive nature of sexual complaints, experts point out, these effects often go unacknowledged in patient-provider conversations.
One problem is that sexual side effects aren’t tracked in a systematic way like other drug side effects – even though they can be severely damaging to intimate relationships and undermine a person’s overall quality of life and well-being. “There’s no requirement, for example, for drug companies to track sexual side effects. They’re not considered serious adverse events, although the potential for them to continue post-medication I would consider extremely serious – even a disability,” says Audrey Bahrick, staff psychologist at the University of Iowa’s counseling service.
Bahrick recently signed onto a petition, along with Mangin and others who’ve researched enduring sexual side effects, asking the U.S. Food and Drug Administration and other regulatory bodies to require makers of SSRIs and SSNIs to update drug labeling to warn that such legacy effects can occur and continue for years or even indefinitely.
Sandy Walsh, a spokesperson for the FDA, said it would review the petition and respond to the petitioner, but declined to comment further regarding the petition. Drugmakers who responded to a request for comment say they work closely with regulatory agencies to keep information updated.
Mads Kronborg, a spokesman for pharmaceutical firm Lundbeck, notes that summary production information for its SSRIs, citalopram (Celexa) and escitalopram (Lexapro), “already states that side effects can occur upon discontinuation, and that such side effects may be severe and prolonged.” Specifically, it’s stated that “generally these events are mild to moderate and are self-limiting, however, in some patients they may be severe and/or prolonged.” The side effects listed for citalopram and escitalopram “include sexual side effects,” he says, though he adds that sexual side effects are not among the most commonly reported reactions to discontinuation. “So information about potential enduring side effects is actually already included.”
But the petition asserts drug companies aren’t going far enough to acknowledge these concerns.
Bahrick says though the prevalence of enduring sexual side effects remains unknown, “My own impression clinically is that it’s not at all uncommon, and that it can range from subtle – not returning to sexual baseline – to really a complete sexual anesthesia, where a person who has been without any significant sexual problems prior to taking the medication might be rendered unable to experience sexual pleasure, unable to have sensation in the genitals, having orgasms that are not associated with pleasure,” she says. “These are clearly, I think, drug effects. [Issues] like genital anaesthesia and pleasureless orgasm – these are not symptoms that are associated with any sexual problems, say, that are commonly associated with depression. We can see these as legacy effects of the SSRIs.”
In the absence of prevalence data, clinicians continue to debate the potential extent of enduring sexual side effects for those who have stopped antidepressants. Some worry about unnecessarily scaring patients away from antidepressants who may benefit from taking the drugs.
“These medications are used to treat symptoms of illnesses that are potentially quite debilitating and can be lethal, so while I want to encourage a discussion of side effects, the intent is to use medications to help improve significant symptoms,” Menninger says. She points out, as the petition notes, that to date no prospective studies have been done assessing sexual dysfunction prior to SSRI and then during and after SSRI use. Though certainly side effects are real and concerning, she says, “there is clinical evidence the medications make a significant difference in helping [and/or] saving a life.” That’s something some clinicians emphasize shouldn’t get lost in the discussion.
But Bahrick says for patients, not having information that these effects may occur undermines their ability to make a fully informed decision when deciding to go on antidepressants, and deciding whether to try alternative treatment options first. “It’s so important to get this information out there on the front end. Because these injuries are very real and can be lifelong and seriously limit intimacy and create a lot of shame and isolation and despair,” she says. While for some the side effects go away on their own, for others they persist – and Bahrick says there’s no known cure for PSSD. “So this is in service of informed consent that is quite lacking at this time.”
Complete Article ↪HERE↩!
[E]ver had one of those days when your brain seems to be dead set on working against you?
You’re planning a nice bit of sexy time – whether with a partner or simply some solo fun – but your head’s just not in it.
However much you might want to get jiggy with it, your brain is skipping around elsewhere and you just can’t concentrate, let alone roll around in orgasmic delight.
So what causes your head to seemingly separate from your body at just the moment you want to be able to focus on fun times?
All too often it boils down to lack of confidence in yourself and what you’re doing.
If you have problems with self esteem, it can trickle into all areas of your life – and that includes the bedroom.
The saying ‘first you have to love yourself’ is bit of a cliche – but like most cliches, it’s actually true. Many things can sap your confidence, both mental and physical.
For my friend Amy, the problem is a lack of confidence caused by physical issues.
The problem has grown over the years, to the stage where it’s such a big issue that she’s unsure how to even start working through it.
‘I was born with cerebral palsy and I also have ME and fibromyalgia,’ Amy says.
‘I’ve gone from being moderately active and social to spending most of my time at home and sleeping a lot.
‘I was never particularly confident with guys because I have always been overweight.
‘I’ve had four sexual partners so far, three men and a woman. All were basically one night stands that were pretty unsatisfactory for me (and probably them too).
‘I’ve not had sex in years now and have never really dated anyone.
‘I’m pretty fed up of that to be honest but I feel quite isolated socially and wary of anyone who might take an interest because I feel so unattractive.’
My personal suggestion in any situation like this always boils down to that same cliche – you have to learn to love yourself first.
Mirrors, masturbation and practice is the key.
Look at yourself so that you’re used to what your own body looks like and learn what really turns you on.
If you practice this alone then you’ll have all the more confidence when it comes to getting down to it with someone else in the room.
Amy’s story is just one of many I hear all the time from people whose sex lives have become unsatisfactory through no fault of their own.
I spoke to relationship and sexuality counsellor Jennifer Deacon and asked for her general advice on separating sex from anxiety.
‘When you’re anxious it’s often hard to feel turned on – or even have any desire at all.
‘That in turn can feed the anxiety more, particularly if you’re in a relationship where you might feel you’re letting your partner down, bringing up a whole heap more anxiety.
‘As with any anxiety the first thing is to try and find that tricky balance between reflecting on what’s going on with your thoughts and over-analysing.
‘What’s stopping you – is it the thought of being naked with someone else? The physical acrobatics that you might feel you ought to be performing?
‘Or is your sexual desire being suppressed because of meds that you’re taking?
‘Try to reflect on what’s going on, and then work through the ‘what ifs’ and ‘shoulds’ that often make up a huge part of anxious thoughts.
‘If you have a partner, try to communicate with them what you need – for example if you’re missing intimacy but are scared of initiating hugs or cuddles because you’re not sure you want full sex, then try to find a way to talk about this with them.
‘If your anxiety has roots in a trauma that you’ve experienced then communication becomes even more important – both communicating with yourself as to what you need and want, and communicating with your partner so that they can support you.
‘Lack of libido can be a common side effect from medication so if you notice that your sexual desire has waned since you started a new medication or changed your dose, consider discussing this with your GP or specialist.’
Many prescription drugs do indeed have side effects that affect the libido – and doctors aren’t always up front about explaining the risks.
Okay, so ‘losing interest in sex’ might be a long way down the list of worrying potential side effects, but given that antidepressants often cause this issue, I’m always amazed that it isn’t discussed more.
Sex is a healthy part of life and if you still want it but struggle to get any joy out of it, that’s going to affect your happiness levels.
After literally decades of living with chronic anxiety, I’ve been through endless different drugs in the hope of finding one that will help without ruining the rest of my life.
The problem is that drugs affect everyone differently – what works brilliantly for one person can potentially have drastically negative effects on another.
The first antidepressant I was given was Prozac.
Back then it was the big name in drug therapy and widely considered to be suitable for everyone.
And yes, it helped my depression – but it also completely removed my ability to orgasm.
I still wanted to – my sex drive itself wasn’t affected in any way – but I simply couldn’t ‘get there’.
I still regale people about ‘that time I gave myself RSI through too much w*nking’ – it’s a funny story now, but at the time it was utterly true and completely miserable.
I went back to the doctor and had my meds changed.
At the last count, I think I’ve tried about thirteen different anxiety meds and I still haven’t found one that I can cope with.
Ironically, if I was happy to lose my libido then several of them would have been perfect – but why should we be expected to go without one of the most enjoyable life experiences?
Personally, that makes me just as miserable as being anxious or depressed, so it invalidates the positives anyway.
Currently I’m med-free – and not very happy about it – but at least I still have my sex life.
For some people, finding the right medication without it affecting their libido will be easy.
But everyone has to find their own balance – some might prefer to take the meds and sacrifice their physical enjoyment.
But it’s okay to want both.
Complete Article ↪HERE↩!
I always say that sex and depression is the intersection of two taboo topics.
It’s especially hard to talk about the two together because, frankly, it can be hard to talk about either topic separately.
Today, we’re going to look at some commonly held (and oft-repeated) beliefs that really need to be retired in the name of destroying the stigma around these important topics.
Also, they are just not true.
Depression is hard enough to cope with on its own. Don’t make it worse by piling on unfair, untrue cliches. Know the truth about sex and depression and help end the stigma.
Depressed people don’t want to have sex anyway
In 2014, I launched a survey on the impact of depression and its treatment on sexual function and relationships.
A total of 1,100 people took that survey.
In 2015, I started interviewing participants and only then did I spot the massive flaw in my survey: it only allowed for people to give responses about decreased libido.
When I conducted a second round of interviews in 2016 I asked, ‘Did depression impact your sex life? If so, how?’ and more than 29% of the respondents reported increased sexual activity during depressive episodes.
Don’t stick it in the crazy
Stop with this. It’s ableist and frankly it’s ridiculous.
Depression is not an STI and we don’t need to quarantine all the people with depression so they don’t sexually infect you.
Certainly you get to choose who you do and do not engage in sexual activity with, but reciting a (not at all clever) catchphrase, that is based in nothing, about dismissing an entire group of people just helps further stigma and makes people feel like they need to hide their own mental illness struggles.
Sex isn’t important enough to worry about when you’re fighting depression
A scenario that came up over and over in my research was patients being dismissed by doctors or the other people in their lives when they objected to sexual side effects because sex isn’t important enough to worry about ‘at a time like this’.
In some cases, the respondents believed it – ‘I didn’t worry about sex because there were more important things to worry about!’
Listen, yes, sometimes depression treatment is a fight to stay alive and we do whatever it takes, other times, it’s about maintenance and we are allowed to want more than just survival.
People with depression are allowed to want to actually live, and for a lot of people that includes sex.
You have to love yourself first before you can love anyone else
A lot of people will never love themselves.
When we tell people they are ineligible for love until they have hit this self-love goal (I know no one who has done this), what we are really doing is telling them that they have to be a better person in order to be loved.
Another variation on this is, ‘you have to get yourself together first’.
These are all nonsense, and the domain of people who want others to believe that relationships shouldn’t involve any baggage.
Everyone’s got baggage. You don’t need to pretend yours isn’t there to be loveable.
Complete Article HERE!
As anyone who has been depressed will tell you, depression isn’t just about feeling blue.
It is an incredibly complex condition which brings with it a whole slew of emotional, mental and physical symptoms with it. For men and women both, part of the problem can revolve around their sexuality – and this in turn can cause problems in a relationship at the time when the depressed person most needs the support. Fortunately, there are ways to help treat this particular problem and restore intimacy and pleasure to a relationship.
Depression and Male Sexuality
It is common for both men and women to experience sexual problems as part of their depression – but the ways in which this presents itself can be different. Healthline notes that in men, depression will often express itself as feelings of low-esteem, anxiety and guilt and this, in turn, can cause problems with erectile dysfunction, delayed orgasm, premature ejaculation or just a loss of interest in sex itself.
There is still a lot we just don’t know about exactly how depression affects the brain. But according to Net Doctor, researchers have learned that the chemical changes which take place when someone has this condition can lead to an increase in emotional withdrawal and low energy levels so that activities like sex, which require a connection to your partner as well as physical energy to perform, can become a challenge. This can be hurtful for the person’s partner and make them feel unwanted or unloved, putting a strain on the relationship that can, in itself, be difficult to deal with.
To make matters worse, many antidepressants are notorious for their side effect of causing sexual dysfunction or loss of interest. Included in this group are MAOI inhibitors, SSRI’s and SSNRI’s and both tetracyclic and tricyclic antidepressants.
What to Do
So the long and short of it is, both depression itself and some of the treatments for depression can both put a damper on a guy’s sex life. So what are some solutions to the problem?
Get the Treatment You Need
Depression is not a choice that people make – and it is usually not a problem that goes away by itself. If you have not yet been diagnosed, talk to your doctor about the symptoms you are having and get started on a plan of care that involves the combination of medications, therapy and lifestyle changes that are right for you.
If you are already being treated for depression and suspect that your anti-depressants might be putting the kybosh on your sex life, find out if you can switch medications. While it might take a little time to take effect, there are some drugs which do not seem to effect one’s libido, including Wellbutrin and Remeron.
Both Healthline and Everyday Health recommend regular exercise – preferably with your partner – as part of a program to help reconnect sexually. First, it gives you and your partner time together doing something enjoyable and this alone can be good for a relationship. It also helps to release feel-good chemicals like endorphins that help fight depression naturally and keeps you in good shape so that you feel good about yourself and the way you look. All this can go a long way to enhancing your sex life.
Take Your Time
According to Everyday Health, sex therapist Dr. Sandra Caron also has a few tips for couples who are struggling to overcome the barrier that depression has placed on their sives. She recommends, first of all, that couples engage in more foreplay and other physical expressions of intimacy – hand holding, caressing, massage – before engaging in intercourse itself. Depression tends to slow down all responses, so taking this extra time to achieve arousal can help enhance the pleasure for both partners. She also recommends the use, if needed, of estrogen creams or lubricants and even erotica (like lingerie or sexy movies) to help sparthe mood.
Probably the most important advice for men who are trying to reconnect with their partner sexually is to open up and communicate with your partner. This can be more difficult for men to do in general, but is even more of a challenge when it comes to talking about intimate issues like sexuality, desire and arousal. But being honest about how you are feeling and letting your partner know that it is the depression that is a problem and not a loss of interest or a loss of love can be an incredibly powerful way to overcome this challenges and get support from your loved one at a time when you need it the most. Also, partners can be more understanding and supportive if they understand more about what is going on – otherwise, it is easy to interpret a low mood or lack of responsiveness as being hostile or unloving.
In short, depression is a difficult condition with a whole slew of symptoms that go far beyond just feelings of sadness or being blue. And when depression begins to affect a person’s sexuality, this in turn can lead to a strain on intimate partner relationships. However, while there are no quick solutions to this problem, getting on a treatment program that is tailored to someone’s individual needs as well as exercising regularly, spending time with a partner to engage in more foreplay and simply opening up and talking about the problem can all help to reignite the sexual spark in a relationship – and hopefully make the battle against depression that much easier.
Complete Article HERE!