When quitting isn’t an option, is it possible to overcome the sexual side effects that come with an SSRI?
So, you’ve finally filled the antidepressant prescription that’s been acting as a bookmark for the most recent novel you’re feigning interest in. Somewhere between missing your own birthday party and watching everyone else have fun without you, you gave in. After a few medicated weeks, things are starting to look up. Except for your sex life, that is.
Just last week, you were tied to a kitchen chair enjoying an amazing (albeit rather mournful) few minutes of escape through sex. Today, getting naked seems less appealing than all the other pressing tasks you have new-found energy to complete.
“Is it the meds, or is it just me?” you wonder as you deep-clean the fridge with new vigour. After some soul-searching, it becomes clear that you’re still the same person—just with fewer festering foodstuffs and a lot less crying.
“It must be a side effect,” you decide. But months after filling your prescription, your genitals are still giving you the physiological equivalent of
Why Antidepressants May Be a Downer for Your Sex Life
“[Sexual dysfunction] is a difficult, frustrating, and very common issue with this class of medications,” says Jean Kim, M.D., clinical assistant professor of psychiatry at George Washington University.
Twelve percent of American adults reported filling an antidepressant prescription in the most recent Medical Expenditure Panel Survey. Not just for clinical depression, but for all kinds of off-label conditions like chronic pain and insomnia.
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant class. And between 30 percent and 50 percent of individuals taking SSRIs experience sexual dysfunction. Desire, arousal and orgasm may be affected by changes in function of neurotransmitters like serotonin and dopamine; the very mechanisms through which SSRIs treat depression.
How to Work Around the Side Effects
When fighting to survive a potentially fatal mental illness, there are often more important concerns than getting it on. It’s frequently not an option to stop taking life-saving medication to avoid side effects. So what’s a sexual being to do?
Despite SSRIs being pretty pedestrian, there’s no concrete answer to addressing sexual side effects. “Unfortunately, not much is reliably effective to deal with this [sexual dysfunction],” Dr. Kim notes.
This may sound pretty gloomy, but there are plenty of things you can try to bring sexy times back around. “Don’t hesitate to bring up the issue with your prescribing clinician, as there might be some helpful interventions available,” says Dr. Kim.
Here are other ways to work around the sexual side effects of antidepressants:
1. Time It Right
“Some literature advises trying to have sexual activity when the serum level of a daily antidepressant might be lowest in the bloodstream,” says Dr. Kim. In other words, the ideal time to get it on is right before you take your next daily dose.
If your dosing schedule makes it tough to pencil in sexual activities, chat with your clinician about changing the time of day you take your meds. In many cases, there’s room for flexibility.
“This would not work much with some SSRIs that have a longer half-life like fluoxetine (Prozac),” Dr. Kim adds. Those taking antidepressants that exit the body quickly, like Paxil and Zoloft, could be in luck.
2. Switch It Up
Switching to a different medication, with the support of your prescribing clinician, may make all the difference. Certain antidepressants have a greater incidence of sexual side effects than others. Commonly prescribed SSRIs associated with a high frequency of sexual dysfunction include paroxetine (Paxil), sertraline (Zoloft) and fluoxetine (Prozac).
Besides exploring the SSRI class, venturing into atypical antidepressant territory is another option. Buproprion (Wellbutrin) is an atypical antidepressant observed to present the lowest sexual side-effect profile of all antidepressants.
It may take some trial and error, mixing and matching to identify what works best for you, but it will all be worth it when you can [insert favorite sex act here] to your heart’s content again.
Some treatment add-ons may act as antidotes to SSRI-induced sexual dysfunction. “Supplementing with other medications that have serotonin blocking effects (like cyproheptadine [Peritol] or buspirone [Buspar]) or enhance other neurotransmitters like dopamine (like Wellbutrin) might help,” says Dr. Kim. She is quick to note that these findings are yet be confirmed by “larger-scale randomized controlled clinical trials.”
“Another common strategy is to prescribe erectile dysfunction drugs like sildenafil (Viagra) and the like for as-needed use before activity,” says Dr. Kim. Viagra has been found to reduce sexual side effects, even if you’re not in possession of a penis. In Dr. Kim’s clinical experience, “[Viagra] seems to help in more than a few cases.” Discuss with your doctor before adding any more medications to the mix.
Now’s the time to take up aquacycling, indoor surfing sans water or whatever fitness fad tickles your fancy. Keeping active could be the key to preventing sexual dysfunction caused by SSRIs.
“Sometimes sexual dysfunction is not just a primary SSRI drug side effect but part of underlying depression/anxiety as well,” Dr. Kim explains. “Anything that helps enhance overall blood circulation, mood and libido might be helpful, such as exercise.”
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By Kim Eckart
Same-sex marriage has been the law of the land for nearly two years — and in some states for even longer — but researchers can already detect positive health outcomes among couples who have tied the knot, a University of Washington study finds.
For years, studies have linked marriage with happiness among heterosexual couples. But a study from the UW School of Social Work is among the first to explore the potential benefits of marriage among LGBT couples. It is part of a national, groundbreaking longitudinal study with a representative sample of LGBT older adults, known as “Aging with Pride: National Health, Aging, Sexuality/Gender Study,” which focuses on how historical, environmental, psychological, behavioral, social and biological factors are associated with health, aging and quality of life.
UW researchers found that LGBT study participants who were married reported better physical and mental health, more social support and greater financial resources than those who were single. The findings were published in a February special supplement of The Gerontologist.
“In the nearly 50 years since Stonewall, same-sex marriage went from being a pipe dream to a legal quagmire to reality — and it may be one of the most profound changes to social policy in recent history,” said lead author Jayn Goldsen, research study supervisor in the UW School of Social Work.
Some 2.7 million adults ages 50 and older identify as lesbian, gay, bisexual or transgender — a number that is expected to nearly double by 2060.
Among LGBT people, marriage increased noticeably after a 2015 U.S. Supreme Court ruling legalized same-sex marriage nationwide. A 2016 Gallup Poll found that 49 percent of cohabiting gay couples were married, up from 38 percent before the ruling.
For the UW study, more than 1,800 LGBT people, ages 50 and older, were surveyed in 2014 in locations where gay marriage was already legal (32 states and Washington, D.C.). About one-fourth were married, another fourth were in a committed relationship, and half were single. Married respondents had spent an average of 23 years together, while those in a committed, unmarried relationship had spent an average of 16 years. Among the study participants, more women were married than men, and of the respondents who were married, most identified as non-Hispanic white.
Researchers found that, in general, participants in a relationship, whether married or in a long-term partnership, showed better health outcomes than those who were single. But those who were married fared even better, both socially and financially, than couples in unmarried, long-term partnerships. Single LGBT adults were more likely to have a disability; to report lower physical, psychological, social and environmental quality of life; and to have experienced the death of a partner, especially among men. The legalization of gay marriage at the federal level opens up access to many benefits, such as tax exemptions and Social Security survivor benefits that married, straight couples have long enjoyed. But that does not mean every LGBT couple was immediately ready to take that step.
According to Goldsen, marriage, for many older LGBT people, can be something of a conundrum — even a non-starter. LGBT seniors came of age at a time when laws and social exclusion kept many in the closet. Today’s unmarried couples may have made their own legal arrangements and feel that they don’t need the extra step of marriage — or they don’t want to participate in a traditionally heterosexual institution.
“More older people are living together and thinking outside the box. This was already happening within the LGBT community — couples were living together, but civil marriage wasn’t part of the story,” she said.
The different attitudes among older LGBT people toward marriage is something service providers, whether doctors, attorneys or tax professionals, should be aware of, Goldsen said. Telling a couple they should get married now simply because they can misses the individual nature of the choice.
“Service providers need to understand the historical context of this population,” she said. “Marriage isn’t for everyone. It is up to each person, and there are legal, financial and potentially societal ramifications.” For example, among the women in the study, those who were married were more likely to report experiencing bias in the larger community.
At the same time, Goldsen said, single LGBT older adults do not benefit from the marriage ruling, and other safeguards, such as anti-discrimination laws in employment, housing and public accommodations, are still lacking at the federal level.
Over time, Goldsen and colleagues will continue to examine the influence of same-sex marriage policy on partnership status and health.
The study was funded by the National Institutes of Health and the National Institute on Aging. Other researchers were Karen Fredriksen-Goldsen, Amanda Bryan, Hyun-Jun Kim and Sarah Jen in the UW School of Social Work; and Anna Muraco of Loyola Marymount University.
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