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Understanding Antidepressants and Erectile Dysfunction

Feeling depressed, unhappy or miserable is something almost everyone experiences occasionally. However, suppose it becomes a chronic, repetitive and debilitating condition that is interfering with a person’s daily life to the extent that they can’t function properly. In that case, doctors will start treating it differently, as clinical depression. You can read some more about the ways you can deal with depression and anxiety here.

Because behavior and emotion cannot be strictly monitored or measured in the same way as diseases, like physical disorders that can be detected – blood pressure can be measured;  blood sugar levels are easily read; arthritic joints will show up in an X-Ray – there is a much broader definition of what constitutes clinical depression. 

This leads to a particular need to understand how the usually prescribed medications for clinical depression, known collectively as antidepressants, can have unwanted or unexpected side effects.

Most prescription medications come with warnings about side effects. It usually means that there is some possible unwanted result, apart from the desired effect, that can affect the patient’s quality of life. Doctors always consider these, and prescribe medications whose benefits outweigh the potential risks.

What are the side effects of antidepressants on sexual activity?

Both the condition of clinical depression and the antidepressant medications prescribed to handle it can cause symptoms affecting sexual activity, such as low libido, erectile dysfunction and vaginal dryness. It is more common to have difficulty achieving satisfaction through to orgasm. Research indicates these sexual side effects are quite common.

One of the main unwanted side effects of antidepressants themselves is to interfere with the psychological drives for sex with lower levels of arousal, absent or delayed orgasm in both men and women, and the loss of ability to achieve and sustain erections for men.

The leading group of medications prescribed for clinical depression are Selective Serotonin Reuptake Inhibitors (SSRIs – see the FAQs below) and Selective Norepinephrine Reuptake Inhibitors (SNRIs). Some of the more severe side effects are their influence on sexual activity. These include a significantly reduced sex drive (loss of libido) and difficulties achieving orgasm during sex for both men and women, and problems obtaining or maintaining an erection during sex for men (erectile dysfunction).

A study of hundreds of people diagnosed with clinical depression published by the National Center for Biotechnology Information found that “overall, 73% of the SSRI-treated clients reported adverse sexual side effects …  SSRIs, to an equal degree, significantly decreased libido, arousal, duration of orgasm, and intensity of orgasm below levels experienced pre-morbidly.”

How to overcome the effects of antidepressants on erectile function

In many cases, the only way that sexual dysfunction will go away is by stopping medication with antidepressants. This may not be an option and any such decision should only be taken in close consultation with your healthcare providers.

In most cases, erectile dysfunction from antidepressants will gradually recede, and there will be a return of libido and sexual function after stopping SSRIs or SNLIs. However, sometimes effects persist for several months, known as post-SSRI sexual dysfunction syndrome.

Some medications can be taken in parallel. The alternate antidepressant Wellbutrin (bupropion) may ease sexual side effects caused by SSRis. There are also drugs that on their own improve sexual function, such as Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil). These are all treatments that work specifically to boost erectile function in the  short-term .

Conclusion

Antidepressant drugs, primarily SSLIs and SNLIs, have known side effects that can diminish sexual function for both men and women. In the case of men, one of the main side-effects is to produce an erectile dysfunction, failing to achieve or sustain an erection and achieve orgasm. Although there are no direct cures as long as the antidepressants are being taken, there are some immediate medications that can alleviate this problem – talk to your healthcare provider without any feeling of embarrassment, because the condition is common and familiar, and help may be at hand. 

FAQ

What are the main kinds of clinical depression?

According to Wikipedia, clinical depression is a mental disorder characterized by pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. The term was adopted by the American Psychiatric Association in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.

There is no laboratory test for the disorder, but testing can be done to rule out physical conditions that could cause depression, such as nonspecific somatic complaints, chronic pain, fibromyalgia, chronic fatigue, or after effects of a stroke in the left frontal lobe regions of the brain.

The diagnosis of major depressive disorder is based on the person’s reported experiences and a mental status examination. It means that the diagnosis can be highly subjective, based both on the examining doctor’s own methods, and on the patient’s personal responses. One result of this is that prescribing medication for clinical depression is also not fully calibrated, in a form where a given degree of the disorder mandates a specific level or type of medication, or  frequency of dosing.

What are the main medications used to treat clinical depression?

Primarily, clinical depression is treated with Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin Norepinephrine Reuptake Inhibitors (SNRIs). The most common forms of these are Celexa (citalopram); Prozac (fluoxetine); Zoloft (sertraline); Lexapro (escitalopram); Trintellix (vortioxetine); Paxil (paroxetine); and Luvox (fluvoxamine).

Neurotransmitters such as serotonin and noradrenaline are chemicals that pass messages between nerve cells that are thought to be linked to mood and emotion. SSRIs work to increase levels of serotonin and SNRIs the levels of norepinephrine in the brain by slowing down their reabsorption by the nerve cells (inhibiting its reuptake). This makes more molecules generally available. 

Antidepressants like SSRIs and SNRIs are used to treat more severe cases of depression, in combination with Cognitive Behavioural Therapy (CBT). They do not address its causes or provide a cure. There’s no way of knowing beforehand what the side effects will be, or the degree to which it impacts on daily life. So, in the end, its usage is really a matter of trial for the patient to establish whether the penalties are greater than the benefits.

What are the main side effects of SSRIs and SNRIs

Some of the more common side effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are:

  • Feeling agitated, shaky, anxious, or dizzy
  • Difficulty falling asleep or staying awake; not sleeping well (insomnia), or feeling very sleepy
  • Headaches
  • Upset stomach, vomiting, indigestion and stomach aches
  • Diarrhea or constipation, loss of appetite

One of the more severe side effects is its influence on sexual activity. These include a significantly reduced sex drive (loss of libido), difficulties achieving orgasm during sex for both men and women, and problems obtaining or maintaining an erection during sex (erectile dysfunction).

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