“I had no sex drive—none,” complained the middle-aged patient to Glen Stimmel, Pharm.D., professor of clinical pharmacy and psychiatry at the USC School of Pharmacy and the Keck School of Medicine of USC. “You can imagine what it was doing to my relationship with my husband. So I stopped taking my Paxil.”
Paxil is an antidepressant that may cause sexual dysfunction. Sexual dysfunction is a general term for a wide variety of symptoms such as decreased sex drive, difficulty with erections, loss of sexual sensation, inability to reach orgasm, painful ejaculation and vaginal dryness.
The patient knew about this possible side effect, as did her husband, who had heard it mentioned in a television ad for the drug. “What they didn’t know,” says Stimmel, “is that the kind of sexual dysfunction that Paxil typically causes has more to do with the inability to reach orgasm than with the loss of sexual desire.”
A board-certified psychiatric pharmacist, Stimmel says one-third to one-half of all patients taking antidepressants have “changes” in sexual function. This affects a huge number of people, as antidepressants are the most prescribed drugs in the United States, with more than 31 million Americans over the age of 18 taking them and accounting for some 118 million prescriptions each year.
According to Stimmel, if you’re taking an antidepressant and experiencing a sexual problem, you should not discontinue your medication, skip doses or make other changes in treatment until you ask your physician or pharmacist about the problem. There are ways to accurately diagnose the sexual problem and to treat it while still treating your depression.
Stimmel says that Paxil, like Prozac, Zoloft, Celexa, Lexapro and a few other antidepressants, belongs to a category of drugs known as selective serotonin reuptake inhibitors or SSRIs. These medications increase levels of serotonin, a chemical that is “good in the brain but not so good in other areas of the body.”
“Patients often do not come up with the right conclusions. In the case of the patient on Paxil, the medicine is likely to improve libido—as depression lifts, people typically experience improved sex drive,” Stimmel says. In fact, this patient did resume her Paxil, and the medication worked—her depression subsided and her libido improved.
“Determining if a medication is causing sexual dysfunction is a little tricky,” says Stimmel, who is a member of the Sexual Medicine Society of North America.
He notes that antidepressant use is just one of many possible reasons for sexual dysfunction. Sexual problems may surface due to relationship issues, medicines other than antidepressants, and alcohol use, among other reasons. Patients starting an antidepressant must focus on any changes in sexual functioning that occur after drug therapy begins. Otherwise, they may inaccurately blame a pre-existing sexual problem on the drug.
To complicate matters further, patients are often embarrassed to discuss sex and consequently do not bring up the subject. Stimmel says it’s important for people to realize that today’s physicians and pharmacists have studied sexual function, including dysfunction, and are increasingly being trained to competently counsel patients on sexual issues. Additionally, pharmacists have extensive training in medications, their side effects and drug interaction profiles.
“Sex can be very hard for people to talk about,” Stimmel says. “Once they do, they’ll learn that there are many ways to take care of sexual dysfunction. In addition to medication substitutions, there are other options for the physician to correct sexual problems while continuing to treat the depression.”
It is important that people who are experiencing depression or sexual dysfunction talk with their physician or pharmacist. “Some antidepressants do cause sexual dysfunction, but it is treatable,” Stimmel emphasizes.
“There are plenty of good choices,” he says. “A bad choice is to simply decide on your own to stop taking your medicine.”
Talk to Your Physician or Your Pharmacist
If you’re taking an antidepressant, be sure to ask your physician or pharmacist:
» What should I do if I forget to take a dose?
» Should I feel better immediately or does the medicine take time to work?
» Do I have to take my antidepressant with a meal?
» What should I do if the medicine does not seem to be working?
If sexual issues surface after you start taking the medication,
be sure to tell your physician or pharmacist if:
» You experience difficulty achieving orgasm.
» You lose interest in sex.
» You have delayed ejaculation.
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