Drugs and the Libido

Sexual dysfunction occurs often all across America. In a 1994 survey 33% of women and 17% of men reported no sexual interest. In another survey, one-third of women 18 to 59 reported lack of sexual desire within the last 12 months. Subjects with depressive disorder or bipolar disorder are more likely to report sexual dysfunction than members of the general population. Often, patients reported a loss of the ability to enjoy sexual activity.�

What's behind it? Possible causes include stress; an underlying or undiagnosed and untreated illness, hormonal conditions such as low testosterone, undisclosed impotence, psychiatric disorders and autoimmune diseases, among others. Men suffering from sexual dysfunction may refrain from informing their doctors, and doctors do not often inquire about such matters.�

Lowered libido often affects people who are depressed. No one knows what the connection may be, but treating either condition frequently improves both in two-thirds to three-fourths of patients. Alternately, antidepressants may actually lower libido and sexual function. If this seems like a Catch-22 solution, that's because it is. And in a one-month count, some 3.4 million prescriptions were written for the serotonin-reuptake inhibitors, Prozac, Zoloft and Paxil.�

How to know if you're suffering from lowered libido? This may seem obvious, but it isn't, always, especially among women. Sex researchers have routinely relied on questionnaires and interviews to diagnose sexual dysfunction, but scientists have now developed a test to measure a person's level of sexual desire. It involves the recording of brain waves as the subject looks at a variety of erotic videos and measuring the response. This test is useful for measuring the sexual side effects of drugs.�

According to Yoram Vardi, head of the neuro-urology unit at the Rambam Medical Center and the Technion faculty of medicine in Haifa, Israel, sexual dysfunction was previously measured via "Changes in [genital] blood flow and effects on the heart rate and blood pressure... it may now be a cliché, but it is no less true-the most important sexual organ is the brain."�

Vardi believes that the test will aid in determining the "root cause" of lowered libido, whether the problem is best treated by medication or by some other method, and just how much libido is aided or repressed by drugs. The "libido meter" has so far only been used with well patients; the testing of people suffering from lowered libido will begin soon.�

Why not just do without sex? Many people believe their lives would be dulled if they abandoned sex altogether. Also, sex is good for you; it contributes to your overall health, mental and physical. "I think having frequent, satisfying sex keeps the hormone levels up and keeps us young," said Barbara Bartlik, a psychiatry professor at Cornell University.

What are the drugs that affect sexual functioning and how serious are the effects?

Prozac: In trials,

7% of Prozac takers reported abnormal ejaculation, as opposed to a little over 1% of placebo takers;

4% reported decreased libido on Prozac as opposed to 0% of placebo takers;

2% of Prozac takers reported impotence, as opposed to a little over 1% of placebo takers.

Zoloft:

14% of Zoloft takers reported abnormal ejaculation, as opposed to a little over 1% of placebo takers;

6% reported decreased libido on Zploft as opposed to 1% of placebo takers;

Paxil

13% of Paxil takers reported abnormal ejaculation, as opposed to a little over 1% of placebo takers;

3% reported decreased libido on Paxil as opposed to 1% of placebo takers;

10% of Paxil takers reported impotence, as opposed to 0% of placebo takers.

Celexa

6.1% of Celexa takers reported abnormal ejaculation, as opposed to 1% of placebo takers;

3.8% reported decreased libido on Celexa as opposed to 1% of placebo takers;

3.1% of Celexa takers reported impotence, as opposed to 3.1% of placebo takers.

Wellbutrin

3.1% reported decreased libido on Wellbutrin as opposed to 0.6% of placebo takers;

3.4% of Wellbutrin takers reported impotence, as opposed to 3.1% of placebo takers.

Effexor

17% of Effexor takers reported abnormal ejaculation, as opposed to 1% of placebo takers;

6.2% reported decreased libido on Effexor as opposed to 2% of placebo takers;

6.1% of Effexor takers reported impotence, as opposed to 1% of placebo takers.

Serazone

A little over 1% of Serazone takers reported abnormal ejaculation;

1% of reported decreased libido on Serazone as opposed to a little over 1% of placebo takers;

A little over 1% of Serazone takers reported impotence.

Luvox

8% of Luvox takers reported abnormal ejaculation, as opposed to 1% of placebo takers;

2% reported decreased libido on Levox as opposed to 1% of placebo takers;

2% of Levox takers reported impotence, as opposed to 1% of placebo takers.

This is only a representative sampling of the antidepressants that may cause lowered libido and should not be used for any but informational purposes.

If psychiatric drugs were taken only for a regimen of 10-15 days, like antibiotics, more patients would be able to cope with the decrease in sexual enjoyment, but some of these drugs must be taken for months, or even years. For some patients, this is unbearable, and they respond by dropping the medication. Doctors need to inquire about patients' sexual activity as they routinely do for the patient's blood pressure, bowel habits and heart function.�

Dr. Robert T. Segraves, psychiatrist at Metrohealth Medical Center in Cleveland, in an interview cautioned doctors that before they prescribe an antidepressant or any other drug that has a possibility of decreased libido as one of the side effects, inform the patient of the risk, and "establish a baseline of sexual functioning beforehand," to have something to measure against. Dr.�

Segraves suggests asking the patient these questions:�

• Have you experienced any sexual difficulties?�

• Have you experienced any difficulty with lubrication?�

• Have you experienced any difficulty with erection?�

• Have you experienced any difficulty with orgasm?�

• Have you experienced any difficulty with ejaculation?�

If the patient is reluctant to answer, Dr. Segraves recommends consulting the spouse or significant other. After the drug prescribed has had a chance to work for a time or has run its course, the patient's libido should again be checked. The doctor should also ask the patient (in confidence, of course) if they have had the same sexual problem with other partners, and whether they are successful with masturbation while unsuccessful with their partner. If a patient who has had no problem in the past but has developed one after beginning with the drug, it is likely that the drug is to blame.�

What can be done? Dr. Anthony J. Rothschild, a psychiatrist at Harvard Medical School and McLean Hospital in Belmont, Mass., suggests that if the drug is suspected, a lowered dosage might be the solution, if such can be done without influencing the efficacy of the drug. Or, a patient might follow a timeline in which they have sex before taking their daily dose, but this may prove impractical. The patient might also consider trying one of the "sexual enhancement" drugs like vohimbine or amantadine. These drugs may not work consistently, he warned.�

Dr. Rothschild also advocates weekends free of the drugs, a plan where the last dose for the week is taken Thursday morning, and the next dose Sunday morning. He reported good results for patients on Zoloft and Paxil, but poor results with Prozac, which takes longer to leave the body. Taking a weekend off the drugs did not hamper their antidepressant action.

Newer drugs promise more. Serzone (featured above), was tried on 80 patients who were being treated with Zoloft for depression, and who were experiencing sexual dysfunction. They reported no increase in sexual desire, but when they switched to Serzone, they described a dramatic improvement in their interest. Both drugs lifted depression in 64% of the patients.�

If you are seeking a doctor's advice for depression or any other illness for which they might prescribe medication, don't be shy, ask about side effects, in particular lowered libido. You'll be glad you did.