Depression and Sexual Health

September 12, 2008 4:23 AM

Question about men's sexual health and medications for depression

I am a 28 year old male with a professional job. I am very physically fit. I run 15 miles a week, plus sports, plus regular weight lifting. I have sex with my girlfriend one, two or three times a day on average. I also suffer from depression. The depression is not so bad that I want to stay in bed all day or harm myself, but it completely fucks with my head, my emotions, my motivation, my outlook on life, and generally how I value my life.

So I have gone to the general medicine doc and gotten meds for it. I was first given Zoloft. I felt absolutely great! I felt bolts of euphoric optimism running through my blood. But I lost 90% of my sex drive and had difficulty having an orgasm. I only made it 3 months on Zoloft.

So next I tried Wellbutrin. It probably worked 55% on the mental health side with no negative side effects. This was a functional solution for about 9 months or so. The stuff quit working. I go back to the doc. He gives me Cymbalta. This basically has all the same features for me as Zoloft. It works great on the mental stuff but destroys my sex life.

At this point in my life I value my sexual health more than my mental health. Or so I feel that way when I am on the pills. Then it gets so bad and I have to take them again.

Ok, so I guess my questions are:

Are there any other meds that any of you can recommend that my be helpful? I ask specifically because I always feel like I am making the suggestions or driving the discussion with the doc. Yes I have switched docs already.

If I get these side effects from one SSRI does this mean that I am likely to get these effects from all of them? (I.e is something like Prozac potentially helpful)

Is there any permanent risk to my sexual health from having to take these drugs periodically?

In looking back at my questions, I guess I can see that these are more of questions that should be directed towards a medical professional, but I guess I am just looking for any suggestions to help prepare for the conversation at the doc's office again. I would just like to find a way to be content and sexually healthy.

Thanks for any insights you can offer.

[e-mail]

posted by anonymous to health & fitness (14 comments total)

I have sex with my girlfriend one, two or three times a day on average.

This is confusing to me. You think having sex up to three times a day means you have no sex drive? Or did you mean per week or per month? Unless you meant "per month" it doesn't sound that bad. Or did you mean that you used to have sex that much but you don't anymore?
posted by Nattie at 4:48 AM on September 12, 2008

I assume the poster (who is anonymous, and therefore unlikely to reply, Nattie) means that this is the normal frequency when he isn't taking medication and suffering the side effects he describes.
Personally, Prozac destroyed my libido, to the extent that it was the main reason I gave up with it. From talking with docs, these things can be extremely subjective and individual side effect responses.
posted by hydatius at 4:53 AM on September 12, 2008

From what I can interpret from your post you've been medicated for depression for 12 months minimum. I would reccomend putting much greater emphasis on your depression and looking for ways to end that as comprehensively as possible rather than devoting your energy and worry on the sex issue.

At this point in my life I value my sexual health more than my mental health. Or so I feel that way when I am on the pills. Then it gets so bad and I have to take them again.

Respectfully, this makes me think that your mental health is more of a problem than you admit, and that you may be using the sex issue to avoid tackling the causes of those other problems with your emotions, motivation and outlook on life.

When I was medicated for depression the best piece of advice I was given by my doctors was that antidepressants should be treated as a means of giving you mental space and strength to work out what's making you depressed in the first place, figure it out, tackle it and change it. Don't fall into the trap of them being a magic wand, because that way lies dependence and entrenchment of the things in your life you need to change, not to mention having to deal with the raft of side effects which they have (as are seeing) and which can often become increasingly problematic with long term use.

Antidepressants should be treated as a bandage to be applied and removed when the wound's healed, not as a crutch to lean on whenever you're feeling worn out.
posted by protorp at 5:26 AM on September 12, 2008

Rubbish - (as you are seeing)
posted by protorp at 5:28 AM on September 12, 2008

Antidepressants should be treated as a bandage to be applied and removed when the wound's healed

For many people, this would be a VERY dangerous generalization to make.

It might help you to become familiar with the various types of antidepressants. The three drugs you mention are all in different categories, and work in different ways. If you think one worked more effectively than others, then it might be worth asking if you should try a different medication in the same group.
posted by gnomeloaf at 5:45 AM on September 12, 2008

This is a common side-effect of SSRIs and other types of anti-depression medication. You should talk to your doctor about this. You might have to try another few medications. Perhaps youre a good candidate for non-SSRIs like Serzone.

>Is there any permanent risk to my sexual health from having to take these drugs periodically?

No. I have not seen this in any literature.
posted by damn dirty ape at 7:03 AM on September 12, 2008

First of all, good on you for trying to manage your depression, but I would venture to say a general medicine doc is probably not going to cut it. Primary care providers mean well, but you should really see a specialist i.e. a psychiatrist. Wellbutrin has the least sexual side-effects, and from my understanding, is unique in that respect. Maybe supplementing that with another medication would work? IANAD obviously, and I really would urge you to see a psych. Good luck!
posted by katemcd at 7:55 AM on September 12, 2008

The first thing I'd ask is: Have you tried therapy? You obviously have a very active life, which suggests that your depression is mild to moderate in severity. Talking therapies are generally regarded as at least as effective as medication for that kinds of depression and have no side effects.

There are reports of sexual dysfunction continuing after discontinuation of SSRIs - this Wikipedia page might be a good place to start.

I also found it kind of interesting that you described Zoloft as making you feel there were "bolts of euphoric optimism running through my blood." That's really not how people normally respond to SSRI's and other antidepressants. They're supposed to lift your mood, not cause euphoria. I'm probably projecting a lot, but this sounds a lot like hypomania. Psychiatrists are good at picking this kind of thing up and, if you did want to manage the sexual side-effects of your medication more effectively, a psychiatrist would be the obvious person to look at ways of doing this.
posted by xchmp at 8:39 AM on September 12, 2008

At this point in my life I value my sexual health more than my mental health. Or so I feel that way when I am on the pills. Then it gets so bad and I have to take them again.

Well, we all make our own decisions about the trade-offs in life we make. If that's yours then that's that. However, I'll share my personal perspective on the matter.

I take prozac, which is actually the only AD I have ever taken. It works for me so I am not inclined to mess with it, even though it has some side effects. It also has the advantage of a long half-life, allowing me to take it M/W/F/S rather than every day.*

The most prominent side effect is, indeed, sexual. It impedes my ability to orgasm and "raises the bar" as it were for arousal. If stimulation was measured in cookies and it took 1 cookie to "sufficiently motivate me" without prozac then it takes four cookies on a full dose and 2 or 3 on the dose I take now. When I first started taking the pills it was probably more like six cookies, but as I got used to the medication's effect the impact lessened.

My two observations about this are as follows: One, at my most athletic I could spend no more than 1 hours a day having sex. That leave 23 other hours in the day where I want to function and enjoy myself. Two, when I finally accepted my situation and started ADs I had been down so low and long that the rest of my life wasn't conducive to getting laid anyway. So being able to perform when I didn't have the will to sustain a relationship or even meet people to HAVE sex with was precluding me from having sex with other people anyway.

If you'll forgive some completely half-baked armchair psychology, do you think to some extent you're coping with your depression with this quantity of daily sex? It's certainly not an abnormally large amount but it probably is more often than the average for a 28 year old man. I ponder this only because if it's a coping mechanism that you don't need when you're on the pills that would be another contributing factor to your screwing less.

Make your own decision about the tradeoffs, but for me at least I can say with certainty that the side effects either lessened after a while or I adjusted to them, and I have a perfectly healthy and enjoyable sex life now... though not as prolific as yours.

* Prozac's long halflife is part of why they were able to more easily make and market this ProzacXL or whatever their "long acting" version is that they created to extend their patent protection. It's not necessary - you can do an every-other schedule with the generic.
posted by phearlez at 8:41 AM on September 12, 2008 [1 favorite has favorites]

I've been on Paxil (or the generic equivalent) for several years now for depression and anxiety. Shortly after starting on it, I began experiencing the symptoms you mentioned (lack of interest in sex, delayed orgasm, etc.) so my doctor added Welbutrin to my daily medications. He said that many people complain that Welbutrin raises their libido so much that it's a problem, so maybe the two together would balance out. It helped with the lack of desire, but not the delayed orgasm. Many people would consider that a "feature" :-) When I used to last maybe 5-10 minutes, now I can go for half an hour or more, and nobody is complaining. I'd say that you need to examine your priorities, because depression can sneak up on you and really wreck your life. If it's down to that or sex three times a day, I'd recommend you treat the depression and let the sex life sort itself out. You might even try buying a "toy" to use on your girlfriend, so you can still fulfill her needs, even if you're not particularly interested in sex.

One thing - I was warned by my therapist that many times, if you start and stop with SSRI's, their effectiveness decreases each time. He also cautioned me not to ever stop taking the drugs abruptly, as it could result in a psychotic break.

Best of luck getting things worked out, in any case!
posted by Death by Ugabooga at 9:40 AM on September 12, 2008

I was on Wellbutrin for several years with no negative side effects. Like you, it pretty much stopped working after a while, even after increasing to the maximum daily dosage.

Three different doctors (one primary care and 2 psychiatrists) prescribed several rounds of various SSRIs supplemental to Wellbutrin. I had extreme side effects from ALL of the SSRIs, including, but not limited to, the loss of sexual drive and functioning as you described.

I am now taking Abilify in addition to Wellbutrin and am experiencing some remarkable results. The few side effects I did have, like headache and nausea, were brief and ended about two weeks into treatment. While originally approved for the treatment of schizophrenia, some patients, like myself, are finding it beneficial as an add-on treatment to major depressive disorder or otherwise drug-resistant depression.

I agree with damn dirty ape in that you may be a candidate for treatment using such non-SSRI drugs. As Wellbutrin was initially successful for you, perhaps you should speak to your doctor about trying other meds that, like Wellbutrin, affect dopamine receptors.
posted by eviltiff at 9:44 AM on September 12, 2008

I'm nth-ing the suggestion to see a specialist. You really need to see a psychiatrist who specializes in psychopharmacology, not a general practitioner.

General practitioners have enough information to start someone with depression on one of the standard medications. If that doesn't work for them, or if they can't tolerate the side effects, the next step should be to see a specialist, just as it would be with another ailment that wasn't responding to a standard medication.

Psychopharmacology is a specialty. See someone who's a specialist in that field.
posted by Sidhedevil at 12:00 PM on September 12, 2008

2nding seeing a psychopharmacologist, not just a psychiatrist.

if you haven't already tried cognitive behavioral therapy or interpersonal therapy (both of which appear to be equally effective as drugs for some), try one or the other. but don't just see a random therapist who won't actually do one of those therapies specifically but is "eclectic."

Eclectic is fine if the evidence-based stuff doesn't help-- but I'd want the therapist to try the stuff that works for the most people before they "wing it" on me based on their anecdotal clinical experience, thank you!

if you are a person for whom talk therapies do all but take away the key part of the depression-- anhedonia, no one can seem to talk me into feeling good when nothing that usually makes me feel good does so, that's what drugs do--then you will need the psychopharmacologist as well.

for me, prozac plus wellbutrin works well-- but i'm female.

also, recent research shows viagra reduces sexual side effects of antidepressants in women-- but i don't know if this is true for men. worth trying potentially, as we now know that viagra doesn't just affect the little brain, but the big one too, increasing release of oxytocin, involved in orgasm and bonding.
posted by Maias at 3:40 PM on September 12, 2008

Good questions. Let me take a shot at a couple:

If I get these side effects from one SSRI does this mean that I am likely to get these effects from all of them? (I.e is something like Prozac potentially helpful)

Not invariably, no. But there is no magic formula, and often times the answer for an individual patient is yes.

Is there any permanent risk to my sexual health from having to take these drugs periodically?

Not that I'm aware of. I don't believe it's ever been studied, but the problems are generally self limited and disappear a few months after stopping the meds.

It's worth knowing that sometimes the underlying diagnosis, such as depression, can itself impair sexual function. A lot of people blame the meds when they are not entirely at fault for the problem. You need to discuss these issues with your treating physician.
posted by ikkyu2 at 7:32 PM on September 12, 2008