Anxiety meds that won't cause sexual problems or hair loss?

September 18, 2014 4:48 PM

Are there any traditional or non-traditional prescription medications for anxiety that don't pose a risk of sexual side effects or hair loss? SSRIs can cause both. Buspar poses a risk of hair loss, and benzos like valium pose a risk of sexual side effects. Is there anything that doesn't?
posted by iamisaid to Health & Fitness (22 answers total)

Remeron is apparently sometimes used off-label for anxiety, though it isn't FDA-approved for it. Its major side effects are weight gain, constipation and sleepiness. The ones you're worried about are apparently rare.
posted by nebulawindphone at 5:03 PM on September 18, 2014

Hydroxizine doesn't have either hair loss or sexual side effects listed. It does make you quite sleepy when you first take it, but like Benadryl (to which it is related), you acclimatize pretty fast.
posted by KathrynT at 5:12 PM on September 18, 2014

Wellbutrin doesn't generally negatively affect libido or ability. Not sure about the hair loss with that though.
posted by cjorgensen at 5:12 PM on September 18, 2014

Came here to suggest Wellbutrin before I saw cjorgensen's comment. I am quite sure it does not cause hair loss.
posted by Juffo-Wup at 5:14 PM on September 18, 2014

I'm taking gabapentin for anxiety, which is an offlabel use for it, and it works for my anxiety. SSRIs/SNRIs (and other serotonergics) cause anorgasmia for me, but, gabapentin doesn't. YMMV. See also pregabalin the successor to gabapentin.
posted by and they trembled before her fury at 5:17 PM on September 18, 2014 [1 favorite]

Remeron works very well for anxiety for me. I'm far more laid back than I ever was on SSRIs. But a big deal is that it's not recommended to drink on it. My gut feeling is that when I have, I've been very sleepy, and been closer to baseline depressed and anxious the following day. And I don't think I've had more than 2 pints in an evening since I've been taking it.
posted by ambrosen at 5:21 PM on September 18, 2014

Wellbutrin can cause hair loss. It did for me. It's listed as a rare side effect, but affects between 1 in 100 to 1 in 1000 people.
posted by cecic at 5:31 PM on September 18, 2014

Also, you say in your question SSRIs can cause both those side effects, not that you are experiencing them. If you're worried about starting antidepressants because of them, then the hair loss is reversible, and not related to male pattern baldness if it does occur. If the sexual side effects occur and are problematic, then it might be worth considering Viagra. Neither of these, in my view, are serious enough risks to outweigh the very serious risk of all that you would miss out on from undertreated depression, and given that they're both reversible, they are bridges that you can cross when you get to them.
posted by ambrosen at 5:47 PM on September 18, 2014 [4 favorites]

Response by poster: Yes, hair loss/alopecia is listed as a common side effect of Wellbutrin which is why I ruled it out.

Trembled, gabapentin can cause sexual side effects, as you allude to, namely inability to orgasm. I've experienced it. I know less about pregabalin but I see this listed as a infrequent side effect for it as well.

Ambrosen, I have experienced them and am unwilling to make that trade-off again, hence my question. I get your point, though.

Remeron sounds like the most promising of the lot so far.
posted by iamisaid at 6:10 PM on September 18, 2014

benzos like valium pose a risk of sexual side effects.

From that abstract, it's only clonazepam that showed those side effects; the other three in the study did not.

Are you sure you aren't looking for reasons (real or imagined) to justify not using the options available? That's a common manifestation of depression (as well as how anxiety can make it hard to change existing patterns even if they are negative).
posted by Dip Flash at 7:01 PM on September 18, 2014 [6 favorites]

"Can" != "will".

I had moderate anorgasmia from Prozac (and daily diarrhea). Switched to Lexapro, and the problem was 1/3 as bad. Switched to Celexa (the chiral form of Lexapro); if the side effects remains, it's too low-key for me to notice.

As far as hair loss, I was already balding, so I can't say, but it's also not a guaranteed side-effect.
posted by IAmBroom at 7:34 PM on September 18, 2014

FWIW I only have "mild" anxiety but Wellbutrin made me feel AWFUL (as in, took me from feeling "worrisome/nervous" into "utter despair" and Buspar has worked well for me, leveling out any periodic panicky feelings and I experienced no discernible hair loss. Just a data point...
posted by lovableiago at 8:22 PM on September 18, 2014

Wellbutrin is nasty crap. It basically caused me to lose two jobs, from anxiety. As in, the boss says she wants to meet with me in the afternoon, and I spend lunch in the parking lot crying hysterically, in the phone to my wife. And my psychiatrist never mentioned the side effects. That's one of the reasons we called him "Dr. Feelgood".
posted by happyroach at 9:02 PM on September 18, 2014 [1 favorite]

I did fine with Welbutrin back in the day. As to hair loss, I was always advised to take Centrum Silver vitamins, as two minerals (I forget which ones) contained therein helped forstall the hairloss. I never really noticed any, fwiw.
posted by St. Alia of the Bunnies at 9:05 PM on September 18, 2014

(It did make me feel wired the first couple of weeks on it but long walks helped with that, and then I adjusted.)
posted by St. Alia of the Bunnies at 9:06 PM on September 18, 2014

Remeron causes bad weight gain.

It is very uncommon for benzos to cause sexual side effects.
posted by persona au gratin at 1:05 AM on September 19, 2014

A lot of times, doctors will use blood pressure meds like clonidine or propanalol to help with anxiety. It might be worth a try if you don't have low blood pressure.

When I tried those, they helped some with the physiological symptoms of anxiety (shaking, heart racing, etc.) but they didn't do a ton for the more psychological symptoms.

Though of course your mileage varies and a lot of doctors are very hesitant to prescribe benzos anyway, I've taken benzos (Xanax and then clonazepam) for 12 years now and never had any sexual side effects. Especially if you start out with something like a low dose of Xanax as needed, that would be a good way to check if you have any side effects. Plus, a lot of benzos like Xanax or Ativan wear off fairly quickly, so they may not even have a chance to interfere with your sex life.

And I agree with some comments about Wellbutrin. i am not a doctor, but if I were, I don't think I'd ever prescribe that crack for someone with anxiety issues.
posted by mermaidcafe at 1:42 AM on September 19, 2014 [1 favorite]

Agomelatine (brand name Valdoxan, at least in Australia) is a newer antidepressant you might look into. It works on the melatonin system, rather than serotonin (as SSRIs do), so it has a much different mode of action, and is known specifically for NOT causing the sexual dysfunction SSRIs are notorious for. The wiki article does not list hair loss or sexual issues as side effects. Although it's an antidepressant, a search for "agomelatine anxiety" yields a study that seems pretty positive as the first hit (based on the abstract anyway - full article behind a paywall, natch). If you have sleep issues, it can also potentially help with those; it can encourage sleep, much like taking a low dose of melatonin. The only other negative I can think of is that because it's new, it might be expensive and/or not covered by insurance. Might be worth asking your doctor about, in any case.
posted by po at 5:40 AM on September 19, 2014 [1 favorite]

(Nthing the suggestion that Wellbutrin, while great for depression, may not be a good choice for anxiety. Though obviously ask your doctor etc etc.)
posted by nebulawindphone at 6:45 AM on September 19, 2014

Don't rule out benzos. I've never had sexual side effects from Klonopin, Xanax, or Ativan, although I have with SSRIs. The difference between SSRIs and Benzos, is that they can be taken as needed and each pill is effective, where SSRIs need to develop a serum level in your blood, which is why you can't miss doses. If you do get sexual side effects from benzos, you can just stop taking them and they'll go away very quickly. Xanax in particular is very short acting, so you could even plan around sexy times -take a pill very early in the day, or skip it. That's if you even get side effects. It certainly wouldn't hurt to try and find out, since as I said, the effects would be limited to more like a day than months.
posted by catatethebird at 8:22 AM on September 19, 2014

I've had good results taking clonidine for anxiety. I also use it as a (very mild) sleep aid. I haven't had any side effects from it, although it is a blood pressure med, so it might not work if you have low blood pressure already. Of course, IANAD and YMMV.
posted by litera scripta manet at 9:19 AM on September 19, 2014

Remeron is the only thing that's ever worked for me. You do have to watch what you eat when taking it, because it will make you crave carbs like it was the last food on earth.
posted by jenh526 at 9:27 PM on September 19, 2014