SNRIs vs. libido

December 9, 2007 7:18 PM

Is there any way to stay on SNRIs but restore libido? Possibly TMI about sex life inside, quite possibly NSFW.

My doctor started me on an SNRI and it's working great except for one thing: my libido has decreased drastically.

I frequently can't maintain an erection or, when I can, there's no guarantee even under direct stimulation of ever reaching an orgasm. After an hour or so it's more likely the skin will eventually tear, even with a lot of lube.

It's not necessarily a problem when single, but I haven't been dating throughout most of this depression and I'd like to start again. Ability to have a reciprocal sexual relationship would be a big plus.

I tried a couple of cock rings; one couldn't guarantee an erection; the other kept the blood inside but after about 45 minutes I got bored and gave up, wanting to avoid hurting myself again.

Yes, I have a doctor and no, you are not him, but I'd like to try to solve this somehow without telling him the details of my mostly nonexistent sex life.

Are there any over the counter treatments reliably good at increasing libido? Naturally I'll look them up first in PubMed, PDR, etc. to make sure they play well with my particular SNRI.

posted by anonymous to Health & Fitness (9 answers total)

Withholding information from your doctor is seldom a good move, unless your doctor is your father-in-law.
posted by dws at 7:28 PM on December 9, 2007

This is such a common problem with SSRIs, and I assume SNRIs as well, that I think you should just tell your doctor and work with him to try to adjust your meds to avoid the side effect. Maybe a different dosage, maybe a different (but related) drug ... I think doctors who deal with these drugs are very, very accustomed to having to futz with the prescription a bit to work around each person's idiosyncratic reactions.

It's embarrassing to bring up, but I doubt you'll have to go into any detail, since it is a known and common side effect.
posted by hattifattener at 7:54 PM on December 9, 2007

Seriously, he's heard it before. You don't have to tell him about cock rings, he's familiar with the problem, and like hattifattener said, is used to working with people to balance out the problem.
posted by Roman Graves at 7:57 PM on December 9, 2007

Your doctor has heard this a million times, its nothing unusual AT ALL. If he's a primary care doc its probably in his top 50 issues to deal with. Just tell him.
posted by Bob Dobbs at 8:40 PM on December 9, 2007

First off, everyone is right about letting your doctor know. Even though some general physicians aren't that great with the finer points of psych drugs.

Second, are you on Effexor or Cymbalta. Effexor has about twice the incidence of sexual dysfunction as Cymbalta (6-12% as compared to <6>
Viagra, Cialis, or Levitra are always an option. Cialis is the better choice for most people due to the longer window of action (12-36 hours.) The downside is cost. If not going through insurance (most don't cover it anyhow,) I would have the physician prescribe the 20mg tablets and see if you could get away with just taking a half at a time. It will save you about 40% (still about $12/pill I believe.) Most people have pride issues with this solution.

Yohimbe is the only natural product with some documented effectiveness, particularly is SSRI-induced sexual dysfunction, but the evidence is minimal and I would not readily recommend it. I also have absolutely no experience with anyone using this. I'd be curious if anyone has recommendation of herbal supplements that they have tried. I generally regard them all as placebo.

He could always switch you to bupropion (Wellbutrin), which I think has almost no incidence of sexual dysfunction, but in my experience Cymbalta is a much more effective drug.

I am a pharmacist and will probably check this thread later if you have any more questions.
posted by jjbb at 8:56 PM on December 9, 2007 [1 favorite]

I second the idea that these things take tuning, and you should work with your doc to find a dosage or a different med which doesn't cause you discomfort. That said, small drug vacations may help reduce sexual dysfunction. If you know you will be having sex (or be in a position to have sex) on a certain day, skip the drug THAT day. The therapeutic effect of SNRIs takes a while to build up, and will not be diminished because you skipped a day, but the side-effects are usually short-lived, and might not show up on days you skip. Another thing that might help is additional stimulation -- anal stimulation helps some guys in this situation, other things might work for you.
posted by ubiquity at 10:43 PM on December 9, 2007

I'm kind of confused; you say that the problem is that your libido has been busted up. But your question is all about maintaining an erection. Is the problem actually your libido or is it just keeping a boner?

If it's just a keeping a boner, this is a completely solved problem. Get ye some Viagra and your problems are most likely over.
posted by Justinian at 11:21 PM on December 9, 2007

Just an extra note on ubiquity's post: Drug holidays can be dangerous on SNRIs (and others). I recently titrated down from the usual dose of an SNRI and had two weeks of horrible withdrawal. It started about 24 hours after my last (small) dose, and really destroyed the my quality of life. I stopped because I had the same problems as you (although modified suitably for me being a female).
posted by nursegracer at 6:55 AM on December 10, 2007

While not denying nursegracers experience, I will say that it's very unusual to have those kinds of effects upon skipping a single day of an SNRI or SSRI. Drug holidays were specifically recommended to me by my shrink both while taking Wellbutrin and Prozac; he did not have any special medical knowledge of me to indicate that it was safe for me and not for others, nor did he warn me of the possible dangers of skipping a single dose. But IANAD, and since you have one, ask him.
posted by ubiquity at 5:45 AM on December 13, 2007