At the same symposium, Dr Clayton mentioned that serotonin can dampen sexual desire and excitement. It can also deaden sensation, leading to vasocongestion (“blue balls”). Prolactin can have a negative impact on sexual excitement.
Philip Muskin MD of Columbia University cited these statistics:
* Married couples report having sex 68.5 times a year (1.3 times a week) according to a 2002 University of Chicago National Opinion Research Center Report. According to a 2003 cover story in Newsweek, 15 to 20 percent of couples have sex less than 10 times a year, regarded as a sexless marriage.
* Various studies give the following breakdown for incidence of sexual disorders: Hypoactive sexual desire (27-34 percent women, 13-17 percent men); Sexual arousal disorder (11-27 percent women); Erectile disorders (eight-38 percent men); Orgasmic disorders (15-28 percent women); Premature ejaculation (25-32 percent men); Pain during intercourse (eight-23 percent women).
Dr Clayton cited her 2001 study that found that 37 percent of men taking antidepressants experienced sexual dysfunction. Paxil was the highest at more than 40 percent and Wellbutrin the lowest at about 20 percent. Remeron was surprisingly at the high end of the scale.
Only 14.2 percent of patients spontaneously report antidepressant induced sexual dysfunction to their physicians, according to a 1997 study vs 58.1 percent responding to a questionnaire.
Antipsychotics pose their own set of problems. A 2003 study by Knegtering et al reports that 60 percent of Risperdal patients reported sexual side effects vs about 27 percent for Zyprexa and about 44 percent for old generation antipsychotics.
Risk factors for sexual dysfunction include being at least 50 years old, married, less than college education, not employed full time, tobacco use, higher doses of antidepressants, concomitant meds, co-occurring ills known to cause sexual dysfunction, prior history of antidepressant-induced sexual dysfunction, history of little or no sexual enjoyment, and regarding sexual functioning as not or somewhat important.
According to data from the 1992 National Health and Social Life Survey, 43 percent of women and 30 percent of men have a sexual complaint (a sexual complaint is not of the same magnitude as sexual dysfunction or sexual disorder). In patients with depression, that figure is 70 to 80 percent. Depression itself rarely causes sexual dysfunction, Dr Muskin explained. Untreated depression, however, often causes a lack of interest in sex, and disrupts intimacy.
Dr Muskin says doctors must encourage their patients to accept the reality that getting well is more important than sexual dysfunction. Patients and their partners, he said, may need to reconfigure how they have sex. Arousal may need to be at a higher pitch before intercourse, and orgasm need not be linked to the act.
But patients may want to try these antidotes first, cited by Dr Clayton: Wellbutrin, Viagra (for men), and Buspar (for women), all supported by studies. Other possibilities include hormones (testosterone, estrogen), yohimbine, amantadine, and low dose psychostimulants.
At another APA forum, WebMD reported on a presentation by Richard Brown MD of Columbia University, who noted that although Viagra may improve erection, it doesn’t help much with libido and orgasm. The following natural treatments, he said, show promise: Rhodiola (an arctic plant that works for both men and women, may work on dopamine, helps libido and boosts energy); Ginko biloba (for impotence in men and maintains erection); Gingseng (appears to work on dopamine, so woman can benefit too); Maca (a Peruvian root that “can have powerful effects on desire, erections, and orgasms”); Horny goat weed (forgive the term, little data). Via