All medications have side effects. Antidepressants have a range of side effects depending on which specific one is being considered. For example, venlafaxine (Effexor) can cause excessive sweating, bupropion lowers the seizure threshold so a patient with a seizure disorder is more likely to have a seizure, and SSRIs like fluoxetine (Prozac) often produce nausea when started. Fortunately, many such side effects go away with continued use as the body adapts to it.
One fairly common side effect from a number of antidepressants are various forms of sexual dysfunction. In men, this usually includes erectile dysfunction (impotence), loss of interest in sex (reduced libido), or delayed ejaculation. This last side effect is sometimes used to treat premature ejaculation, which is having an ejaculation during sex too quickly for the wishes of both partners. Women can have loss of interest in sex and diminished or absent organisms as a side effect from some antidepressants.
While most side effects from antidepressants go away with time if you just stay on them, the sexual side effects are much less likely to. Unfortunately, many patients are embarrassed to tell their doctor about them or they don't realize that what they are experiencing is the result of the medication. It is also a shame that physicians often don't think to ask their patients about sexual side effects. The result is that these side effects may not dealt with.
Sometimes the sexual side effects can be managed by providing an antidote such as giving a medication like sildenafil (Viagra). At other times, it is best to change from the offending antidepressant to one that is unlikely to cause sexual side effects. The SSRI antidepressants like fluoxetine (Prozac) are among the more common offenders, but most patients do not have these side effects. On the other hand, these side effects are quite unusual with other antidepressants such as bupropion (Wellbutrin) or mirtazapine
(Remeron). One option may be to change to one of those if a patient experiences sexual side effects from one of the others.
Sexual side effects must be distinguished from sexual dysfunction from the underlying illness for which the medication was prescribed. For example, depression itself is often associated with a decrease in sexual desire and other sexual problems.
Fear of sexual side effects should not stop you from taking an antidepressant. Most of the time it is not a problem, and when it is, the problem can typically be solved by prescribing an antidote or changing to a different antidepressant. Likewise, if you do develop a sexual side effect, do not hesitate to let your doctor know so that he or she can help to resolve the problem.
Antidepressants are commonly prescribed medications that provide a lot of benefit to many patients. However, side effects may occur as with any medication. Fortunately, your doctor may have a solution if they occur but only if you let your doctor know.
Peter M. Hartmann, MD
