Erectile dysfunction and those antidepressants.
If you’re at the age of 40, you’re at risk of some kind of erectile dysfunction (ED). Some 10% of you will have a complete failure of erections - more often, this affects older men. Alongside this news is the equally significant evidence of depressive illnesses. Researchers estimate that about a quarter of men will suffer some degree of anxiety or depression at some point during their lives. When this happens, the symptoms may not appear too serious and you will probably not seek treatment. This is an entirely understandable reaction. But it is always better to get a professional opinion before self-medicating.
If you seek for a treatment, your physician will advise you some. In such cases, the issue of cause and effect can become complicated. The ED may have been caused by the anxiety or depression itself, or there may have been an independent cause. But what began as a small problem can be aggravated as a side effect of the antidepressant medications you are prescribed. It is somewhat ironic that one of the factors depressing you may be your declining sexual performance, but the treatment for that depression can complete deprive you of your desire to have sex. If it gets worse, the selective serotonin reuptake inhibitors (SSRIs) antidepressants not only affect sexual performance, but may also disturb sleep patterns and cause weight gain. Not surprisingly, this prompts many patients to stop taking the medication. Thus, although treatment using one or more antidepressants is usually successful in 90% of all cases, less than one third of patients complete the course of medication, and the incidence of relapse is high.
This creates big problems for the medics trying to balance treatments for both the depressive illnesses and the ED. Because there may be adverse reactions between the different medications, you should not take Viagra, Cialis or Levitra on your own initiative if you are already taking any other medications. Your physician has a number of options:
- First way is to change antidepressant. In a number of clinical double-blind studies, Serzone (Nefazodone) and Wellbutrin (bupropion) were shown to cause fewer problems on sexual function than SSRIs. If you respond well to either of these, you may find that you feel less depressed and your sexual performance improves. Wellbutrin is also less likely to cause weight gain which may aid your choice of medication.
- With some drugs, e.g. Zoloft (sertraline) and Anafranil (clomipramine), it may be possible to change the medication regime. If you have a fairly consistent time when you engage in sexual activity, this should be timed when the drug’s level in your body would be at its lowest, i.e. you would take your daily dose after sexual intercourse.
- Then your physician may authorise you to take one of the specific ED medications such as Viagra, Cialis or Levitra. In a 2003 randomised study of ninety men suffering from antidepressant-induced ED, 54% of those treated with Viagra (sildenafil citrate) as against the placebo showed improvement. Note that only slightly over half the sample showed improvement. There are limits to the effectiveness of Viagra, Cialis and Levitra.
- There are some case reports and small clinical studies that have found some additional medications can modify the effect of the antidepressant. For example, in an off-label test, Amantadine has been shown to relieve the SSRI-induced inability to reach an orgasm in some but not all people.
All this has assumed that the ED was in fact caused by the depression or the medication to treat that depression. If there are alternative explanations for the ED, those should also be thoroughly investigated. It would compound the irony if the true cause of your ED should prove not to be the antidepressants but a condition requiring a different treatment.