How antidepressants affect sex life – 11/25/2023 – Balance

Doctors and patients have long known that antidepressants can cause sexual problems. Lack of libido. Orgasms without pleasure. Insensitive genitals. Well over half of people taking these medications report such side effects.

Now a small but vocal group of patients is speaking out about serious sexual problems that persist even after they stop taking selective serotonin reuptake inhibitors, the most popular type of antidepressants. The effects of the medications have been devastating, leaving them unable to enjoy sex or maintain romantic relationships.

“My clitoris feels like a joint,” said Emily Grey, a 27-year-old in Vancouver, Canada, who took one of these medications, Celexa, for depression from ages 17 to 23. “It’s not a normal thing to conform to.”

The safety leaflet for Prozac, one of the most prescribed SSRIs, warns that sexual problems may persist after stopping the medication. And health authorities in Europe and Canada have recently acknowledged that the medications can lead to long-lasting sexual problems.

But researchers are just beginning to quantify how many people have these long-term problems, known as post-SSRI sexual dysfunction. And the chronic condition is still contested by some psychiatrists, who highlight that depression itself can reduce sexual desire. Clinical trials have not followed people after stopping the medications to determine whether these sexual problems stem from the medications.

“I think it’s recurrent depression. Until proven otherwise, that’s what it is,” said Anita Clayton, chief of psychiatry at the University of Virginia School of Medicine.

Clayton published some of the first research showing that SSRIs have widespread sexual side effects.

She said patients with these problems should talk to their doctors about the possibility of switching to a different antidepressant or combination of medications. She worries that too much attention to apparently rare cases of sexual dysfunction after stopping SSRIs could dissuade suicidal patients from trying the medications.

By the mid-2000s, the sexual effects of SSRIs were well recognized. In fact, the medications decreased sexual responses so much that doctors began prescribing them to men with premature ejaculation.

But sexual symptoms that persist after stopping medications haven’t received much attention in the medical literature.

In 2006, a few cases of persistent genital numbness were reported in Canada and the United States. In the same year, a newsletter from the American Psychological Association described emerging data on the lasting sexual effects of medications.

“I believe we have barely begun to appreciate the scope and complexity of the impact of these medications on sexuality,” wrote Audrey Bahrick, then a psychologist at the University of Iowa (USA), in the article.

In an interview, Bahrick said she felt an ethical obligation to draw attention to the condition because she had experienced it herself.

She started taking Prozac in 1993, when she was 37 and facing a difficult job in a new city. The first day she took the pill, her clitoris and vagina became numb. “It was like there was a glove over them — a very, very stuffy feeling,” she recalled.

For a while, she said the switch was worth it: the antidepressant made her more energized and resilient. But after two years, she stopped taking it for the sake of their relationship. However, the sexual symptoms persisted and the relationship ended.

“It never occurred to me that this would be something that would actually, in my lifetime, never be resolved,” said Bahrick, who is now 67 years old.

In the following decades, the use of SSRIs soared, especially among teenagers. They are prescribed not only for depression and anxiety, but also for a range of other conditions, including irritable bowel syndrome, eating disorders, and premenstrual symptoms. However, researchers are still struggling to understand how SSRIs work and why sexual problems are so widespread.

The drugs target serotonin, an important chemical messenger in the brain and other parts of the body. The molecule is involved in decreasing sexual responses, including the orgasm reflex that originates in the spinal cord. Serotonin also affects estrogen levels, which in turn can affect arousal.

But depression also decreases sexual desire. Among unmedicated men with depression, 40% report loss of arousal and sexual desire, and 20% have difficulty achieving orgasm. Common conditions like diabetes and cardiovascular disease can also cause sexual problems.

Clinical trials rarely look at what happens when medications are stopped. And studying what happens after people stop taking SSRIs is particularly challenging because many people never stop taking them. Because of the lack of data, “persistent sexual dysfunction caused by SSRIs is a hypothesis, not a proven phenomenon,” said Robert Taylor Segraves, professor emeritus of psychiatry at Case Western Reserve University School of Medicine, who has studied the effects of antidepressants on sexuality.

Still, some researchers have found ways to estimate the prevalence of the condition. A recent study in Israel reported that about 1 in 216 men who stopped using SSRIs were later prescribed erectile dysfunction medications, a rate at least three times higher than among the general population.