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Q: I'm 29 years old and I've been taking Paxil for two years for depression. Occasionally, I encounter some weird sexual side effects (like low sex drive and I won't tell the other). I also get shaky. Thing is, I feel better on the medicine, but I won't take it if this is my life. Anything you tell me would be appreciated.
A: I can understand how frustrating this is, especially since you are still in your prime. When these drugs first came out, the sexual side effects were not discussed. You heard about tremors, agitation, dizziness, insomnia and sleepiness.
Paxil belongs to a group of medications called selective serotonin reuptake inhibitors, or SSRIs. Other drugs in this category include Prozac (fluoxetine), Zoloft, Lexapro and Celexa. You may do better with one drug over another.
SSRIs work by making the best use of a chemical in the brain called serotonin. It's an unfortunate irony that antidepressants cause arousal in the brain and can simultaneously obliterate function in the sexual organs.
You're only willing to mention low sex drive. I'm willing to tell all. Some people get delayed orgasm. In fact, you can use SSRI drugs in men with premature ejaculation. Depending on the antidepressant, you might get painful erections, impotence, pain on climax or penile anesthesia. Rarely, you hear of spontaneous orgasm induced by yawning. Boy, that would make Sunday morning services a bit more lively. Hallelujah!
The symptoms you describe are probably medicine-related, but remember, sexual appetite naturally wanes with depression and even with cholesterol-reducing meds. Even though it's hard to sort this out, I believe that the prevalence of SSRI-induced sexual dysfunction is grossly underestimated and people just put up with it.
Treatment is a challenge. In most cases, lowering the dosage of your medicine works. Cyproheptadine is a prescription drug that may reverse the symptoms. Amantadine, typically used for Parkinson's, is another potential antidote for sexual dysfunction.
Your doctor could switch you to trazodone, Serzone, Wellbutrin or Effexor; these antidepressants seem to be less sexually disruptive, generally speaking. Natural remedies to reverse the dysfunction include ginkgo biloba or yohimbe (but be careful if you have high blood pressure). Natural mood elevators have less risk or none at all.
Get your doctor's consent before altering your drug regimen. Make sure you fully explain that the annoying symptoms are cramping your lifestyle. Be clear and insist on some sort of action. Honestly, do you know any people in a good mood when their sex life is ruined?
You won't be able to buy new Medigap policies that cover prescription drugs after Jan. 1. Medicare recipients will get a detailed notice by mail from their Medigap insurance company describing their choices for prescription drug coverage. Read the notice carefully before making any decisions.
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