Health

What to Do When Anti-Anxiety Medication Kills Your Sex Drive

There's no perfect solution, but it's worth trying the following options.
07 November 2019, 11:44pm
Prozac pills
Image via Wikimedia, CC licence 3.0

In 1967, a study published in the British Journal of Psychiatry cited how there were remarkably lower levels of serotonin in the brains of people who’d died from depression-related suicide, compared to the brains of people who’d died of other causes. It was a grim discovery for sure, but one that helped popularise a now widely-accepted hypothesis on how levels of serotonin affect happiness.

This wasn’t by any means the first study to explore this association, but it was one that initiated what seemed like a novel strategy for treating depression: a class of antidepressant known as “Selective Serotonin Reuptake Inhibitors,” or SSRIs for short. These were a series of meds designed to increase and regulate levels of the neurotransmitter serotonin. These medications were so effective that fluoxetine, an early SSRI that’s still in circulation and more well-known as Prozac, has been prescribed since 1986.

Since Prozac, the number of SSRIs on the market have multiplied dramatically and today include such brands as Lexapro, Zoloft, Paxil, and the very similar Pristiq—an SNRI which addresses both serotonin and the stress hormone ‘norepinephrine’. Chances are if you’ve ever been prescribed an antidepressant, it’s probably been an SSRI. Lexapro, for example, was reported last year as the 10th most prescribed drug in Australia. And there's a reason why they’re so popular: they’re cheap, effective, and most of the time, pretty benign. But there’s one particular side effect synonymous with SSRIs: a lowered sex drive.

The negative effects that SSRIs have on libido are well-established, both clinically and anecdotally, with some research reporting that 60 percent of men and 62 percent of women on SSRIs experience sexual dysfunction. Symptoms range from failing to orgasm, to experiencing painful sex, to simply not being in the mood, ever.

Now for the record, I’m not a “doctor”—just someone who’s dealt with this in the past. And I know that if you’ve tried to find a solution to address it, it’s not so straightforward, with medical professionals offering few solutions beyond additional medications like Viagra. Or you’ll have heard the conversation about changing or lowering the medication—which actually makes sense when you understand how SSRIs operate.

This is going to get technical for a moment, but bear with me.

SSRIs don’t just increase levels of serotonin in your brain; they also prevent surrounding cells from reabsorbing and recycling that serotonin that’s already been released. This leaves the serotonin sitting in your synapses, where it’s then able to bind to more receptors, leaving you feeling self-assured and happy.

The thing about blocking the uptake of serotonin is that it slowly builds up within our brains—and this seems to have an odd effect on sex drive. Basically, inadequate serotonin makes us sad, but too much seems to nullify libido. And interestingly, a 2011 study seemed to indicate the same occurs in animals. Lab rats, it was found, also experienced delayed ejaculations with increased levels of serotonin.

Not all antidepressants target the same neural mechanisms, though, so sometimes changing medications really can resurrect your interest in sex.

Valdoxan, for example, stimulates melatonin and blocks your serotonin receptors in a way that doesn’t cause serotonin levels to rise. Then you’ve got antidepressants that address dopamine, like Bupropion, which has been shown to alleviate depression without the sexual side effects.

But these drugs don’t come without their own issues. Valdoxan, for example, isn’t on the PBS, meaning it’s expensive, and it's also associated with liver damage. Bupropion, meanwhile, presents the potential for weight loss and a (low-risk) of seizures. But a key point is that these medications are different from SSRIs—meaning they might not be as effective in addressing your anxiety or your depression.

If you’re keen to not change your medication or to just get off the pharma bandwagon altogether—which no one recommends without a conversation with your doctor—one option, according to a recent study, could be sniffing the essence of Damask rose to offset the effects. In 2014, researchers from the Kermanshah University of Medical Sciences in Iran recorded the self-reported results of 60 men who lived with depression while also taking SSRIs. These 60 men were exposed to the Damask rose essential oil, and from four to eight weeks researchers documented improved rates of sex drive as well as decreased rates of depression.

Of course, we need to point out that such a study likely reflects only a correlation and not causation. Furthermore, sniffing, as a delivery method, provides a pretty unreliable dosage, so it’s hard to call such a study “conclusive.” Thus, as usual, the more universally-agreed upon method to offset sexual side effects is simply changing to a healthier lifestyle.

Research has found that there is an association between healthier lifestyles and increased sex drives. Two studies in 2010 both recorded increased libidos in women after 12 weeks of yoga and (in those with diabetes) changing to a Mediterranean diet. In terms of offsetting SSRI sexual dysfunction, a 2012 and a 2014 study both documented evidence suggesting that exercise prior to sex did offset SSRI sexual dysfunction.

The take-away message is that there isn’t a single one-size-fits-all way to address anxiety while also maintaining a bulletproof libido. Basically, the precise mechanisms behind depression and anxiety remain poorly understood, and we’ve got a long way to go to understand the interplay between neuropharmacology and underlying emotional trauma. But if you feel like your anti-anxiety medication is having an unacceptably detrimental effect on your sex life, the first step is to talk to your doctor.

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