Posts Tagged ‘anti-depressants’

Testosterone, Depression, and SSRI’s or Anti-Depressants-What’s the Connection?

December 21, 2015

Many people that take antidepressants, specifically SSRI’s (selective-serotonin reuptake inhibitors), find out that they have abnormally low testosterone. So what does this all mean? Did the initial low testosterone lead the individual to become depressed and go on an antidepressant? Or did the treatment with an antidepressant actually slowly reduce the individual’s natural ability to produce testosterone?

It really is a “chicken vs. egg” type argument in regards to whether low T caused depression or an antidepressant caused low T. Unfortunately there is no clear-cut scientific answer as to whether the antidepressant you took caused your testosterone to be lowered.

With that said, new research comes out all the time finding new things about antidepressants (SSRI’s) – they really aren’t well understood. Many antidepressants medications are now linked to development of diabetes, birth defects, etc. Although there are no formal studies to link antidepressants with low testosterone, many people taking these drugs are convinced that they are the root cause.

It could have been that the lower testosterone was what caused the person to feel depressed in the first place. The low T could have also merely been a coincidence among those who are depressed – after all, having low T is a pretty common issue.

Antidepressants and Testosterone: Many people taking antidepressants experience low testosterone. Similarly, many people with low testosterone are taking antidepressants. These two factors could also occur independently. In other words a person may develop low testosterone while on an antidepressant without the antidepressant being the cause. 



Depression and Testosterone: Many people may be experiencing depression as a result of low testosterone. Similarly many people may be experiencing low testosterone as a result of depression. Additionally, these two factors could be totally unrelated and independent of each other. In other words the depression could have nothing to do with low T and vice versa.
Depression and sex drive – Many people with depression tend to have lower than average sex drives. It is the depression that is thought to lead to disinterest in pleasurable activities like sex. People may be in such a depressed, low level of arousal, that they don’t feel like having sex. Therefore in this case, it could be that the depression and not testosterone is causing reduced sexual interest.
Testosterone and sex drive – It is well known that healthy testosterone levels are linked with a healthy sex drive. Men that have low T tend to have less fuel for sex, erectile dysfunction, and other performance issues. If your testosterone level were to be lowered, the natural result would be a reduced sex drive. This reduced sex drive could be linked to depression – therefore testosterone could play a role.
Low testosterone causing depression? – Individuals with lower than average levels of testosterone could be experiencing depressive symptoms as a result of their low T. Studies have found that among men with abnormally low levels of T, testosterone therapy helped reduce symptoms of depression. For this reason it is important to rule out all causes of depression (including low T) before you get on an antidepressant.
Antidepressants and low testosterone – It is well documented that antidepressants can affect hormones. Therefore some hypothesize that hormonal changes can influence our sex drive. It is not known whether antidepressants are the culprit behind lowering levels of testosterone. Many people that have taken SSRI’s believe that the drugs they took lowered their testosterone.
Bottom Line: There is no question that there is a relationship between testosterone and depression. I cannot say for certain that low testosterone is a result of the use of SSRIs. However, if you are taking SSRIs and you are experience a low sex drive or libido, it is very easy to ask your doctor to obtain a blood testosterone test. If it is low, treatment is easily accomplished with either testosterone injections, topical gels or pellets.

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Medicines and Your Performance In the Bedroom

October 22, 2014

There are hundreds of medicines, some commonly used drugs, that can affect a man’s sex life and sexual performance.  Many of these drugs are necessary for treatment of depression and hypertension and shouldn’t be stopped.  This blog will discuss the causes of medications and deterioration of sex drive and sexual performance.

How can medicines affect sexual function?

The mechanism of sexual function involves a complex coordination of hormones, chemical messengers in the brain (neurotransmitters such as dopamine and serotonin) and the sexual organs. In general:

  • dopamine increases sexual function
  • serotonin inhibits sexual function
  • the hormone testosterone is important, as are the blood vessels supplying the penis are also involved in producing an erection.

A medicine can therefore affect sexual function in several ways.

Libido or sex drive

Sex drive is influenced by reproductive hormones, particularly testosterone, which is required for sexual arousal.

Medicines that reduce the testosterone level or block its effects are likely to reduce sex drive.

Libido is also affected by your general emotional and physical health. Medicines that affect any of these aspects, even indirectly by causing drowsiness, lethargy, weight gain or confusion, have the potential to reduce your sex drive.

An erection is the result of coordination between nerves, hormones, blood vessels and psychological factors. This means there are many areas where things can go wrong.

Medicines that have a physical effect on the blood vessels in the penis, those drugs that act on the brain or interfere with hormone levels (particularly testosterone) or affect the transmission of nerve messages, can all cause impotence.

Ejaculation is a complex reflex process that involves the activation of alpha receptors in the prostate gland and seminal vesicles.

Medicines that block alpha-receptors can interfere with ejaculation.

During ejaculation, increased alpha-receptor activation closes the bladder neck, facilitating the normal flow of semen out of the penis.

If this mechanism is disrupted, it results in retrograde ejaculation, with semen flowing along the path of least resistance from the urethra up into the bladder.

Various chemicals in the brain are also involved in orgasm and ejaculation, and medicines that affect these chemicals can also cause ejaculatory disturbances.

The most widely prescribed centrally acting agents that affect ejaculation are selective serotonin re-uptake inhibitor (SSRI) antidepressants.

Antidepressants are the medicines most frequently implicated in causing sexual dysfunction. This is because they work by altering levels of chemicals in the brain. In particular, SSRIs increase serotonin levels, which inhibits sexual function.

Blood pressure lowering (antihypertensive) medicines are also implicated, although the mechanism by which they cause sexual problems will vary from medicine to medicine.

The table of medicines below lists the sexual side effects that some people have reported during their use.

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Antidepressants Main use Possible effect on sexual function
MAOI antidepressants (eg moclobemide, phenelzine) Depression Decreased sex drive, impotence, delayed orgasm, ejaculatory disturbances
SSRI antidepressants (eg fluoxetine) Depression Decreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
Tricyclic antidepressants (eg amitryptiline) Depression Decreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
Antiepileptics Main use Possible effect on sexual function
Carbamazepine Epilepsy Impotence
Antihypertensives Main use Possible effect on sexual function
ACE inhibitors (eg enalapril, lisinopril) High blood pressure, heart failure Impotence
Alpha-blockers (eg prazosin, doxazosin) High blood pressure, enlarged prostate Impotence, ejaculatory disturbances
Beta-blockers (eg atenolol, propranolol and including timolol eye drops) High blood pressure, angina, glaucoma Impotence
Calcium channel blockers (eg verapamil, nifedipine) High blood pressure, angina Impotence
Clonidine High blood pressure Impotence, decreased sex drive, delayed or failure of ejaculation
Methyldopa High blood pressure Impotence, decreased sex drive, ejaculatory failure
Thiazide diuretics (eg bendroflumethiazide) High blood pressure Impotence
Antipsychotics Main use Possible effect on sexual function
Phenothiazines (eg chlorpromazine, thioridazine) Psychotic illness Ejaculatory disturbances, decreased sex drive, impotence
Risperidone Psychotic illness Impotence, ejaculatory disturbances
Cholesterol lowering medicines Main use Possible effect on sexual function
Fibrates (eg clofibrate, gemfibrozil) High cholesterol Impotence
Statins (eg simvastatin) High cholesterol Impotence
Other Main use Possible effect on sexual function
Benzodiazepines Anxiety and insomnia Decreased sex drive
Cimetidine Peptic ulcers, acid reflux disease Decreased sex drive, impotence
Cyproterone acetate Prostate cancer Decreased libido, impotence, reduced volume of ejaculation
Disulfiram Alcohol withdrawal Decreased sex drive
Finasteride Enlarged prostate Impotence, decreased sex drive, ejaculation disorders, reduced volume of ejaculation
Metoclopramide Nausea and vomiting Decreased sex drive, impotence
Omeprazole Peptic ulcers, acid reflux disease Impotence
Opioid painkillers (eg morphine) Severe pain Decreased sex drive, impotence
Prochlorperazine Nausea and vomiting Impotence
Propantheline Gut spasm Impotence
Spironolactone Heart failure, fluid retention Impotence, decreased sex drive

Bottom Line: This blog makes the connection between medications and sexual performance.  The next blog will discuss how to

approach your physician and what options are available for men who have sexual side effects from medications.

Don’t Let Anti-Depressants Rain on Your Love Life

September 24, 2011

B.B., a 52-year old lady, had a history of depression, which has been controlled with Prozac. She noted a waning of her libido or sexual desire. She consulted with her doctor who prescribed the Prozac and he changed her medication to Wellbutrin, which allowed her libido to return to normal, and controlled her depression as well.
Sexual dysfunction, which includes loss of libido, decrease in arousal or vaginal dryness for women and decreased libido, and erectile dysfunction in men, is common in both men and women with depression. If that wasn’t bad enough, the treatment for depression with the antidepressant medication can cause sexual dysfunction. It is estimated that 30-70% of men and women who use antidepressant medication, such as Celexa, Prozac, Effexor, Zoloft and Remeron, experience a sexual dysfunction. The lowest rate of sexual side effects occurred in patients taking Wellbutrin.
Many men and women who experience these side effects of the medication may try to resolve the problem by stopping the use of their antidepressant medication. This should be avoided, as restoring sexual intimacy is not a good trade off if the depression returns. Fortunately, there’s a solution to this dilemma for those who suffer from depression or for those who require the use of antidepressant medications.
How do you know if your antidepressant is causing sexual problems? Experts say that the trouble is probably the result of the medication if a person who did not previously have sexual dysfunction experiences problems within two to three months of beginning antidepressant treatment.
What To Do

First and most importantly, do not make any changes in your treatment regimen without first consulting your physician. Here are some suggestions which you might discuss with your physician:

1. If you are experiencing sexual side effects from your antidepressant medication, your doctor may consider switching you to Wellbutrin, which has a low rate of sexual side effects. Wait to see if sexual side effects abate.
2. Consider taking your medication after you have engaged in sexual intimacy.
3. With your doctor’s permission you may consider a drug holiday. A drug holiday involves taking a short break from your antidepressant. By taking periodic two-day breaks from antidepressant treatment can lower the rate of sexual side effects during the drug holiday without increasing the risk of a relapse or recurrence of depressive symptoms.

Bottom Line: Sexual side effects are common in men and women with depression. Most men and women can be restored to a meaningful sexual function by sharing with your doctor your concern and having him\her making changes and adjustments in your medication or changing to another drug as described in my patient B.B.