One of the great ironies of the Prozac era is that the little green- and cream-colored capsule you take to brighten your mood can simultaneously dampen your sex life.
More than 24 million people around the world have received prescriptions for Prozac since it was introduced in 1987. Two similar drugs, Paxil and Zoloft, are its top competitors. But psychiatrists and pharmacologists say all three drugs have a sexual side effect no one wants to talk about.
“It’s turned out to be the Achilles’ heel of the serotonin drugs,” says Clarke St. Dennis, a Washington State University pharmacologist who consults in the psychiatric unit at Sacred Heart Medical Center.
These drugs, called selective serotonin reuptake inhibitors, treat depression by increasing levels of a neurotransmitter called serotonin. Serotonin balances people’s moods, energizing those who feel exhausted and drained, or calming restlessness and anxiety.
When Prozac was first introduced to the American market, pre-release studies didn’t seem to indicate that sexual dysfunction would be a serious problem. It was reported by only 1.9 percent of patients. Pre-marketing studies on similar drugs showed that 3 to 13 percent of patients on Zoloft and 17 percent of those on Paxil reported this side effect.
But early studies relied on patients to spontaneously tell researchers these symptoms. Given the American public’s general reticence to bring up the topic of sex, experts now doubt the accuracy of the early studies.
More recent research, in which patients were questioned directly, have shown rates of sexual dysfunction connected to Prozac ranging from 8 percent to as high as 75 percent, according to an article in the September 1994 Journal of Clinical Psychiatry.
“I think the current consensus is at least 20 to 40 percent,” says St. Dennis.
Physicians were sometimes the last to know. One doctor told St. Dennis that he had prescribed SSRIs for years. It wasn’t until a patient finally brought in a copy of an article from Playboy magazine that the physician discovered the link to sexual dysfunction.
The drugs appear to hinder patients’ sex lives in several ways. The simplest is a loss of libido, a lack of interest that Clarke dubs “sexual anesthesia.”
Men also report difficulty in sustaining an erection or reaching orgasm when taking one of these prescriptions.
“It decreases ejaculation time in males,” says Dr. Michael Manz, a Spokane psychiatrist. “Some people call it a blessing, others a curse.”
Urologists sometimes prescribe these drugs to treat premature ejaculation.
Women’s symptoms are less obvious, says St. Dennis, but their side effects appear to be similar to those in men.
He says that these drugs apparently can block a particular serotonin pathway in the spinal cord, resulting in sexual dysfunction in both sexes.
The side effects of SSRIs usually show up before the drugs themselves start to work. Prozac may take six to eight weeks to be effective.
In the meantime, doctors may hear complaints about sex. “People will say, ‘I’m feeling better than I have my entire life, except for this one thing…’” St. Dennis says.
St. Dennis has several strategies for counteracting these side effects.
He usually starts out by asking the patient to wait a few weeks. The side effects may go away.
If they don’t, St. Dennis considers how well the drug is working. If it hasn’t been particularly successful at changing the person’s mood or energy level, he might try another drug. Welbutrin, Serzone and Remeron are three anti-depressants less likely to affect the patient’s sex life.
If the drug has been successful, though, he may add an additional drug to counteract the sexual dysfunction. Welbutrin may work in conjunction with an SSRI. Other possibilities include Buspar, an antihistamine called Periactin, an herbal drug called yohimbine and others.
“It’s a long list,” says St. Dennis, “but that’s sad because that means not any one works all that well.”
St. Dennis may also recommend that the patient try a weekend “drug holiday.”
Patients can schedule a weekend getaway and take a Thursday dose but skip Friday and Saturday pills. St. Dennis warns that this may not work for people on Prozac, which is longer-acting than Paxil or Zoloft. People on Paxil may have flulike withdrawal symptoms, however.
Patients should not try this approach without consulting with their doctor, however.
Clearly, none of these alternatives is perfect. But depression can be such a serious disease that some people simply choose to live with a diminished sex life.
“It’s kind of surprising,” says Dr. Tad Patterson, medical director at Spokane Mental Health. “I have one patient who said, ‘It’s my wife who is more bothered by this than me.”’
A spokeswoman for Eli Lilly & Co., which makes Prozac, says, “Undue emphasis on this side effect trivializes the serious medical illness of depression. We need to be reminded that depression is serious medical illness just like diabetes or cancer.”
She adds, “Sometimes it’s even difficult for physicians to know if the side effect is the result of the medication, the illness or both.”
Local experts agree it’s important for physicians to inform their patients of the possible side effects.
“I always warn people because I feel it’s their life and they need to know,” says Manz. “Most people say, ‘I’m so much less depressed, it’s worth it.”’
, DataTimes ILLUSTRATION: Staff illustration