Treating Depression: How to Offset Pill Side Effects

Published by Contra Costa Times

Posted on Sat, Jan. 24, 2004

By Dr. Barry Miller

DAWN BEGAN missing work. When she did go, it took all of her strength just to get out of bed in the morning. And some days, she didn't get up at all.

Her depression was back. She became withdrawn, tired, distracted and irritable. She had stopped taking her Prozac six weeks before because it had caused her to lose interest in sex. When taking the medicine, she slept better and her mood improved. But her sex drive seemed to disappear, and nothing she or her husband did seemed to help. She was too embarrassed to tell her doctor, so she stopped taking the medicine without telling him.

Many people feel torn by this dilemma: suffer from depression and its devastating effects on their lives, or improve their depression with treatment but forgo sexual satisfaction.

Depression can be so harmful and so devastating, however, that side effects, including the sexual effects of these medicines, should not be a reason to stop them. Depression is more than just feeling "down". It is a clinical illness that interferes with a person's daily life.

An estimated 20 million to 30 million Americans suffer from depression.

The most common treatments are medicines such as Prozac (fluoxetine), Paxil, Zoloft and Celexa. About 30 percent to 60 percent of patients report sexual side effects from these antidepressants, known as selective serotonin reuptake inhibitors.

As a psychiatrist, I've seen SSRIs and other new medications dramatically improve the treatment of depression over the past 10 years. But I've also seen patients give up their depression medication because it decreases sexual interest and/or delays or prevents orgasm. Many people suffering from depression are reluctant to discuss intimate sexual details with their doctor.

Fortunately, there are several ways to deal with this not-so-side effect.

A patient can abstain from taking his or her SSRI pill for a day or two, or a weekend, to temporarily restore sex drive. There is no risk of quickly plunging back into depression because the antidepressant effect of these medicines keeps working even if interrupted briefly, while the sexual side effects can diminish rapidly. This is unlike many other drugs such as antibiotics or pills for blood pressure, which generally lose their effect rapidly if stopped.

Viagra and Levitra also can improve sexual function for people taking SSRIs. Often the increased sexual stimulation of these drugs gives a person more confidence and therefore increases sexual desire.

There are also several antidepressant medications that do not have the same common side effects of SSRIs. These include Wellbutrin, Serzone and Remeron. The addition of one of these antidepressants can often counter the sexual side effects of the SSRI. Sometimes, the non-SSRI antidepressant medicine can be substituted, if the SSRI isn't effective for improving depression.

I haven't seen evidence that herbal remedies are effective either for depression or for the treatment of the sexual effects of SSRIs.

The important thing is to communicate unpleasant effects of medication with your medical provider to see if there are treatment alternatives. Sexual side effects are rarely a necessary evil that you have to accept as part of the treatment of your depression.

Dr. Miller is a psychiatrist and neurologist who practices child and adult psychiatry at the Martinez Health Center.