While antidepressants help many people enjoy life once again, that enjoyment can come at the cost of one's sex life.
That's what's happened to 24-year-old Ana over the past year. Ana, who requested that her last name not be used to preserve her privacy, has been taking Cymbalta, an antidepressant that helps her cope with the struggles she's endured after a recent move to New York City.
"I'm feeling much better, and it's really been helping me with my panic attacks and depression," Ana said.
But "feeling better" has come at a price.
"I have the desire to have sex, but much less than I did before, and I don't enjoy it as much," she said.
Sexual side effects are a common complaint lodged against a number of antidepressant drugs, especially those in the group called selective serotonin reuptake inhibitors, or SSRIs. The U.S. Food and Drug Administration recently approved another antidepressant, Viibryd, which holds the promise of having a less-adverse effect on the libido.
"In the two clinical studies done so far, there was no sign of sexual side effects," said Dr. Norman Sussman, a professor of psychiatry at New York University Langone Medical Center.
Although Viibryd is technically an SSRI, it is a dual-action drug – it increases the body's level of serotonin – a neurotransmitter that contributes to feelings of well-being – and also activates a serotonin receptor.
Experts believe it's the action on this serotonin receptor that helps reduce sexual side effects, although they're not sure exactly how.
Decreased sex drive, difficulty reaching orgasm and erectile dysfunction are among the complications associated with several other antidepressants on the market, such as Effexor, Celexa and Prozac, all SSRIs, but are much less common with another type of antidepressants called monoamine oxidase inhibitors.
Sexual Complications Can Persist
"It's thought that it's a mixture of things happening in the brain, the nervous system and the genital area itself," said Dr. Ian Cook, a professor of psychiatry at the Geffen School of Medicine in Los Angeles.
Sexual problems brought on by antidepressants can last as long as treatment continues, and for one man, they've persisted beyond that.
Michael (not his real name) tried three different antidepressants over a period of five years. Not only did they not help him stabilize his moods, they came with a variety of sexual drawbacks, including no interest in sex and an inability to achieve orgasm.
"I was almost suicidal, so I wasn't going to go off any medications, but eventually, another doctor realized SSRIs weren't the answer," he said.
He now takes a different drug entirely, but his sexual problems persist.
Psychiatrists say problems like these lead many people to stop taking their meds, which can then risk making their depression worse. They're thankful there's now another drug that can perhaps help their patients enjoy life and sex at the same time.
"It would be wonderful to offer a drug that works as well as the drugs we have but doesn't cause sexual dysfunction," said Sussman.
While Viibryd might offer that happy combo, doctors said they're in no rush to prescribe it to their patients.
"There aren't enough data out there yet," said Cook. "The field will look forward to more studies about which patients are best for this treatment and what other conditions it can treat." Clinical Data Inc., the maker of Viibryd, has conducted only two clinical trials so far.
"The important question is how many other studies did they do worldwide that would lead to FDA approval," said Sussman. "It's important to know they reflect worldwide clinical trials."
More Data Needed on Viibryd"These were only eight-week studies, and often people stay on antidepressants for several years," said Dr. Jeffrey Rakofsky, an associate in the Department of Psychiatry and Behavioral Sciences at Emory University in Atlanta. "If a patient really wants to use it, I'd inform them first it's pretty new, but I'm open to trying it."
Likewise for those taking antidepressants for depression and anxiety.
"Having a medicine that can help you avoid having to decide between having so much stress or being able to enjoy sex is huge," said Ana.