by Sergio Silva, M.D.

Created on: August 21, 2009

The selective serotonin reuptake inhibitors (SSRIs, such as Prozac and Zoloft) are the safest and most widely prescribed antidepressant and anti-anxiety medications available and a real boon to millions of patients worldwide. They are highly effective, non-addictive, and they save lives. Unfortunately, among the most common of side effects induced by these medications are those that typically prove to be among the most recalcitrant: sexual dysfunction, in the form of 1) a relative inability to climax (delayed orgasm or complete anorgasmia) and/or 2) decreased sexual arousal, including in a minority of males, erectile dysfunction.

While other side effects caused by these medications, such as queasiness, headaches and diarrhea, resolve rapidly and, for all intents and purposes, completely with continued use, sexual dysfunction is one of those side effects that can persist for many months, or even indefinitely, with little or no improvement (like weight gain, temperature dysregulation and disruptions in the sleep-wake cycle-see my other articles).

Sexual dysfunction as a side effect is one of the leading reasons people who are otherwise benefitting from treatment with psychotropic medications seek to discontinue them. For others, who recognize that they need treatment with psychotropic medications to function, sexual dysfunction is something they "learn to live with." This article addresses how to avoid or at least minimize sexual dysfunction, when treatment with these types of medications is deemed valuable and necessary.

Don't take an SSRI. If you require treatment with psychotropic medication, one obvious strategy is avoiding those antidepressants that are known to cause sexual dysfunction. The problem is that most of them cause it. While it is true that Wellbutrin, for example, does not cause sexual side effects, Wellbutrin is not an SSRI; Wellbutrin does not act on the serotonin system. It is by increasing the neurotransmission of serotonin that sexual dysfunction is induced. However, it is also by increasing the availability of serotonin that we get effects such as protecting a person from crying spells, decreasing irritability and blocking panic attacks. So, while Wellbutrin is a good antidepressant for some individuals who are not particularly anxious or irritable, it doesn't do much for these symptoms in others, and can actually make anxiety and irritability worse in some cases. So, while avoiding manipulating serotonin levels

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