ERECTILE DYSFUNCTION: PSYCHIATRIC MEDICATIONS
ED is not only one of the most troubling side effects of many psychiatric drugs, it is also the least discussed. “I thought it was just me,” a patient said after learning that an antidepressant that he had been taking daily for two years caused his ED. “I was embarrassed to talk to you about it. And I didn’t know if there was anything you could do for it, anyway.”
If ED is going to become a problem for men undergoing pharmacotherapy with tranquilizers or antidepressants, the trouble usually begins during the first month of treatment. For many men who experience this initial side effect, and then stay on the program long enough to benefit from diminished anxiety and/or reduced depression, there will eventually be a reawakening of sexual interest and, consequently, improved sexual performance.
Over time, however, the sexual picture may change, again because of the drugs. Many of the treatments for psychiatric-related disorders negatively affect sexual response by impacting the autonomic nervous system, which controls the genitals. Other psychiatric drugs can block nerve function, making it difficult, or even impossible, to achieve an erection or ejaculation. High doses of tranquilizers prescribed for anxiety and depression not only cause ED, they can also be responsible for the lessening of libido (sexual desire), an inability to ejaculate, and gynecomastia (breast enlargement in men).
The popular new class of depression-fighting drugs, SSRIs, such as fluoxetine and sertraline, also inhibit sexual function. SSRIs are selective serotonin-reuptake inhibitors, a group of drugs which affect the neurotransmitter, or brain chemical, serotonin, which affects mood. These medicines often contribute to ED, diminish sex drive, and block orgasm. This latter problem is so widespread with Prozac, Paxil, and Zoloft, three of the most widely used SSRIs, that I often prescribe low dosages of them to men complaining of premature ejaculation. Current estimates of men taking SSRIs who have erectile problems range from 9 percent to 24 percent.
While it sometimes happens that sexual problems diminish after a man has adjusted to the drug he is taking, it is usually the exception to the rule. Taking a drug “holiday,” or having sex when the drug is at its lowest concentration in the body, are alternatives that work for some men (see pages 165 and 166-68). For others, yohimbe (the pulverized bark of an African tree, available in health food stores or by prescription) or red ginseng can alleviate ED when taken in combination with their SSRI medications. Many of my patients have responded very well to changing from Prozac to either Wellbutrin or Serzone.
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