• Sex Rx: Paxil and Your Sex Life

    Paroxetine (Paxil) is widely used in the United States. It is most often prescribed for anxiety and panic disorder, depression, obsessive-compulsive disorders, among other conditions. While Paxil is effective in treating these disorders, it has been associated with sexual problems.

    How Paroxetine Works

    Paroxetine is one of a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These medicines work by blocking the reuptake of the brain chemical serotonin, which helps regulate mood.

    Other Drugs of This Class (SSRIs)

    • Sertraline (Zoloft)
    • Fluoxetine (Prozac)
    • Escitalopram (Lexapro)
    • Fluvoxamine (Luvox)
    • Citalopram (Celexa)

    Possible Sexual Side Effects Associated With Paroxetine

    • Decreased sexual desire
    • Difficulty reaching orgasm, especially in women
    • Erection impairment
    • Ejaculatory dysfunction

    How This Medication Can Affect Sexual Function

    It is not yet clear how SSRIs affect sexual function. The effects are believed to be related to the increased level of serotonin, which may affect sexual reflex centers.

    Treatment Options

    There are a number of alternative treatment options available if you are dissatisfied with your sexual functioning while taking paroxetine. But, it is important to talk with your doctor about your concerns first. Although it can be very difficult and embarrassing to discuss your sexual functioning, it is crucial that you communicate with your doctor about it. Never make any changes to your medicine regimen or start taking new medicines or herbal supplements without your doctor’s knowledge and approval. Here are some possibilities that you and your doctor may decide to have you try:

    Wait It Out

    As you adjust to your new medicine, the sexual side effects may go away.

    Decrease the Dosage

    This tactic will work occasionally, but carries the risk of a relapse of the depression or disorder. Never change your dosage without checking with your doctor first.

    Switch Medications

    Since the medical response to SSRIs can vary among people, your doctor will consider the severity of your depression or disorder, as well as your response to the drug before switching to another medicine. When switching is appropriate, some options include:
    • Bupropion (Wellbutrin) —This antidepressant medicine does not affect serotonin. It is less likely than the commonly used SSRIs to cause sexual dysfunction and may actually have prosexual effects. Bupropion is used to treat a number of conditions, such as major depressive disorder and seasonal affective disorder. It is not recommended for people with eating disorders or seizure disorders.
    • Nefazodone (Serzone)—This drug does affect serotonin, but not in the same way as SSRIs. It can be used to treat depression and cause fewer sexual side effects. One of its more troublesome adverse effects is sedation.
    • Mirtazapine (Remeron)—This drug is similar to nefazodone in its effect on depression and sexual function. It can also cause sedation.

    Try an Antidote

    This involves maintaining your current level of paroxetine, while adding a second medicine to offset the sexual side effects. This option is generally less desirable since antidotes frequently have their own side effects and may adversely interact with the primary medicine you are taking. However, certain options do exist.
    Sildenafil (Viagra) and related drugs may be helpful for men with sexual side effects of SSRIs. Bupropion also has been shown to benefit men with sexual dysfunction due to taking SSRIs. Amantadine has been used, but studies have not proven that it is beneficial.

    Take a Drug Holiday

    This involves taking your usual Thursday morning dose and then nothing again until noon on Sunday, when you resume your previous schedule.
    There is a risk with this technique that you may feel well enough during the short drug holiday to discontinue your medicine all together, which can lead to a relapse. Furthermore, short-acting SSRIs like Paxil can produce severe withdrawal symptoms in some people unless they are slowly tapered. Again, discuss this option with your doctor before trying it.

    Consider Herbal Supplements

    The efficacy of herbal supplements to treat the sexual side effects of SSRIs is not clear. Care should also be taken with herbal products because they are not strictly regulated, as drugs are. One herb commonly used to resolve the sexual dysfunction associated with SSRIs is yohimbine. More studies are needed to determine the effectiveness and safety of this remedy. Be sure that you talk to your doctor before taking any herbs or supplements. They could react with medicines that you are currently taking.

    RESOURCES

    American Psychological Association http://www.apa.org/

    Food and Drug Administration http://www.fda.gov/

    CANADIAN RESOURCES

    Canadian Psychiatric Association http://www.cpa-apc.org/

    Canadian Pharmacists Association http://www.pharmacists.ca/

    References

    Amantadine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/pointofcare. Updated December 22, 2010. Accessed July 14, 2012.

    Antidepressant medication overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 28, 2012. Accessed July 19, 2012.

    Balon R. SSRI-associated sexual dysfunction. Am J Psychiatry. 2006;163:1504-1509.

    Bupropion. EBSCO Health Library website. Available at: http://www.ebscohost.com/pointofcare. Updated March 28, 2011. Accessed July 14, 2012.

    DeBattista C, Solvason B, Poirier J, et al. A placebo-controlled, randomized, double-blind study of adjunctive bupropion sustained release in the treatment of SSRI-induced sexual dysfunction. J Clin Psychiatry. 2005;66:844-8.

    Modell JG, Katholi CR, Modell JD, DePalma RL. Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clin Pharmacol Ther. 1997;61:476-487.

    Nefazodone. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 11, 2011. Accessed July 7, 2012.

    Paroxetine. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated April 11, 2011. Accessed July 7, 2012.

    Paroxetine (marketed as Paxil) information. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm053346.htm. Updated December 21, 2011. Accessed July 7, 2012.

    Safarinejad MR. The effects of the adjunctive bupropion on male sexual dysfunction induced by a selective serotonin reuptake inhibitor: a double-blind placebo-controlled and randomized study. BJU Int. 2010;106(6):840-847.

    Shen WW, Hsu JH. Female sexual side effects associated with selective serotonin reuptake inhibitors: a descriptive clinical study of 33 patients. Int J Psychiatry Med. 1995;25:239-248.

    Sildenafil. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 11, 2011. Accessed July 14, 2012.

    Smucny J, Park MS. Which antidepressant is best to avoid sexual dysfunction? Am Fam Physician. 2004;69(10):2419-2420.

    Yohimbe. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated August 2011. Accessed July 14, 2012.

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