The impact on sexual performance may vary between these drugs, where Fluoxetine causes more severe effects in general than the others. Naturally, discontinuation of these drugs could or should
What are the Problems?
In this day and age more and more people are turning to anti depressant medication to cope with the pressures of daily living - but do Anti depressants impact male sexual performance? Speaking once again from my experience; during the past few months more clients are coming in complaining about taking long to ejaculate, feeling kind of not very interested in sex, not being able to maintain erections and even simply disinterested in sex or their sex organs.These problems can be caused by medication and since Feb this year four men have specifically mentioned they take Lexamil®. One person said it was part of “The Parkinson’s Pack” routinely prescribed to men diagnosed with Parkinson’s Disease.
I asked Der Apotheker to write this post to address the question of antidepressants killing male sexual performance and once again he has done a splendid article covering not only the usual suspects but also delving into the more obscure antidepressants.
From my perspective; the more uncertain our political / economic situation, ongoing relentless violence, daily protest action, massive traffic snarl ups and pressure to outperform on all levels – the more people turn to and rely on medication drugs (recreational or prescribed) in order to just cope.
That aside here the most informative post about antidepressants killing male sexual performance:
Introduction to Antidepressants
As discussed previously, there are several drugs that can affect male sexual performance. In the previous section, some of the effects and side effects of anti-anxiety medication on male sexual performance was discussed.
In this overview, we will look at the effects of drugs that are used in the long term treatment of anxiety and also those of antidepressants.
Many of the drugs listed below are used in the treatment of both. Antidepressants can be divided into six main classes. Starting with the most unimportant to the main perpetrators for killing male sexual performance
Monoamine Oxidase Inhibitor
This is a small sub family of drugs that are most likely some of the oldest antidepressants that have been developed in modern times, including:
Phenelzine
Selegiline
Tranylcypromine
Due to extensive dangerous side-effects, these drugs are rarely used and can be seen as mostly irrelevant.
Tricyclic Antidepressants
Also part of an old sub family, these drugs are still very often used, but mostly for their useful side-effects. Sexual side effects of these drugs are known to be low, but may cause a decrease in libido and also erectile dysfunction. Members of this family include the following drugs, but are not limited to:
Amitriptyline (Trepiline®)
Clomipramine
Imipramine
As alternative agents, tricyclic antidepressants continue to be most functional in patients with anxiety, sleep disturbances, poor appetite, and those who struggle with excessive weight loss.
Heterocyclic Antidepressants
This sub family includes mostly miscellaneous drugs that are not related to others, but are still commonly prescribed. The most important members of this family include, but are not limited to:
Amoxapine (Not available in South Africa)
Bupropion (Zyban®/Wellbutrin®)
Mirtazepine (Miradep®/Adco-Mirteron®)
The most commonly used of the above mentioned drugs for depression is Mirtazepine. Although not commonly used for depression, Bupropion (Zyban®) has been commonly used as an aid to help patients stop smoking. The effects these drugs have on sexual performance in males are minimal, except for Mirtazepine’s ability to cause marked sedation, which could evidently influence any type of performance.
Selective Serotonin Antagonists
These drugs are part of a small family which is mostly used for its antidepressant and anti-anxiety effects. These drugs are mostly well tolerated, moderately effective, but causes remarkable sedation. A prominent side-effect that must be taken into consideration at all times is priapism, which is a painful and prolonged erection which can take hours and even surgery to repair and renovate. Fortunately this occurrence is fairly rare. Sexual side effects of these drugs are known to be minimal otherwise, except again for the serious sedation that is caused. Members of this family include the following drugs, but are not limited to:
Nefazodon
Trazodone
Selective Serotonin and Noradrenalin re-uptake inhibitors (SNRI’s)
A very potent and very small family of medicines, this liberally used sub-family is widely prescribed and very popular for moderate to severe depression, as well as anxiety. Although these drugs are safe to use in general, they can cause hypertension in high dosages. Sexual performance can be severely affected by these drugs, and it should be noted that severe impotence can be caused by these drugs. Their sexual side-effect profiles are similar to those of the SSRI’s, which are listed in the section below. Naturally, discontinuation of these drugs could or should resolve the problem.Members of this family include the following drugs, but are not limited to:
Venlafaxine(Efexor®/ Efegen®/Sandoz Venlafaxine®/Venlor®)
Duloxetine(Cymbalta®/Cymgen®/Ye
Selective Serotonin Re-uptake Inhibitors (SSRI’s)
Antidepressants: Impacting Male Sexual Performance
Nowadays the most popular and safest choice of anti-depressants on the market, SSRI’S is a large family of drugs that are considered as 1st line drugs when treating depression and long term anxiety. In general they produce the least amount of side-effects compared to the other families of anti-depressants. However, these drugs are notorious for causing severe sexual dysfunction, especially in men, which has an immense impact on quality of life. This includes decreased to zero libido, inability to develop an erection, maintain an erection, prolonged to no ejaculation. In general these drugs have the same mechanism of working, but differ in potency, duration of working and indications, chosen according to the individual’s needs. These drugs include but are not limited to:
Citalopram (Cipramil®/Cilift®/Cilate®/Depramil®)
Escitalopram (Cipralex®/Citraz®/Zytomil®/Lexamil®
Fluoxetine (Prozac®/Nuzak®/Lorien®/Rezak®/ProHexal®)
Paroxetine (Aropax®/Deparoc®/Paxil®/Xet®/Serrapress®/Parax®)
Sertraline (Zoloft®/Sertra®/Serdep®/Serlife®)
Fluvoxamine (Luvox®/Faverin®)
SSRI’s: Impact on Male Sexual Performance: Erectile Dysfunction:
resolve the problem, but may take weeks, depending on the drug used and the duration it was taken. This is also not always recommended. In some cases the erectile dysfunction caused may be temporarily fixed by taking drugs used to treat ED, e.g. Sildenafil (Viagra®), Tadalafil (Cialis®) and Vardenafil (Levitra®). Unfortunately, these aren’t always effective in treating the matter. If the problem is viewed as serious enough, the only way to ‘cure’ the impotence would be to switch the patient to a different type of antidepressant or anti-anxiety drug, as shown in the sections above.
SSRI’s: Impact on Male Sexual Performance: Premature Ejaculation
Interestingly, as an off-label use, these drugs can be used to aid in cases where men experience premature ejaculation, as this group of medication can prolong ejaculation. It has been found that at the right dosage, these medicines can prolong ejaculation – however these studies have not been clinically tested. *
* I think that gives us a good idea how antidepressants impact on male sexuality. I have worked with quite a number of men who struggle for ages, or are completely unable to ejaculate after prolonged use of SSRI’s and I would strongly advise you to ask your doctor to prescribe you a different antidepressant – especially if you are experiencing prolonged ejaculation, weak or no erections. Kindly visit my Appointments page if you would like to make an appointment to discuss this or any other performance issue you may have