I have been on antidepressants since I was 20. They have definitely helped with my mental health for the past eight years, but there is a downside: I have zero libido. Until now, this hasn’t been a problem, but I’ve met a man I want to have a fulfilling relationship with — and that includes sex. How do I get my desire back?
Antidepressants may shift the black dog, but they can have a terrible effect on desire.
Dr David Goldmeier, a globally renowned consultant in sexual medicine, suggests taking a one or two-day medication ‘holiday’ each month to improve your libido without allowing the depression to return.
You haven’t said what type of medication you take, but that can make a difference too. A meta-analysis exploring ‘antidepressant-associated sexual dysfunction in patients with depression’, which was carried out in 2018 at the Loyola University Chicago, found that the odds of developing sexual dysfunction with paroxetine, escitalopram and duloxetine were significantly worse than with placebos.
In contrast, Goldmeier says that antidepressants such as trazodone or agomelatine have a minimal impact on sexual desire and response. He also recommends adding the antidepressant bupropion at a low dose in conjunction with existing medication. Small studies found that this can help to increase libido and orgasm in women. Adding a PDE5 inhibitor such as sildenafil (Viagra) will increase blood flow to the pelvic area. In men this creates an erection and in women it causes engorgement, which creates the feeling of fullness that you experience when aroused.
Anyone who decides to take this route, will need to find a doctor who will prescribe Viagra in conjunction with antidepressants.
A growing number of people are being prescribed antidepressants. Last month, RTÉ Investigates reported that in 2012, around 27,500 antidepressants (which kill libido) were prescribed per 1,000 per year. This figure grew to more than 35,000 dosages per 1,000 by 2017, an increase of 28% over five years. (The data was obtained from the Health Service Executive’s Primary Care Reimbursement Service (PCRS), which is responsible for processing drug payments.)
Sex makes people happy, and couples who have sex have better relationships and stronger marriages, so we ought to take this issue seriously. Clearly antidepressants have an important function, but if you want to stay well and get your libido back, you need to explore non-pharmacological solutions too. I’m sure you know that exercise can really help your mental health.
Getting out in the fresh air and going for a run boosts endorphins and gives you a dose of vitamin D. However, you may not know that exercise can also have a significant effect on libido.
In 2012 the clinical psychologist Cindy Meston at the University of Texas at Austin did a study with 47 women reporting antidepressant-related arousal problems. She found that after just 20 minutes of moderately intense exercise on a stationary bicycle, the women showed significantly higher levels of genital response (lubrication and engorgement) when they watched an erotic film, and the greater their level of sexual dysfunction, the stronger the effect was.
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