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Sex Rx: Paxil and Your Sex Life

Paroxetine (Paxil) is widely used in the United States. It is most often prescribed for anxiety, 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 medications work by blocking the reuptake of the brain chemical serotonin, which helps regulate mood.

Other Drugs of This Class (SSRIs)

  • Sertraline
  • Fluoxetine
  • Escitalopram
  • Fluvoxamine
  • Citalopram

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 medication regimen or start taking new medications 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 medication, 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 medication. When switching is appropriate, some options include:
  • Bupropion—This antidepressant medication 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—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—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 medication 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 medication 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 medication 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 medications 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/dynamed. Updated January 18, 2013. Accessed June 5, 2014.

Antidepressant medication overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 25, 2014. Accessed June 5, 2014.

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

Bupropion. EBSCO EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed June 5, 2014.

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. Updated January 18, 2013. Accessed June 5, 2014.

Paroxetine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 3, 2013. Accessed June 5, 2014.

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 June 26, 2013. Accessed June 5, 2014.

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 25, 2014. Accessed June 5, 2014.

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/biomedical-libraries/natural-alternative-treatments. Updated August 22, 2013. Accessed June 5, 2014.

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