Depression pills can sabotage your love life
Barely a day goes by when I don’t utter a prayer of gratitude that my experience with antidepressants didn’t end in my death or permanent disablement.
I’m one of the estimated 1 to 4 per cent of people who reacts badly to selective serotonin reuptake inhibitors (SSrI) antidepressants, which include Prozac, Seroxat, Cipramil and lustral.
By that, I don’t mean feeling a bit dizzy or not quite myself: a small percentage of us become depressed and suicidal.
My story, previously told in Good Health, started when I was prescribed the antidepressant escitalopram for sleepless nights while going through a divorce.
Within hours, I became dangerously psychotic, hallucinating that I’d killed my children. When I was taken to hospital, doctors failed to spot I was suffering an adverse drug reaction and gave me more pills. Over the course of a year, I became so ill I could barely leave the house.
By a stroke of luck, I was taken to another hospital that took me off all five medications I was on — and within weeks I was better, back at work as a film-maker and training for a half marathon.
That was four years ago, and apart from nightmares and flashbacks, I’ve come out unscathed and thankful to be alive.
recently, I’ve come across a group of people who have given me another reason to be grateful.
That’s because — as a result of taking SSrIs — they can’t have sex and I can.
It’s not something many people, or doctors, will talk about, but sexual dysfunction is a known side- effect of SSrIs while you are taking them.
Symptoms can include erectile dysfunction, inability to orgasm in women and genital numbness.
around five million people in the UK take SSrIs, and 58 per cent of them could be experiencing these kinds of sexual side-effects, according to one authoritative study, published in the Journal of Clinical Psychiatry in 2001.
regarded as one of the most thorough studies on the subject, this analysed the incidence of antidepressant-related sexual dysfunction in more than 1,000 outpatients, all of whom had normal sexual function before being treated. (researchers looked at some of the most popular SSrIs, including fluoxetine, better known by the brand name Prozac).
DavIdHealy, professor of psychiatry at Cardiff University, believes the true figure of sexual dysfunction on SSrIs is far higher. ‘Most people will experience some degree of genital numbing 30 minutes after taking a pill,’ he says.
Why might SSrIs do this? Professor Healy’s theory is they damage nerve cells in the spinal cord linked to the genital area.
‘ We know, when tested on animals, they cause nerve cells in the spinal cord to disintegrate.’
during my year on antidepressants, sex was the last thing on my mind. I would guess that it was also the last thing on anyone else’s mind who met me at the time, as the medications had made me an overweight, dribbling wreck, unable to finish a sentence.
after I came off my five different medications, the rebirth of emotions was overwhelming. But it took a month for my interest in sex to come back and for me to be my old self again.
I was one of the lucky ones, as the effect on sexual function can last even after you’ve stopped taking antidepressants. Post SSrI Sexual dysfunction (PSSd), as it is known, is exactly what it says it is. Both men and women can be affected, and it can go on for weeks, months, years or, in some cases, indefinitely.
Professor Healy, who runs a website where people report adverse drug effects ( rxisk.org), says he is contacted by many patients who have experienced these symptoms.
Sexual dysfunction is not something that many people are able to discuss, but 39-year- old Kevin Bennett, from County durham, has bravely decided to speak out on behalf of sufferers of PSSd.
His story began in 1996 when he was 18. His parents insisted he saw a doctor because he had dropped out of school, deciding not to continue with his a-levels.
Kevin’s GP prescribed Prozac to reduce his anxiety, in the hope he would then return to his studies. Within four days, Kevin was totally impotent. ‘I was surprised the drug was powerful enough to cause impotence, because I thought this was a problem that affected elderly men.
‘However, I wasn’t in a relationship, and I wasn’t particularly concerned as I believed it was a temporary side-effect.’
There were other problems: Kevin became forgetful and drowsy during the day. His GP, thinking these were a sign of depression, doubled his medication.
Things didn’t improve, and by then Kevin had decided to train as a central heating engineer. after four months, Prozac had been of no benefit so he went cold turkey.
In the next few weeks, Kevin’s drowsiness disappeared but there was no improvement in his sexual functioning. ‘When weeks became months, I became concerned.’ His first sexual encounter, a few months after quitting Prozac, was an embarrassing disaster.
a year later, in 1997, when there was no sign of improvement. Kevin wrote to the drug manufacturer, eli lilly, asking for advice.
They wrote back saying Prozac was not the cause of the problem, and therefore he should consult his GP about it. (Since 2011, the product information has carried a warning that symptoms of sexual dysfunction occasionally persist after discontinuation of Prozac treatment). Kevin’s GP insisted his impotence must by psychological, assuring him that he’d be fine once he was in a relationship.
Kevin went on to try to have relationships but they were always inhibited by his impotence.
‘Girls found it hard to accept that I was attracted to them but impotent, and took it personally, so relationships often fizzled out.’ In 2002, Kevin became involved in a long-term relationship with a girl who was very understanding, but the fact remained they had virtually no sex life.
Kevin finally persuaded his GP to refer him to a specialist, and over the next 18 months he saw two urologists, a radiologist, a neurologist and an endocrinologist. Tests, including ultrasounds and blood flow measurements, showed that everything was working normally.
The specialists concluded that it must be the Prozac that was the cause, and Kevin was advised that the best course of action was injection therapy, whereby he injects a muscle relaxant just before intercourse.
at the age of 27, Kevin was able to have sex for the first time.
The drawback is that sex has to be a planned event and erections can last hours — ‘but having sex at all is an improvement’.
Ten years later, his condition hasn’t improved. ‘It’s humiliating,’ he says. ‘What I find hard to accept is how I became impotent.’
Kevin was so angry that in 2007 he flew to the U.S. to give a talk to health professionals about his experience. One of the reactions from doctors was that patients would be reluctant to take SSrIs if they knew it might affect their sex lives permanently.
‘I was astonished that doctors could actually think it’s OK not to warn people,’ says Kevin.
HealSO asked the UK’s Medicines and Healthcare products regulatory authority (MHra) if they had other cases three weeks ago. They responded, saying there had been 1,420 reported cases of sexual dysfunction, with 290 persisting after the drug was stopped.
It may not sound much, but the number of people who report adverse side-effects through the MHra system is a tiny fraction of those affected.
another problem, when people experience sexual side-effects, is that doctors can put this down to the mental illness the drugs are supposed to treat.
Of course, sexual indifference and loss of libido are symptoms of depression, but anyone who has experienced the genital numbness caused by an antidepressant knows this is not psychosomatic.
To get an idea of the impact this side-effect can have, you only have to look at some of the postings on the internet support group SSrIsex that has 3,800 members, all suffering from PSSd.
The most sobering post is the note of a 28-year- old who killed himself in October 2010. He wrote: ‘I love life very much . . . and this has been very difficult on everyone. I cannot express how sorry I am about this decision, I am too scared to live a life in impotence and disability. do not let them convince you that this is just depression. These drugs are the problem. end of the story.’
a spokesman for eli lilly said: ‘There is nothing more important to [us] than the safety of our medicines. any medical issues about fluoxetine have been addressed in our data submissions to regulators and in scientific journals and conferences for more than 20 years.’