July 27th, 2016
According to latest estimates, about 30-40% individuals (globally) suffers from low libido or impaired sexual desires (although it is believed that actual prevalence is even higher). Based on the results of the National Health and Social Life Survey (2), it was observed that the prevalence of hypoactive sexual desire disorder (or poor libido) is higher in females (about 43%) when compared to men (31%). The symptoms in some of these individuals may last for several consecutive months in any given year and are usually accompanied with other issues as well (1). Needless to say that these ailments can directly interfere with mental, physical and psychosocial health of the individuals and can also put a bar on their relationships (1).
It is noteworthy that factors driving libido and sexual desires are complex and often involves a multi-modal trajectory (i.e. several factors contributes to the pathophysiology). Investigators believes that in most cases, mere changes in lifestyle, drugs and diet can help in the restoration of normal libido. Nevertheless, some cases are due to more complicated psychological issues (such as anxiety, depression, schizophrenia, obsessive compulsive disorder, relationship conflicts etc.) and thus demands more comprehensive treatment regimen (2).
If you take one of the following drugs on regular basis, it is time to speak to your doctor regarding an alternative drug or treatment option.
1. Antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRIs):
SSRIs is a very popular and effective class of antidepressants and is also indicated for several other psychological conditions. Popular pharmacological agents include, Zoloft and Prozac. Investigators explained in the peer reviewed Journal of Clinical Psychopharmacology (3) that sexual dysfunction is a common adverse effect of SSRI agents via number of mechanisms; such as:
Individuals who consume SSRI for longer periods of time often develops low libido, erectile dysfunction and other related symptoms. In fact according to another study, sexual dysfunction is reported in 30-80% patients who are on SSRI regimen (and is also one of the reasons why patients opt for alternative regimens (4).
These agents (such as Proscar) are indicated for the management of urinary symptoms in the setting of prostatic enlargement. The pathophysiology revolves around the inhibition of an enzyme, alpha reductase (that is found abundantly in the prostate tissue) and serves to facilitate the conversion of testosterone hormone into dihydrotestosterone (or DHT). So, although the drug intake sorts out the urinary complaints, most men end up developing libido issues due to low testosterone levels (5).
A similar drug (known as Propecia) is indicated for the management of alopecia at rather lower doses. The drug exerts its action by shrinking the hair follicles to prevent hair loss as a result of inhibition of 5-alpha reductase enzyme. Various clinical studies and surveys indicates that Propecia use is associated with impotency and severe sexual dysfunction (6).
This class includes drugs like Chlor-Trimeton and Benadryl that are indicated for the management of allergic conditions. Besides reducing the frequency and severity of allergy attacks, antihistamines also associated with dry orgasms, poor libido and low sex drive. The effects are generally transient and as soon as the drug clears from the system, libido returns to the normal (6).
4. Tricyclic Antidepressants (TCAs):
Besides depression, TCA has indications in the management of nerve pain and related issues. It is less popular when compared to SSRI due to high risk of adverse effects (such as sexual dysfunction, vaginal dryness and low libido).
5. Beta Blockers:
Beta blockers are perhaps the most abundantly used antihypertensive agent, and are also very strongly linked to sexual dysfunction. Based on latest available data, sexual dysfunction is the most common cause of poor patient compliance and adherence to drug regimen. It is unfortunate that a lot of people ignore their symptoms and never discuss the drug interaction with their doctors.
6. Anti-Seizure Drugs:
Drugs in this class reduces the frequency and severity of seizures by slowing the activity of nerve impulses. The same phenomena also interferes with the sexual stimuli and sensation; thereby leading to erectile dysfunction, low interest in sexual activity, and alteration in the semen quality.
1. Parish, S. J., & Hahn, S. R. (2016). The Epidemiology and Diagnosis of Hypoactive Sexual Desire Disorder and Causes of HSDD: Situational, Depression, Drugs, Chronic Illnesses, and Hormonal Depletion. In Management of Sexual Dysfunction in Men and Women (pp. 223-232). Springer New York.
2. Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: prevalence and correlates. Obstetrics & Gynecology, 112(5), 970-978.
3. Ben-Sheetrit, J., Aizenberg, D., Csoka, A. B., Weizman, A., & Hermesh, H. (2015). Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. Journal of clinical psychopharmacology, 35(3), 273-278.
4. Clayton, A. H., Croft, H. A., & Handiwala, L. (2014). Antidepressants and sexual dysfunction: mechanisms and clinical implications. Postgraduate medicine, 126(2), 91-99.
5. Gur, S., Kadowitz, P. J., & Hellstrom, W. J. (2013). Effects of 5-alpha reductase inhibitors on erectile function, sexual desire and ejaculation. Expert opinion on drug safety, 12(1), 81-90.
6. Conaglen, H. M., & Conaglen, J. V. (2013). Drug-induced sexual dysfunction in men and women. Australian prescriber, 36(2).