May 15, 2008Sexual Dysfunction On Anti-Depressants Higher Than Thought, Longer LastingThanks to CL Psych who flagged this issue the other day and posted one academic paper acknowledging that not only are there weird problems such as genital anesthesia--such a polite term--connected with anti-depressant use in some cases, but that the rate of sexual dysfunction on the happy pills isn't very happy at all. In fact, it's much higher than doctors have commonly assumed and than pharma companies have been willing to admit. There's a reason of course: admitting that taking Prozac, for example, could cause sexual dysfunction in a high percentage of cases would utterly crater sales. Let me offer a disclaimer before I dig into all of this: I am not denying that some people experience benefits from taking anti-depressants. I am not saying depression should not be treated. I am not looking for a fight on those fronts. I am simply raising some separate issues that should be of prime concern to anyone who takes or might take an anti-depressant and might want complete information about possible effects of taking these drugs. Classically, the pharma companies have admitted to dysfunction in 10 percent or fewer of cases (I can remember in the early 1990s reading some Lilly literature on Prozac that claimed a rate of less than 5 percent). I think it's generally accepted wisdom among anti-depressant users, current or former, that it's more like 30 percent. And maybe higher, according to this recent study by a psychologist at the University of Pittsburgh: "In postmarket studies, clinicians have more systematically solicited information about SSRI-associated sexual problems such as lowered libido and difficulties with arousal or orgasm, via structured clinical interviews or validated sexual functioning questionnaires and found that they are present at dramatically higher rates, at frequencies as high as 98 percent. While these dysfunctions are very common, and while they typically endure for as long as the individual is taking the medication, it has been generally assumed that these side effects always resolve after discontinuing treatment." Apparently, such side effects don't ebb with discontinuation. That's kind of a problem. What's more, two case reports in the forthcoming Journal of Clinical Psychopharmacology report on sexual problems generated by using Celexa (see pages 16 and 18 of this .pdf). In one case, a patient experienced episodes of spontaneous ejaculation. That's got to be a messy and sad situation. While I don't necessarily believe that sexual dysfunction occurs 98 percent of the time in anti-depressant use--if it did then the word on the street about the problem would be so loud that almost no one would take the drugs and it's clear that about 30 million people take these drugs each year--it's still fairly evident that these problems occur at rates well above 10 percent. Doctors have long told patients, "Oh, it won't happen to you" or words to that effect. They've also told patients that the effects of delayed ejaculation, anorgasmia and libido loss--two of the more common side effects--will go away once a patient is off that particular drug. Unfortunately, the Pitt study reports that this is not always the case and that some patients' sexual functioning never returns to normal. And, the researcher, Antonei Csoka, makes it clear that patients are not being told about this phenomenon. "It is important that patients are informed about the high probability of sexual side effects while on SSRI medications. It is worth noting that none of the three patients received adequate informed consent with regards to the known risks of sexual side effects, so as to be able to consider those risks in their decision to take the medications. Patients should also be told that there are indications that in an unknown number of cases, the side effects may not resolve with cessation of the medication, and could be potentially irreversible." It's absolutely imperative that doctors begin telling their patients about the potential for these problems as part of the informed consent process. I know doctors probably won't like the fact that these papers are being written by psychologists--who not only noticed these kinds of issues cropping up in therapy sessions, but have investigated the various Internet forums devoted to these issues--but it's time that they woke up to the fact that they are supposed to be serving their patients and not a treatment paradigm that refuses to acknowledge significant problems with anti-depressants. What's more, researchers need to actively begin researching these issues, especially in regards to long-term use, and stop acting like this isn't a problem. It would also be swell if they looked into how these drugs might effect the development of sexual function in children and teens who take these drugs. DISCLOSURE: So you all know my personal bias on this matter, here comes the full disclosure. I generally did not experience sexual side effects as a result of anti-depressant use with one exception worth noting. For a time, I experienced a complete lack of interest in sex while taking Prozac (very annoying in retrospect). Luckily, this problem ebbed with time. My experience with the other anti-depressants I've taken--Paxil, Zoloft, Celexa, Wellbutin, Lexapro and Luvox as well as those lovely anti-depressant adjuncts Risperdal and Seroquel--was more positive on this front. Posted by Philip Dawdy at May 15, 2008 12:05 AM
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At the time when I was put on antidepressants, if someone had told me of the increased risk of side effects, I would have opted for the medication anyway - at that point, I was as desperate as I was depressed. In retrospect, considering the fact that I'm bipolar and was on antidepressants for two years without a mood stabilizer, considering that I had several side effects that stayed with me even after discontinuing, and considering that the antidepressants never really worked for me, I wish I'd never started taking them in the first place. That holding back on the truth of side effects causes patients to be less informed bothers me - what bothers me just as much is that it also takes away from the urgency of developing an effective treatment that doesn't have these side effects. Posted by: Fallingleaf at May 15, 2008 02:21 AMThis is more serious. http://www.youtube.com/watch?v=9-6pmsVOe3g&feature=related There are comments from people on their twenties that has the iatrogenic disease. Posted by: Ana at May 15, 2008 03:30 AM Rolling Stones - I can't get no (satisfaction) Pfizer(?!) has sponsored a study of Sildenafil for Treatment of SSRI-Antidepressant Sexual Dysfunction in Women: http://clinicaltrials.gov/ct2/show/NCT00375297?term=sexual+dysfunction+AND+%28woman+OR+women+OR+female%29&rank=3
http://clinicaltrials.gov/ct2/show/NCT00034021?term=sexual+dysfunction+AND+%28woman+OR+women+OR+female%29&rank=8 Posted by: Ana at May 15, 2008 04:02 AMAren't therepists trained to do ANYTHING besides prescribing drugs? Psychologists can't even presribe drugs themselves, and yet that's the only practical advice they ever give toward alleviating suffering. I'm speaking from my own experience out of the 11 therapists I can count that I have seen.
From the 2005 UK parliament review on "The Influence of Pharmacutical Industry" http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf "7.The timing of this Inquiry coincided with an investigation by the medicines regulator into the safety of the newer 'SSRI ' antidepressant drugs, and we refer to these drugs to illustrate some concerns. Depression can be a severely disabling and life-threatening condition, when urgent treatment is needed, but only about 5%of all prescriptions are written for 'severe ' depression, and about two-thirds are for forms of depression classified as 'mild '7 - i.e. mainly for people who are unhappy and distressed by difficult situations and circumstances. Although it is often suggested that antidepressant drugs will help these people, there is no good evidence that they will. Most people prescribed SSRIs in such circumstances can expect modest benefits, but are exposed to substantial risks of harm." p. 10
328.Areas of research that are not of direct interest to the pharmaceutical industry but may significantly benefit patients,such as non-pharmacological treatments,should be funded by Government. p. 95 345.We know that,in the US,the manufacturers of Vioxx and Celebrex did not act in 346.We can be sure, however,that the clinical trials of Seroxat (Paxil in US) and other SSRI antidepressants were not adequately scrutinised.The failings of Seroxat and other SSRIs should have been picked up by a more careful examination of the evidence presented in the Phase III clinical trials and suitable prescribing advice should have been issued on this basis. p. 101 347. Although the case of Seroxat has been described in greater detail elsewhere in this report, it is worth noting here that, in additional information provided to the Committee on the basis of the EWG ’s report on SSRIs,it has been shown that suicidal thoughts and hostility are twice as common in patients receiving Seroxat in the month following drug withdrawal as in those receiving placebo. Data contained in the licence application itself cited studies in which withdrawal symptoms were common.Yet for years the MHRA maintained that withdrawal symptoms were rare, affecting of the order of 0.1 –0.2% of patients.The Agency now acknowledges that 20 –30%of patients might experience withdrawal symptoms when stopping SSRIs. p. 101-102 348.Prescribers must take their share of the blame for the problems that have resulted from the prescribing of SSRI antidepressants and COX-2 inhibitors.There is no doubt that these medicines have been indiscriminately prescribed on a grand scale. This is partly attributable to intensive promotional activity, especially around the time of drug launch,but also the consequence of data secrecy and uncritical acceptance of drug company views.It seems that intensive marketing has worked to persuade too many professionals that they can prescribe with impunity.There is a huge variation in prescribing, even within a limited area.That many acted cautiously makes those who did not more open to criticism.There is a lack of any effective mechanism for tempering the prescribing explosion often seen in the months following a product launch.We have been told time and again that this is the most important period in drug promotion terms,but is also the time when least is known about the product (see Recommendations in Paragraph 358). p. 102 Medicalisation of society:‘ a pill for every ill ’ 350. A major and recurring issue raised during the inquiry is the increased ‘medicalisation ’of our society – the pill for every problem. With over-the-counter statins now promoted for all men over the age of 55, for example, and a vast array of preventative treatments and supplements, it is easy to believe that everybody will be self-medicating every day in the near future. We were pleased that Lord Warner seemed to share our concerns in this regard: "Certainly, if I may put it this way, as a citizen and a father, I have some concerns that sometimes we do,as a society, wish to put labels on things which are just part and parcel of the human condition." Reading the post "America The Medicated Nation" it seems that we are half way there.
Rolling Stones - I can't get no (satisfaction) I believe that Mick and Richards were on cocaine or pot when they wrote the lyrics. It's known that cocaine and other drugs causes sexual dysfunctions.
I can't get no satisfaction When I'm drivin' in my car I can't get no satisfaction When I'm watchin' my TV I can't get no satisfaction When I'm ridin' round the world I can't get no, I can't get no Hey, it helps sell Viagr@! Posted by: Lilly NC at May 15, 2008 12:23 PMI guess I'd better start with the disclaimer that not looking for a fight over whether some people get depressed or have other problems that can be labeled as symptoms of mental illness, benefit from the drugs, benefit from the drugs more than they are harmed by the 'side effects,' ought to continue taking the drugs every day for the rest of their lives, yada, yada, yada... My question is, aren't the problems that are long-term persistent after people have stopped taking the drugs (for instance tardive diskinesia, metabolic syndrome, enervation, and this sexual disfunction) proof of brain damage? Posted by: UnderTheThresher at May 15, 2008 01:03 PMUnderTheThresher, Yes. But it will take years till it will be admitted. The problem is Do you want: "Memory Plus Capsule"; "Liver Transition Formula Capsule"; "Pancreas Formula Capsule"; ????? LOL Soon available: The "PSSD cure capsule"... LOL The precious testimonies written by those who has get off the drug are lost. Gee! I'll make the remark I came here to leave in another comment. Posted by: Ana at May 15, 2008 02:27 PMThis is what I wanted to add: Fluoxetine (Prozac), the prototypical SSRI, is classified as a reproductive toxin by the Center for the Evaluation of Risks to Human Reproduction. :o) Posted by: Ana at May 15, 2008 02:30 PMThis is the first year, I haven't been majorly depressed. It also is the first year that in a long time that I have actually wanted to have sex. Me & my significant other have a very healthy sex life (but not the manic type), and I am happier then ever. Doctors shouldn't right anti depressant scripts. They should scribble on a piece of paper - "Get Laid" Posted by: Janet at May 15, 2008 03:39 PMMe again! http://www.youtube.com/watch?v=YKtkKhqwKpM There's one comment in another video that has choked me: "The media fooled us!!!! I'm not saying that SSRIs or other drugs, like "Halcion" - remember?, are promoting an epidemic violence around the world. This is Eric Pekka profile that was on Youtube last year. I have saved it: Sturmgeist89 aka NaturalSelector89 (3/15/2007 - 10/19/2007). YouTube suspended my previous account but I am back now :) My new account name is German and means "Stormspirit" in English. http://rapidshare.com/files/68 015773/Pekka-Eric_Auvinen___Jo kela_High_School_Massacre.zip Male from Finland. I am a cynical existentialist, antihuman humanist, antisocial socialdarwinist, realistic idealist and godlike atheist. SI VIS PACEM, PARA BELLUM! JUSTITIA SUUM CUIQUE DISTRIBUIT! SIC SEMPER TYRANNIS! I am prepared to fight and die for my cause. I, as a natural selector, will eliminate all who I see unfit, disgraces of human race and failures of natural selection. You might ask yourselves, why did I do this and what do I want. Well, most of you are too arrogant and closed-minded to understand... You will proprably say me that I am"insane", "crazy", "psychopath", "criminal" or crap like that. No, the truth is that I am just an animl, a human, an individual, a dissident. I have had enough. I don't want to be part of this fucked up society. Like some other wise people have said in the past, human race is not worth fighting for or saving... only worth killing. But... When my enemies will run and hide in fear when mentioning my name... When the gangsters of the corrupted governments have been shot in the streets... When the rule of idioracy and the democratic system has been replaced with justice... When intelligent people are finally free and rule the society instead of the idiocratic rule of majority... In that great day of deliverance, you will know what I want. Long live the revolution... revolution against the system, which enslaves not only the majority of weak-minded masses but also the small minority of strong-minded and intelligent individuals! If we want to live in a different world, we must act. We must rise against the enslaving, corrupted and totalitarian regimes and overthrow the tyrants, gangsters and the rule of idiocracy. I can't alone change much but hopefully my actions will inspire all the intelligent people of the world and start some sort of revolution against the current systems. The system discriminating naturality and justice, is my enemy. The people living in the world of delusion and supporting this system are my enemies. I am ready to die for a cause I know is right, just and true... even if I would lose or the battle would be only remembered as evil... I will rather fight and die than live a long and unhappy life. And remember that this is my war, my ideas and my plans. Don't blame anyone else for my actions than myself. Don't blame my parents or my friends. I told nobody about my plans and I always kept them inside my mind only. Don't blame the movies I see, the music I hear, the games I play or the books I read. No, they had nothing to do with this. This is my war: one man war against humanity, governments and weak-minded masses of the world! No mercy for the scum of the earth! HUMANITY IS OVERRATED! It's time to put NATURAL SELECTION & SURVIVAL OF THE FITTEST back on tracks! Justice renders to everyone his due. I knew about the sexual dysfunction but like a lot of other people I thought it resolved when one stopped taking the drug so this information is a shocker and gives me a pit in my stomach because it is so very dangerous and frightening -- so life changing for someone. And to think this stuff is being handed out like candy and no one is being told or even investigating this side effect, worth speaking of. Ah, the wonders of capitalism. It's an outrage I'm afraid and I've sent pdfs of these articles around to every list serve I'm on to spread the word. Also in one of these links, just FYI, it refers to that phenomenon Philip was writing about recently PGAD (Persistent Genital Arousal Disorder) -- turns out this can be one of the persistent sexual effects after withdrawal. So when Paxil is being used to treat it then guess what that demonstrates -- that it's withdrawal that's being treated, not really the underlying cause. Maybe PGAD is some kind of rebound reaction for all that time one was suffering from suppressed libido. All I can say is "Ugh!" Posted by: Sara at May 16, 2008 09:02 AMNo Sara! PGAD or PSAS is a "illness":o) discovered in 2001.
HI PHILIP! DON'T PUBLISH IT PLEASE!!!!!!!! I'M JUST SAYING HELLO!!!!!! Posted by: Ana at May 16, 2008 02:38 PMOk! LOL Posted by: Ana at May 16, 2008 02:52 PMAna, I'm sorry. Here is the quote from the article. It is referring to persistent genital arousal disorder. "Recently, there have been four case reports of patients whose sexual function did not I found the case: Jane Wadsworth Clinic, St Mary's Hospital, London W2 1NY, UK; Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA Case number 5: The whole article is about PSSD. But in both cases the lack of eroticism is the real problem. Third, the possibility of structural changes to brain regions involved in sexual response should also be considered. For example, it has been shown that the treatment of adolescent patients with obsessive–compulsive disorder with paroxetine causes significant reductions in the left amygdala volume [20], a part of the brain shown to be strongly involved in response to visually erotic stimuli [21]. Such structural changes may take a very long time to reverse, if at all, in some patients. The inability to respond to visual stimuli which is largely documented on the Yahoo group they have used is the most schoking: "An invitation for volunteers to be interviewed was posted to the SSRIsex Internet community (http://health.groups.yahoo.com/group/SSRIsex/), a support and discussion group established in January of 2005, of over 1,300 individuals who have identified themselves as experiencing sexual dysfunctions that began on an SSRI, but which have persisted long after discontinuing the medications." This community only reports PSSD. PSAS should be more reported by patients. Priapism is a side effect of some drugs like trazodona and others. Sara, HI PHILIP! I used to relate Seattle to Hendrix, K. Cobain and Frasier Crane... DON'T PUBLISH IT PLEASE!!!!!!!! I'M JUST SAYING HELLO!!!!!! I hope he's in a good mood! Ana, I am sorry but I cannot understand for the life of me why you think Audrey Bahrick's citing of cases of persistent genital arousal disorder as a result of withdrawal from SSRIs is "useless." Just what are you getting at? I actually am not happy to be told that this information that I found is "useless" since to me this is a very dangerous and far reaching aspect of SSRI withdrawal that has been hidden and suppressed. Audrey Bahrick deserves the greatest commendation for her work on persistent sexual dysfunction as a result of SSRI withdrawal. I think she must be one of the only individuals in the world really investigating this other than the patients who are suffering from it themselves. I am fine with you citing research and coming to your own conclusions but please do not call what others find "useless." Maybe you are objecting to the word "arousal" in this case because in fact the sufferers are not "aroused" in the classic sense. Nevertheless their genitals are swollen -- that's the point. All I can say is "Yuck!" Posted by: Sara at May 17, 2008 08:11 PMIt's currently 73 degrees in Seattle, and Frasier is passionate about psychiatry. A staunch Freudian, he strongly believes that "there are no accidents" and that every action (and dream) carries with it a meaningful and unconscious subtext. This frequently leads him to obsessively overanalyze and fret about minor details regarding his life and relationships, which frequently creates problems in his life. Oh cut to the chase Sara, the word is engorged, created (induced) by psych meds. So what. Stephany, "On the whole, as a psychiatrist, he genuinely does desire to help people and is a fundamentally good and kindhearted person." ...from the same link. But his approach is not psychiatric. It's psychoanalytical "Niles describes his profession as "the saving grace of my life" (in episode "IQ") and is greatly respected professionally. He runs his own Jungian practice (Frasier is a Freudian) and has had his research published in several psychiatric journals. Even so, Frasier sometimes quotes Freud to coerce Niles emotionally." These are psychoanalytic not psychiatrist's. When you talk to your psychiatry about your problems it has nothing to do with therapy.
There are such things as psychotherpists, and out of box thinking psychiatrists, mine is not typical thank goodness. Posted by: Stephany at May 18, 2008 11:12 AMStephany, There are plenty old school Freudian shrinks doing psychopharm medication management. It pays the bills. Posted by: flawedplan at May 18, 2008 05:56 PMmy psych listens to all of the shite i post here there, everywhere, and doesnt ask for payment. he has been alarmed to find out about drug withdrawals and has re-considered drug reps in the office now as a result of the convo we have. Posted by: Stephany at May 18, 2008 07:39 PMIt's difficult to find an old school Freudian shrink in Brazil and I'm sad that in America they are even prescribing. my old shrink who got me totally over-medicated started studying at a Freudian Psychoanalytic institute the last few years I worked with him. He's completed training now. Does analysis, drug maintenance and ECT...lovely man full of tricks. Posted by: Gianna at May 19, 2008 06:14 AMGianna, http://www.psychoanalysis.org/about-sinai.html Quite strange! The Program offers pharmacological treatment trials Dear Lord! It has nothing to do with psychoanalysis. Lethal combination! Posted by: Ana at May 19, 2008 12:49 PM Post a comment
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