How can I improve my libido while taking an antidepressant?

A fairly high number of individuals who take anti depressant medications complain that they have decreased libido, lack of sexual desire, failure to achieve an erection or inability to ejaculate. The exact numbers of people who have sexual dysfunction from anti depressant medications is not known, but anecdotal reports suggest that the numbers are high.

The sexual dysfunction that occurs with anti depressants has been known for decades and is somewhat difficult to resolve. Almost every class of anti depressant drugs has been associated with sexual dysfunction and lowered sexual excitement. The sexual dysfunction generally occurs after the patient has been on the drug for a few months. In some cases, the sexual dysfunction improves with time, but in many cases, the problem only gets worse. These sexual side effects while not life threatening, seriously affect an individual’s lifestyle. Often the patients solve the problem by refusing to take their medication. This lack of compliance then leads to worsening of the mental health problem.

So how can this problem be resolved?

When an individual first complains of sexual dysfunction, a wait and see approach may be appropriate because some individuals will improve with time. The wait and see period should not be more than 2-4 months. If the patient has not improved by then, he/she is unlikely to improve.

IF I have bipolar, can I take antidepressant drugs?

As a rule anti depressants are almost never used to treat bipolar disorder. It is only the rare physician who treats bipolar with an antidepressant. The reason for the hesitancy in treating a bipolar patient who is depressed with a conventional anti depressant is that the drug may rapidly induce a state of mania with potential adverse outcomes, such as extreme paranoia, suicide or psychosis.

Further, not all anti depressants work in the same way and there is always a chance of harming the patient. For the above reasons most psychiatrists have been very hesitant in using the conventional anti depressant in individual with a bipolar disorder. The routine practice has been to use an anti depressant in combination with a mood stabilizer to prevent the sudden onset of mania. Some physicians only use a mood stabilizer alone or combine it with a anti psychotic (neuroleptic) drugs which is approved for use in bipolar depression.

At the moment there is no way of knowing which bipolar individual will react adversely to the anti depressant drugs. Most of the factors which determine the type of reaction are individually based. Individuals who continue to abuse drugs, or have had prior treatment failures with anti depressant, or those who have a rapid cycling form of bipolar disorder or those with a genetic alteration a certain gene (serotonin transporter gene) have a high risk of developing adverse reactions.

So far there are no rigid rules or guidelines as to when an anti depressants can be used in patients with bipolar disorder. In those individuals with bipolar disorder who continue to have prolonged episodes of depression, it is important to discuss this issue with your mental health counselor. One needs to develop a treatment plan to meet individual needs. If an anti depressant is started, one needs very close follow up to ensure that there are no untoward problems during the with mania phase.

Why will my Anti Depressant medication not work anymore?

One common complaint among many depressed patients is that their medication no longer works. The majority of individuals notice that the depression just will not go away with the medication that helped them previously. So what gives?

Well, failure of anti depressants to work on long-term basis has been known for decades. The exact number of people affected by this so called “POOPING OUT” effect is not known, but is said to be quite high – at least 20%-40% of individuals.

This phenomenon where anti depressants fail to work has not been thoroughly studied but there are a few speculations as to why this may happen.

Most psychiatrists feel that depression is a chronic disease that does get worse with age. Why depression worsens with age is not understood but is felt to be due to depletion of certain neurochemicals in the brain. With age, the depressive episodes also are more frequent and more intense. Often the depression is affected by daily stresses in life and is harder to control

In a few individuals, the reason why anti depressants fail to work all of a sudden is presence of another medical disorder. The most common disorder that can worsen depression is hypothyroidism. If you are on an anti depressant and the medication fails to work, go and get your thyroid hormone levels checked out.

Often the failure of medications to work is because of interaction with other medications. Most individuals who are on anti depressants are on a hodge podge of many different medications, including sleeping pills, sedatives and anti anxiety pills. In many cases, the use of the other depressant drugs or even alcohol has been found to be the reason why anti depressants no longer work.

There are rare cases when the there has been a confusion in the diagnosis. Often some individuals are diagnosed with depression when they actual have manic depression, a disorder where depression is a well-known element.

Whenever an anti depressant fail to work, your health care professional will adjust the dose. Sometimes an additional drug may be added or a completely new class of anti depressant drug may be prescribed.

For those individual who have depression not responsive to their old prescription, it is essential to follow up with your psychiatrist. Depression is not curable but it is treatable with a number of drugs and psychotherapy.