Q: BP Meds Affect Sexual Function
Dear Dr. Phelps,
I am a registered nurse. This is my 30th year of practice.
Obviously, I am not new to the medical field. I underwent a TAH-BSO 12 years ago. I suffered an unrelenting depression
despite hormone replacement with natural estrogens in various forms for 5 years.
I began testosterone hormone replacement 7 years ago with dramatic improvement
in my depression and energy level. However, within a year of starting it,
what I now know as bi-polar symptoms ensued. Currently, I am under the
care of a psychiatrist who recognizes the bipolar effects. The only
treatment that relieves the depression is continuation of testosterone, estrogen
alone spirals me back into a depression for which antidepressants are of no
value. However, all the antidepressants and mood stabilizers have a
horrific impact on my libido and my ability to orgasm, one of the reasons that I
chose to supplement with testosterone in the first place! Any suggestions
or help would be greatly appreciated.
Dear Ms. T' --
If there is a serotonergic antidepressant in the mix of medications you're
currently taking, that is by far the most likely culprit, I would think. In
fact, the only thing that would really make your question much of a puzzle would
be if there were not such an antidepressant involved.
If there is an SRI in the picture, then you're probably
in roughly the same position as other women with this problem. Options include
looking for a different antidepressant that does not do this (tricky if you're
getting a very good response in terms of mood, otherwise); or using an
"antidote" to this side effect. By far the most commonly used and best studied
such antidote is Wellbutrin (bupropion), which has been combined with SRI's in
the treatment of unipolar depression very frequently and with (somewhat
surprisingly, to me) very little trouble re: combined side effects. In bipolar
disorder I would hope most doctors would be somewhat more hesitant to add a
second antidepressant solely for the "antidote" role, but there is no absolute
reason not to try this, so this option remains on the list. Other antidotes are
much more complicated to use, are less studied, and may be less effective (Wellbutrin
is really remarkably good at this; although I always wonder then if Wellbutrin
alone might be sufficient as an antidepressant, especially in bipolar disorder
where there is just a bit of evidence (with at least one contradictory study as
well) suggesting that Wellbutrin is less likely to worsen bipolar mood stability
than other antidepressants).
If there is not an SRI in the picture, then what? This
would require a step-by-step analysis of the rest of your medications to see
which might be most likely to inhibit sexual function. I rarely run into this
problem with mood stabilizers (as traditionally defined, i.e. lithium and
Depakote etc. ). It is more common with atypical antipsychotics. The
"step-by-step" thing means, ultimately, carefully tapering off one at a time,
presumably while trying to keep symptoms controlled some other way, to see if
sexual function improves in the absence of medications.
Obviously this assumes that there are no other obvious
reasons to assume that sex could have worsened or disappeared, such as
relationship issues or other personal issues (any stresses count in this
respect). So, you can see it's really tricky, especially this idea of tapering
off medications that may be very necessary, looking for the return of something
that might have gone away for some other reason anyway.
Thus we come back to my hope that the explanation lies
in some SRI you're taking, as that one is much easier to address.
Published January, 2005