BP Meds Affect Sexual Function
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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. 

Thank you!

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.  

Dr. Phelps

Published January, 2005


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