Q: Just recently I have been diagnosed as having
Bipolar...I'm on Lamictal...which has affected my sex drive...I've heard that "garlic" would help
this problem..Is there any truth to this? Thanks...
Dear Margaret --
1. First of all, we could ask whether garlic has any impact on sexual drive
under any circumstances, and then wonder if it might have particular value when
people are taking lamotrigine (Lamictal).
So we start by doing a literature search at the National Library of Medicine,
using the terms garlic libido. Only a single article appears (usually
with a broad search like this, one would get at least tens if not hundreds of
articles, so that tells you something right there). The single article is about
placebo effects, a review in the Urology literature (Moyad).
Then, let's try the same search in Google. Garlic libido yields a
whole bunch of links, but garlic libido randomized trial (which would
include a control group, taking a placebo) yields none that actually describe a
So I think you could conclude that at present, there is no clear evidence
(indeed, there is not even really much murky evidence) suggesting that ginkgo
has an effect on sexual drive, in anyone. Therefore, we can also assume that it
has no benefit in people taking will lamotrigine either.
2. However, here is a puzzle for you to consider. People with bipolar II
report that over 95% of the time when they are having symptoms, they are having
symptoms of depression. By contrast, the careful "fine toothed comb"
review of their symptoms often reveals that they are having phases of
dramatically increased energy -- sometimes instead of, and sometimes embedded
within the depression symptoms. These phases are often quite brief, and
sometimes include "dysphoric" features such as agitation, irritability, or
troublesome insomnia. But interestingly, these phases also often include
increased sex drive. Sometimes one of the most distinctive features of the
depression, by contrast, is a complete lack of interest in sex.
So now we have a problem: what is "normal" sex drive for such a person? And
here's what makes it a particular problem: oftentimes people are so used to the
depression, that when their energy levels finally come up, they experience the
shift as finally joining the rest of their family and friends, in terms of their
ability to do things and enjoy them, or at least participate. In that respect,
they associate the increased sex drive with phases of relatively normal behavior
(certainly more normal for them than not wanting to get out of bed, having no
motivation for anything). Such people are likely to regard high levels of
sexual activity as "normal".
And indeed, for them, this is close to a truth. There is no way to "take an
average" of their sexual activity, when it varies so dramatically from being an
important part of their life, to being completely absent.
Okay, now take such a person and give her or him a mood stabilizer that
really levels things out in terms of those dramatic shifts in mood and energy.
They are no longer having a severe depressions. And they are no longer having
those up phases either. Exactly where they will land, with their new
"baseline", is almost always unclear. Sometimes they feel quite good.
Sometimes they're just mildly depressed all the time, no longer cycling, but not
where they want to be either.
Sexual activity often follows the same pattern: sometimes, it levels out at
about once a day, but often a levels out at once a week or less. People who are
used to being highly sexually active when they are feeling good, say having
intercourse once or twice a day, associate the mood stabilizer with having a
strongly negative effect on their sexual activity. Some medications are known
to have a direct negative effect on sexual interest and enjoyment, such
as serotonergic antidepressants. But this effect of the mood stabilizer I am
describing here is an indirect effect. It is not "causing sexual dysfunction",
it is decreasing sex drive overall (on the presumption that such drive was in
the high range, at lease for that given person, during shifts into hypomania).
And so, the puzzle then: how could the person her or himself, or the
psychiatrist, figure out whether the mood stabilizer this person is now taking
is actually just leveling their sexual activity along with other aspects of
"cycling"; or whether it is having a direct effect on libido. In my experience,
this is a very difficult distinction, but frankly, most of the time, when I
explain all this, people seem to accept that the lower level of sexual activity
is part of not cycling anymore. (I will confess, I actually don't know how this
attitude shift takes place. I wonder if people are quietly pulling their peers
to get an idea of how sexually active other people are, and then discover that
their new baseline is pretty similar to their friends').
Of course, there is no way for me to tell whether this whole story applies to
you. But it is a story that should be taken into account when trying to figure
out changes in sexual activity associated with bipolar disorder treatment. Good
luck getting your story figured out and addressed.
Published January, 2009