Does Garlic Help Libido?
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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 --

Two thoughts:

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 randomized trial.

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.

Dr. Phelps

Published January, 2009


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