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Q: Experiences Loss of Sexual
Function, What Are My Options?
I have been on Bupropion (Wellbutrin XL300) and Lamotrigine (Epitec 200mg) for
18 months. This isn't enough to control my downs anymore and my psych has
suggested that we add Sertraline (Zoloft 50mg). I have taken fluoxetine before
and experienced the side effect of total loss of sexual function. I have read
that this is a possible side effect of Sertraline as well.
The Lamotrigine already affects my
sexual function quite a bit. I take the bupropion and lamotrigine in the morning
and the sertraline at night. It seems to me as if I will lose all function
again. This is obviously a problem as far as maintaining a health relationship
with my partner. What are my options, if any?
Dear Tania --
First of all, there is the grand controversy about whether antidepressants
actually work in bipolar disorder, although recent evidence quite strong that
they can be effective in bipolar II (which presumably is the type which you
have, based on your current medication lists). If you wish, you can read about
these
antidepressant controversies
on that webpage, for my views on whether they should be used at all (it’s pretty
technical, that page, but it’s pretty detailed as well. )
However, to
answer your question, about alternatives to antidepressants that can affect
sexual function: well, again, in my view that sees it, because there are at
least nine alternatives to antidepressants that don't make bipolar disorder
worse like regular antidepressants do, and none of them (well, maybe one) make
sexual function worse either. Here is my list, and you can find details on my
Nine Alternatives
webpage; most of these have at least as much research evidence for their
effectiveness in bipolar depression as antidepressants:
|
Not Pills |
"Natural" |
Pharmaceutical |
|
Regular physical activity
Psychotherapy (at least three different kinds)
Light therapy (particularly using a Dawn Simulator)
|
Omega-3 fatty acids (fish oil)
Low- dose lithium
Thyroid hormones
N-acetylcysteine |
Lamotrigine (you're already on that)
(the remaining options in this column have such a risk of weight gain, there
are only last alternatives)
quetiapine/Seroquel
olanzapine/Zyprexa |
Decreased
sexual function from lamotrigine is extremely uncommon. But it is frequent for
patients to see a dramatic decrease in their sexual activity when they are no
longer having hypomanic phases. (Although they are probably seeing an increase
in their sexual activity relative to what happens during their depressed
phases). So you may have to try to carefully distinguish whether or not
lamotrigine is really affecting sexual function directly, or only indirectly
through its impact on bipolar disorder itself.
Good luck
sorting through all of that, and finding a better working solution.
Dr. Phelps
Published May, 2010
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