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The question was submitted 07/12/2007

Subject: SEX DRIVE AND MEDS

Hello
I am a middle aged female who has been on anti dep medication Dothiepin @ 300mg which is augmented by Lithium. My depression is now under control and I am feeling well. However, my lack of any interest in sex with partner for a long time (since the beginning of the year) concerns me. I would have hoped with feeling better it would have improved.

Is it the medication?
Is there some way to increase my libido medication wise?
What can I do?

Answer from DepNet

Thanks for writing to us. You have asked about an enormously important and very common problem. Information on specific medications and medication combinations needs to come from your treating doctor and/or directly from the company that manufactures the medications. We will give more general information and guidance on how to approach the issues you describe.

Reasons for loss of interest in sex
There are many reasons why someone who is, or has recently been, depressed might experience a loss of interest in sex. This will obviously be different for each person, as every individual is different and every relationship is different. Reasons include:

• The depression itself, as loss of libido is a very common symptom.
• The medications used to treat the depression. All antidepressants have the potential to diminish sexual interest and/or sexual pleasure and/or sexual drive and/or sexual performance, for both men and women. Obviously this will vary greatly between people and many people experience difficulty with some medications and not with others.
• Medication interactions: the more medications that someone is taking (both for the depression and for other medical conditions), the greater the chance that there can be problems. Sexual dysfunction can be due to one of them or can be due to a combination. Medications for many conditions can interfere with sexual function.
• Other things being used, the most common of which is alcohol, which can be a powerful depressor of sexual performance. But other substances can do the same, including many over the counter, alternative, herbal and illicit substances (such as cannabis).
• Issues in the relationship that may be as a result of the depression or may have been a problem before the depression. Often a depression can highlight problems in relationships, and this might be evident as sexual difficulties.
• Medical issues that might be unrelated to the depression or to its treatment, such as complications of diabetes, high blood pressure and other conditions.
• Other life issues that might be unrelated to the depression or to its treatment, such as a change in personal circumstances. This could include a change in work hours for one partner, the birth of a child or going back to work after time off while unwell, all of which can have an impact on sexual relationships.

How to treat a loss of interest in sex
The treatment will obviously depend on the cause. So the most important thing is to discuss it with the people involved: your partner and your treating clinicians (your local doctor, your psychiatrist and/or your psychologist). If you have only been treated by a local doctor, this might be a time to get an opinion from a specialist, if the problem does not resolve as expected. You may also find that you just need a bit more time after your mood has improved, before everything about you returns to normal. That is not to say, though, that you should overlook the problem – sexual enjoyment is very important to relationships and to a sense of personal well-being.

Medications are certainly a very common cause for sexual dysfunction, but it is important to think widely, to be sure that you do not overlook other possible causes.

The answer was published on DepNet 17/12/2007