Often people taking antidepressants - or really any drug - have to balance side effects versus benefit overall. Those crippled by depression and/or anxiety may be willing to give up a few things to dispel the gray clouds. For example, sex.
Doctors in a study published in JAMA estimate antidepressant treatment-associated sexual dysfunction occurs in 30 percent to 70 percent of people treated for major depression. Also, women experience major depressive disorder at nearly double the rate of men and also experience greater subsequent sexual dysfunction.
There hasn't been a randomized controlled trial to demonstrate an effective treatment for women experiencing sexual dysfunction from antidepressant drugs, the authors note. And the dysfunction can result in premature medication discontinuation. So, naturally, a big pharma with flagging drug sales of a sexual dysfunction drug sponsored (via a research grant) a small study to evaluate whether the drug can help premenopausal women on antidepressants. (And of course, big pharma also markets antidepressants.)
Thankfully the JAMA article is free.
An 8-week trial (prospective, parallel-group, randomized, double-blind, placebo-controlled) included 98 premenopausal women "whose major depression was remitted by SRIs but who were also experiencing sexual dysfunction." The participants reported disturbances in desire (87.8 percent), subjective arousal (80.6 percent), lubrication (79.6 percent), orgasm delay (98.7 percent) and other difficulties (23.6 percent).
Clinically, 73 percent of women taking placebo compared with 28 percent of women taking Viagra reported no improvement with treatment. The authors made several interesting points in the discussion; in particular:
"Secondary efficacy measures revealed improved orgasm delay with sildenafil treatment, which is considered a central feature of SRI-associated sexual dysfunction. Orgasm function has received far less attention than sexual arousal, perhaps due to erectile dysfunction being the only FDA indication and primary marketing focus for selective phosphodiesterase type 5 inhibitors."
"This study may not be generalizable to women who did not meet the criteria of this study. ... The limitation of the trial to 8 weeks is also a consideration and it is unknown whether women would be willing to continue treatment over time."
Neither point was made in the general lay press stories (of which, as you'd expect, there are many).
In a somewhat related story, Scientific American featured an article by Adam Marcus, noting that striped bass exposed to Prozac (Eli Lilly) shun food and become easier prey.
A study found that "hybrid striped bass exposed to the antidepressant fluoxetine (the generic name for Eli Lilly's Prozac) were markedly less interested in feeding than other fish. The more fluoxetine ingested, the less the appetite. The fish also did things that could lead to life-shortening events—like failing to take usual precautions around predators and making them easier prey."
The fish exhibited "remarkably un-basslike" behavior, "staying at the top of the tank with their dorsal fin above the waterline or tilting to a vertical position. Such behavior in the wild could make a bass an easy target for a hungry predator."
Hmm. Taking antidepressants makes you happy and thin - something our society suggests generally attracts potential mates - but women want sex less. So, take Viagra and you'll want sex more. However, taking antidepressants makes you easier prey (if you're a fish, anyway). I see a lot of lawsuits in the future. "I swear, Judge, she was sitting there at the bar with her dorsal fin tilted vertically! What else was I supposed to think?"
Or you could just eat watermelon.