Jennifer’s complaint was that the antidepressant her doctor prescribed seemed to be causing problems in her sexual relationship. As many as 96% of women taking an SSRI (Selective Serotonin Reuptake Inhibitor - e.g., Prozac, Zoloft, Lexapro, etc.) or SNRI (Serotonin Norepinephrine Reuptake Inhibitor - e.g., Effexor, Pristiq, Cymbalta, etc.) experience negative sexual side effects from the medication.
- A lack of sexual desire,
- Problems with arousal (i.e., difficulty feeling aroused or becoming physically aroused evidenced by swelling and/or lubrication), or
- Difficulty achieving orgasm.
These sexual side effects tend to antagonize the depression by lowering overall life satisfaction, increasing feelings of being broken or abnormal, and increasing marital discord and dissatisfaction. If you and your husband are fighting more because you have lost interest in sex and he’s suggesting you’re “broken”, you definitely haven’t lightened the depression load.
Unfortunately, many of the interventions designed to combat the sexual side effects work poorly, making the antidepressant less effective, or causing additional side effects and problems. The result tends to be ongoing sexual frustration or a decrease in medication compliance.
“I don’t take [the antidepressant] all the time because it keeps me from having an orgasm,” was Jennifer’s solution. This is not a lasting solution, however, because these medications must be taken regularly to work effectively. Taking an antidepressant sporadically dramatically reduces its effectiveness. Thus, Jennifer was not getting the help needed from her antidepressant and was still having sexual problems.
A study recently published found support for an approach that might help counter some of the sexual side effects caused by these antidepressants — exercise.
For women with diagnosable sexual dysfunction, a regimen of 30 min of vigorous exercise 3×/week was sufficient to produce clinically relevant improvements in sexual function, particularly sexual desire. For maximal benefit, exercise should be scheduled to occur immediately prior to sexual activity. However, some benefit may be seen with exercise in general. (Lorenz, 2013, p.7)
The study was laid out fairly well. Researchers randomly divided 52 premenopausal women who complained of sexual side effects from their antidepressants (SSRIs and SNRIs) into two groups of 26. Both groups were instructed to spend three weeks where they had sex three times a week (up from the average of 1.37x per week before the trial). This was followed by three weeks where half the group exercised 3 times a week for 30 minutes (70%-85% maximum heart rate during mix of resistance and cardio exercise led by an exercise video) and engaged in sex “as soon as possible but no more than 30 min after the exercise video ends”. This was the experimental group. The other half participated in similar exercise by waited at least 6 hours after exercising to engage in sex, but still had sex 3 times per week (the control group). After three weeks, the groups switched places. Women who were already in an exercise routine were asked to add this on top of their current routine.
Sexual activity and functioning was assessed through a variety of instruments shown to be effective in the sex therapy field (i.e., diary, FSFI, SSS-W). Using this, 38 of the women had scores that showed enough sexual distress to be in a “clinical” category. This means the sexual effect they experienced from the antidepressant was high enough for us as sex therapy professionals to say it needs treatment.
For all women, exercise helped. Simply exercising increased sexual desire, whether they exercised right before sex or not. The effect was modest, but consistent. For women who were in the “clinical” category, moving the exercise to right before sex helped their overall sexual function.
An additional finding of the study came in prescribing sex. For the first three weeks of the study, the women began having sex 3 times per week (without changing anything else). This alone resulted in improved orgasmic function for all the women (whether they were in the clinical category or not).
The findings from the present study suggest engaging in sex may be sufficient to reduce antidepressant-related orgasm problems. It may be that committing to regular sexual activity breaks a pattern of avoidance established earlier in the antidepressant regimen, when side effects were more severe. (Lorenz, 2013, p.7)
Because exercise improves many other areas of mental and physical health, and has limited to no cost, even a modest impact may be a good investment.
So, if you are one of the many women who experience lower desire from your antidepressant, exercise might help. It might also be worth trying the exercise right before sex. If the antidepressant is causing problems with orgasm, you might try committing to more frequent sex.
If you try this yourself we’d love to hear about the results for you. You can report anonymously through this link - https://www.surveymonkey.com/s/D9VK9F6. If we receive comments we’ll post a follow-up listing some of the results.