Antidepressants can significantly improve many people’s lives, but there’s often a downside. Research indicates that between 25% and 80% of individuals on these medications experience some sort of sexual side effect.
However, there is a glimmer of hope. Early studies suggest that a new tool might help patients feel better while preserving their sex life.
There has been documentation of sexual dysfunction caused by antidepressants since the 1960s. Yet, until now, there hasn’t been a reliable way to predict sexual issues like libido, arousal, and orgasm before starting treatment.
That could change thanks to a brain test that indirectly measures serotonin levels, a neurotransmitter linked to libido, mood, appetite, and more.
This innovative test is set to be detailed in a study presented at the 38th ECNP Congress in Amsterdam. As it stands, the research is still an abstract and awaits peer review before being published.
If these findings hold up in larger studies, they could lead to a more focused approach in treating depression, according to lead researcher Dr. Kristian Jensen.
This testing could assist doctors in choosing medications that minimize the chances of sexual side effects in those who are most at risk, said Jensen, a doctor and researcher at Copenhagen University Hospital.
The noninvasive testing method involves an electroencephalogram (EEG), which places small electrodes on the scalp to monitor brain activity.
The technique measures a specific biomarker, Loudness Dependence of Auditory Evoked Potentials (LDAEP), which reflects the brain’s electrical responses to sound. Serotonin plays a crucial role in how the brain processes sensory information, including sound, Jensen explained.
A lower LDAEP indicates greater serotonin activity. Medications like escitalopram—common antidepressants that act as selective serotonin reuptake inhibitors (SSRIs)—limit reabsorption of serotonin, making more available to improve mood. However, this mechanism might also contribute to sexual dysfunction related to these drugs.
Previous studies have implied that the LDAEP marker could help predict how individuals with depression or anxiety respond to various psychiatric medications.
In the latest research with 90 participants suffering from major depressive disorder, lower LDAEP levels predicted orgasm dysfunction with an impressive 87% accuracy after eight weeks of escitalopram treatment.
Jensen and his team are currently launching a similar study involving 600 participants.
The LDAEP didn’t show a strong association with reduced libido but had a slight correlation with the severity of libido loss caused by antidepressants. Interestingly, participants’ baseline LDAEP levels didn’t align with their sexual function before treatment, suggesting that the medication itself led to the dysfunction.
Ultimately, the approach described by Jensen and his colleagues could enhance treatment adherence and improve quality of life. However, a larger study with more male participants is needed for accurate assessment of issues like erectile dysfunction.
Participants in the study were unmedicated prior to treatment, averaging 27 years old and primarily female. To gauge LDAEP, researchers played sounds at various volumes while measuring brain activity—an easy, 30-minute, non-invasive process. Although not widely available yet, this could change if the test meets expectations.
While the research is still in its early stages, it holds promise, according to Dr. Josef Witt-Doerring, a psychiatrist not involved in the study. He specializes in helping patients manage withdrawal from psychiatric medications.
Still, there are caveats. Dr. Sameer Jauhar, a psychiatrist at Imperial College London, pointed out that LDAEP measures aren’t direct indicators of serotonin activity.
He explained that conventional methods measure neurotransmitter levels through molecular imaging like PET scans, which, while accurate, are invasive and cost-prohibitive. However, Jensen noted that past studies have indicated a link between LDAEP and serotonin levels.
Jauhar also mentioned the need for careful validation of predictive accuracy in larger peer-reviewed studies. Ideally, a placebo-controlled study would also help clarify findings.
Antidepressants and Sexual Function
Currently, at least 11.4% of adults in the U.S. are taking antidepressants for depression alone. Many others use them for various mental health issues like anxiety, PTSD, and more.
The mechanics behind sexual dysfunction tied to antidepressants involve neurotransmitters, blood flow, and muscles—factors all governed by the brain.
Increased blood flow to the genitalia is essential for physical arousal and orgasm, according to Dr. Lauren Streicher. Anything that restricts this flow can inhibit these functions, and SSRIs may bind to certain receptors that control blood vessel constriction and dilation, potentially causing issues.
Interestingly, not everyone on these medications experiences sexual dysfunction, even when serotonin levels are high. Genetics might play a role in why some individuals are more susceptible to side effects.
Among the vast number of antidepressant users, a small percentage experience prolonged sexual side effects, sometimes lasting years after discontinuation—a phenomenon known as post-SSRI sexual dysfunction (PSSD). Although not formally recognized, PSSD often comes with emotional and physical impairments.
Witt-Doerring noted that while we can’t yet predict who is likely to develop PSSD, understanding serotonin’s role could help reduce this risk.
The difficulty in forecasting antidepressant-related dysfunction is largely due to a lack of research rather than past attempts, he said.
“It’s surprising someone is finally digging into this,” he added, acknowledging the public health importance but honesty about the motivations behind research.
Jauhar believes the new findings should motivate further studies into these common side effects.
Given the widespread nature of antidepressant-related sexual dysfunction, plus the struggles some individuals face with these drugs, this new line of research may eventually lead to better predictive measures regarding drug effectiveness and potential side effects.
Some people choose to counteract sexual dysfunction by switching to bupropion, which boosts dopamine levels rather than serotonin.
If you’re already experiencing sexual issues on an antidepressant, it’s essential to work closely with your healthcare provider. They may opt for a wait-and-see approach or consider medication adjustments if side effects persist.
Sometimes, doctors may add another medication to help relieve sexual dysfunction. Common medications like sildenafil are often prescribed to enhance blood flow and muscle relaxation, potentially offsetting the constriction caused by elevated serotonin levels.
