SexRx: Luvox and your sex life

by Karen Schroeder, MS, RD

Medication

Fluvoxamine

Commonly Used Brand Name

Luvox

What This Medication Is Most Often Prescribed For

Obsessive-compulsive disorder
Depression

How This Medication Works

Fluvoxamine is one of a class of drugs called selective serotonin reuptake inhibitors or SSRIs. These medications work by increasing the activity of the brain chemical serotonin, which helps regulate mood.

Other drugs of this class (SSRIs):

Sertraline (Zoloft)
Citalopram (Celexa)
Paroxetine (Paxil)
Fluoxetine (Prozac)

Possible Sexual Side Effects

Decreased sexual desire
Difficulty reaching orgasm
Impotence in men

How This Medication Can Affect Sexual Function

It is not yet clear how SSRIs affect sexual function. The effects are believed to be related to the increased levels of serotonin, which may affect sexual reflex centers in the central nervous system. In some reports, fluvoxamine was less likely to cause sexual side effects than other SSRIs.

Treatment options:

Wait it out

As you adjust to your new medication, the sexual side effects may go away.

Decrease the dosage

This tactic will work occasionally, but carries the risk of a relapse of the depression or disorder. Never change your dosage without checking with your doctor first.

Switch medications

Since the medical response to SSRIs and other drugs to treat these disorders can vary among people, a doctor will consider the severity of your depression or disorder as well as your response to the drug before switching to another. When switching is appropriate, your three main options are:

Bupropion (Wellbutrin) � this antidepressant medication does not affect serotonin. It is less likely than the commonly used SSRIs to cause sexual dysfunction and may actually have prosexual effects. However, it is not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorders.

Nefazodone (Serzone) � this drug does affect serotonin, but not in the same way as SSRIs. It can be used to treat depression and has been found to cause fewer sexual side effects. It's most troublesome adverse effect is sedation.

Mirtazapine (Remeron) � this drug is similar to nefazodone in its effect on depression and sexual function.
Try an antidote

This involves maintaining your current level of fluvoxamine, while adding a second medication to offset the sexual side effects. This option is generally less desirable since antidotes frequently have their own side effects and may adversely interact with the primary medication you are taking. Drugs that have shown some promise as antidotes are:

Bupropion (Wellbutrin) � not recommended for people with eating disorders, panic disorders, seizure disorders, or obsessive-compulsive disorders. Side effects include anxiety, delirium, myoclonus (irregular involuntary contraction of a muscle), uncontrolled hypertension, nausea, headache, dizziness, fatigue, constipation, diarrhea, drowsiness, and low blood pressure.

Sildenafil (Viagra) � commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, the expense of this drug may prohibit many patients from using it.

Amantadine (Symmetrel)� several case reports have shown amantadine to be an effective antidote for SSRI-related sexual dysfunction, however it has not yet been proven effective in a double-blind clinical study, the gold standard for drug efficacy.
Take a drug holiday

This involves taking your usual Thursday morning dose and then nothing again until noon on Sunday.

There is also a risk with this technique that you may feel well enough during the short drug holiday to discontinue your medication all together, which can lead to a relapse. Again, discuss this option with your doctor before trying it.

Consider herbal supplements

The efficacy of herbal supplements to treat the sexual side effects of SSRIs is not clear. There have not been any double-blind clinical studies, only case reports, some of which have shown positive effects and others that have shown no effects. Care should also be taken with herbal products because they are not strictly regulated, as drugs are. Two herbs commonly used to resolve the sexual dysfunction associated with SSRIs are:

Yohimbine
Ginkgo