Herbals For Antidepressant-Induced Sexual Dysfunction

Antidepressant-induced sexual dysfunction affects 30% to 70% of the more than 12 million Americans treated annually with antidepressants. Since 90% of patients with antidepressant-induced sexual dysfunction discontinue use of their medication prematurely due to the adverse effects, antidepressant-induced sexual dysfunction is associated with increased relapse rates of major depressive disorder, and resultant morbidity and mortality. The seriousness of this should not be dismissed by clinicians, cautioned Christina M. Dording, MD, at a meeting on natural remedies for psychiatric disorders sponsored by Harvard Medical School and Massachusetts General Hospital.

Dr. Dording encouraged physicians to question patients about sexual functioning and explore solutions to the problem. Although augmenting existing antidepressant treatment with is the current standard of care, "The problem - is that there is a large patient population that is excluded from treatment, since sildenafil is contraindicated in cardiac patients who are being treated with nitrates,- Dr. Dording noted. These patients may benefit from herbal remedies for sexual problems caused by antidepressants, she suggested.

Other populations who should consider herbs are those patients for whom Viagra has been ineffective or who have discontinued treatment with Viagra due to adverse effects such as headache, flushing, and changes in color perception. Additionally, there are patients who are reluctant to take additional pharmaceutical agents and are more comfortable with natural remedies. "They feel that with their antidepressant therapy, they are taking enough medication already," said Dr. Dording, a psychiatrist on staff at the Depression Clinical Research Program of Massachusetts General Hospital in Boston.

Yohimbine and ginseng are Dr. Dording's first choices of herbal treatment for erectile dysfunction. "Given the literature available, these seem to be the most studied and effective remedies," she said, adding that treatment is highly individualized and will depend on the patient's reasons for seeking alternatives, and on his clinical history.

Yohimbine

Yohimbine has been approved by the Food and Drug Administration for the treatment of erectile dysfunction. Studies of yohimbine, an alkaloid derived from the bark of the Central African tree Coryanthe johimbe, have shown it to be significantly superior to placebo in the treatment of erectile dysfunction. Adverse effects can include agitation and anxiety, headaches, and sweating.

Yohimbine can be an excellent choice for men who are seeking a natural alternative to Viagra for reasons of personal preference or lack of medication efficacy, Dr. Dording advised. However, it is contraindicated in those with a history of cardiac conditions, as it increases adrenergic flow. And because yohimbine has been associated with panic attacks, it should also be avoided in psychiatric patients with a history of panic disorders.

Findings concerning use of yohimbine are unclear, Dr. Dording noted. "I recommend a dosage of 5 mg, three times daily," she said.

Ginseng

Both American ginseng (Panax qinquefolium) and Asian ginseng (Panax ginseng) have been shown to enhance libido and arousal in male rats and mice. Results from human studies are also promising, Dr. Dording noted. She cited a double-blind crossover study by Hong et al of men with erectile dysfunction. After eight weeks of treatment, the group treated with ginseng showed significant improvement in scores of erectile function, sexual desire, and intercourse satisfaction, in contrast to the placebo group.

Some of the adverse effects of ginseng include hypertension, nervousness, insomnia, and headache. "Though not an absolute contraindication, there is a theoretical risk in using ginseng for patients with certain cardiac problems, so they should check with their primary care physician before starting therapy with ginseng," Dr. Dording added. She recommended a dosage of 900 mg of ginseng, three times daily.

Other Natural Remedies

The herbs ginkgo biloba and maca root have also been studied for their effects on erectile dysfunction. The evidence is weaker to support the use of these agents, Dr. Dording noted. However, she added, maca appears to have no downside. "The people in Central and South America use maca root liberally in cooking, they sprinkle it in their cereal, and they use it as a beverage flavoring. It appears to be safe, although this has not yet been clinically proven in studies" she said.

Further Investigation Required

Herbal remedies may provide safe and efficacious alternatives for those who cannot tolerate , but "we need many more double-blind, placebo-controlled trials," Dr. Dording acknowledged. Additionally, psychiatrists need to be proactive in investigating whether patients on antidepressants are experiencing sexual dysfunction. Dr. Dording cited a poll of 500 American adults that showed that 71% of participants did not initiate discussion of erectile dysfunction with their physician because they thought clinicians would dismiss sexual concerns, and 76% thought there would be no medical treatment. "You need to directly question patients and tell them that there are treatments available," she said.

Such discussions can cover conventional as well as herbal agents, Dr. Dording noted. However, she does not recommend adding an herbal remedy to treatment with (Viagra) sildenafil, because there may be drug/herb interactions. "If you don't get a response from sildenafil, then you can try something else, and if that doesn't work, then try something else," she advised.