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Before you mainline yet another dose of a potent herb or drug (which, too, may carry side effects), most psychiatrists suggest one of the following strategies to help stoke your libido. Don't try the following at home, kids, until you discuss it with your physician.

Also Today Prozac indignation How a little-known Harvard clinician needled sleeping giant Eli Lilly By Craig Offman At peace with Prozac The drug was my salvation. Does that make me a spiritual sloth? By Kelly Luker

Plan a drug-free holiday. For example, go off your SSRI Thursday through Sunday and then attempt sex (even wild sex!) Sunday night. This may work with Paxil, Zoloft, Celexa or Effexor, but it won't if you're taking Prozac, which stays in your system for a longer time than the other drugs. Drug half-life is the time it takes for the pharmaceutical to decrease by half of its original dose in your blood stream. Prozac's half-life is about a week; Paxil's and Zoloft take about a day. The drug-free holiday strategy is a gamble. Many users don't want to risk being off their SSRI, even for a day.

Lower your dosage. The standard daily dose of Prozac, for instance, is 20 mgs. Reduce it to 10 mgs., by either getting a new prescription or (the less expensive way) by taking a 20-mg. capsule once every other day. This works especially well with Prozac, precisely because its half-life is so long; results with other SSRIs may be mixed.

Switch antidepressants. Wellbutrin, Remeron, Effexor, Luvox, Celexa, Serzone and Desyrel may be less likely to destroy libido but, for many, aren't as effective in combating depression as Prozac, Paxil or Zoloft. (Interestingly, the smoking-cessation drug, Zyban, is the exact same formula as Wellbutrin in a smaller dose.)

Wait. Give your body time to compensate for the rush of serotonin that bathes the delicate receptor tissues of the brain. Some or most of your sex drive may eventually return. Some people, like Holly, develop tolerance to the sexual side effects and eventually bounce back.

If you are able to maintain your composure and return to your sexual equilibrium after trying the above, read no further. If not, some additional gambits: The drug yohimbine has shown to reverse the sexual side effects of SSRIs, says M.J. Gitlin, a psychiatrist at UCLA. Yohimbe, an African bark, is available over the counter; your physician will have to write a script for yohimbine, a pharmaceutical agent. It is a non-hormonal drug, in pill form, designed to decrease the outflow of blood from the penile tissue. Yohimbe chewing gum is available in some health food stores. One patient reported to his physician that he chewed 10 to 15 pieces immediately before he "had an incredible sexual time with his girlfriend."

Some physicians suggest taking a half-tab to one tab (5.4 mg. each) of the pill an hour or so before the "event." Beware, though, yohimbine can produce insomnia, already a side effect for many people on SSRIs.

The herb ginkgo biloba may also work. Alan Jay Cohen, a psychiatrist at the University of California at San Francisco, did a study on ginkgo-tree leaf extracts in which he reported that 86 percent of patients who took two 60-120-mg. capsules twice a day reported substantial improvement in their sexual function, with no side effects. Cohen says that ginkgo biloba restored the blood flow to the genitalia often blocked by the serotonin-enhancing drugs. In the business, ginkgo biloba is called a vasodilating agent. The popular prescription drug, Viagra, does much of the same.

The key issue is that the SSRI-related drop in libido is related to dopamine down-regulation. Some shrinks suggest Ritalin (methylphenidate) as an antidote for sexual dysfunction. Methylphenidate and Symmetrel (amantadine) trigger dopamine. Others prescribe Periactin (cyproheptadine) to be taken several hours before sex. Another option is Buspar (buspirone), administered concurrently with the SSRI, to get sexual responsiveness back.

Clearly, what worries some physicians and positively terrifies Eli Lilly and Company, the maker of Prozac, is that such onerous side effects will cause people to abandon the drug. In 1998, Lilly spent more than $95 million on promoting Prozac, which put the drug on a list of the 10 most-promoted pharmaceuticals in the U.S., and made it the list's only antidepressant.

Lilly ostensibly wants to make a last-ditch try to hook as many new customers on Prozac as possible. Lilly's Prozac patents expire in 2004, when drugmakers will be able to formulate a generic version at prices 60 percent to 80 percent less than what Prozac goes for now. Lilly, though, has something else up its lab-coat sleeve. It plans to license a variant of Prozac, called R-fluoxetine, and that patent doesn't expire until 2015. Lilly is touting R-fluoxetine, saying it has fewer severe impotence side effects and won't keep people up nights.

When I asked Lilly flack Blair Austin about worries that Prozac takers' loss of sexual interest will cut into the company's business, this is what I got: "It is difficult to determine the level of impact by SSRIs on sexual function and interest. Some patients do experience problems with sexual functioning during treatment with SSRIs; others have shown improvement during SSRI therapy." So much for going out on a limb.

If all else fails, here's another idea: Three psychiatrists wrote in the Journal of Clinical Psychiatry that granisetron (a sexual stimulant in rats) works great in men and women, if taken one hour before sex. But the drug, available as Kytril (and labeled for chemotherapy-related nausea control), costs $50 a pill. That means it would have to be a very hot date.
salon.com | May 17, 2000

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