Most of the people who take antidepressant medication experience some form of sexual side effects. Out of the several types of antidepressants, it is the SSRIs that are associated with the highest incidence of sexual dysfunction. Nevertheless, the severity of the condition varies among individuals, and even in some cases, it is probable that some people are unaware that they are suffering from it. However, in Allen’s case he conscious of the adverse effects that his antidepressant medication, paroxetine was exerting on him.
Allen is suffering from antidepressant-induced sexual dysfunction. As much as impotence and delayed ejaculation can be a symptom of major depression; it can also be a side effect for the medication used to treat this illness, which in this case, is paroxetine. Paroxetine is part of a drug family referred to as SSRIs (selective serotonin reuptake inhibitors). By increasing the serotonin levels in the body, an individual experience a feeling of calmness and less anxiety.
While this medication has proven effective in alleviating Allen’s depressive and anxiety symptoms, it has affected the serotonin receptors on the spinal cord hence inhibiting orgasms, spinal reflexes and ejaculation. Empirical literature indicates that the sexual side effects of SSRIs are quite common, as 50% of individuals taking them are at risk of developing sexual dysfunction (Ingersol & Rak, 2016). Sexuality seems to be a critical aspect of healthy life to Allen; therefore, experience such side effects is bothersome and embarrassing. Consequentially, this might lead to him stopping to take the drug, and in turn, this will revert his depressive and anxiety symptoms. It is essential to communicate with Allen that prescribing professionals can do a lot to decrease this side effect.
There are multiple approaches to treating this side effect, and from a prescribing professional perspective, these can include switching Allen to another medication or reducing the dosage. With regards to lowering the dosage, with the help of the psychiatrist, he can reduce the dosage of paroxetine; however, this should be closely monitored (Ingersol & Rak, 2016). On the other hand, in terms of switching to another medication, paroxetine is regarded as a second-generation antidepressant; therefore, it should be replaced with a third-generation antidepressant.
Third generations comprise drugs whose pharmacokinetics revolves around serotonin reuptake inhibition; however, they have better side effect profiles than their precursors. According to Ingersol and Rak (2016), the only antidepressants that do not have sexual dysfunction as a side effect include Wellbutrin/bupropion and Remeron/mirtazapine, which are the third generation.
Bupropion is a noradrenaline dopamine reuptake inhibitor. Research has shown that the drug effectively treats anxiety and major depression and has no negative impact on libido (Ingersol & Rak, 2016). It has also been reported to increase libido in some instances, as an “aphrodisiac”. It requires only one dose per day. On the other hand, mirtazapine is a serotonin-norepinephrine antagonist. It functions by increasing the norepinephrine and serotonin levels in the body by blocking specific autoreceptors so that the neurotransmitters bringing about depression are not secreted (Ingersol & Rak, 2016). Furthermore, the drug shows better efficacy when treating mixed anxiety and depression.
Wellbutrin/bupropion and Remeron/mirtazapine are the only alternative SSRIs that might prove useful in treating Allan’s major depression and anxiety (Ingersol & Rak, 2016). However, bupropion has potential side effects that might increase his blood pressure; hence, the psychiatrist needs to monitor his blood pressure while taking the medication. Nevertheless, it is a much better alternative as compared to mirtazapine. Bupropion is a third generation drug, hence it has a better side effect profile as compared to the second-generation SSRIs, it still has existent effects (Ingersol & Rak, 2016). These include gastrointestinal distress, insomnia, and treatment-emergent hypertension.
In conclusion, sexual dysfunction is a common, potentially distressing, adverse effect of SSRI medication. As a result, it has been associated with medication non-adherence, for instance, Allen had considered stopping to take his medication. Therefore, this suggests the need for therapists to notify clients on the potential side effects of various medication before prescribing them to patients. Additionally, the management of SSRI-induced sexual dysfunction dictates an individual approach, including reducing the dose, using an additional medication to treat the side effect or switching to an alternative antidepressant.
Reference
Ingersol, R. E., & Rak, C. F. (2016). Psychopharmacology for mental health professionals (2nd ed.). Cengage Publishing. Web.