More than 300 drugs have sexual dysfunction as side effects, and those that treat depressive disorders are among those that cause the greatest damage.
In an auditorium full of family doctors, when psychiatrist Ángel Luis Montejo asks how many of them ask their patients about their sex lives, barely one in five raises their hand. Due to shame, taboos, lack of training or knowledge, there is very little talk about sex in health centers. And, what’s worse, many times the recipes will make your intimate life worse. “We are the largest purveyors of sexual dysfunction,” Montejo says.
More than 300 commonly used drugs have sex-related problems as a side effect: loss of appetite, impotence, difficulty achieving orgasm, vaginal dryness. “If you prescribe more than two a day to a patient, it’s wrong, it’s not done,” reproached this psychiatrist specializing in sexuality in a speech at the national congress of the Spanish Society of General Practitioners (Semergen), at which EL PAÍS He came invited by the organization.
The title of the conference was explicit: Sex, drugs and depression. Because medications to treat some mental health problems are among those that cause the most sexual dysfunction. Antidepressants can cause these types of side effects in more than half of users, although the proportion varies greatly depending on the active ingredient. And Spain is the fourth largest consumer of these drugs among developed countries, with 98.4 daily doses of antidepressants per 1,000 inhabitants. According to data from the Organization for Economic Co-operation and Development (OECD), only Portugal (150), Canada (134) and Sweden (114) surpass it.
A study by the Ministry of Health reveals that 15% of women and 6% of men have at least one container of antidepressants at home (more than four million people), a figure which coincides with the prevalence estimates of this pathology: three times more frequent in women than in men.
The side effects, beyond the peculiarities of each sex, are similar in both: a third of patients who notice sexual problems with the treatment abandon it, which is highly undesirable in this type of pharmacological therapies. And these dysfunctions can have repercussions on mental pathology.
Carlos – a fictitious name for a 43-year-old man – has experienced these side effects twice in his life. The first, when he was around 25 years old: he began to experience panic attacks, tachycardia, sweating and an atrocious fear of death. He began seeing a psychologist and discovered he suffered from depression. “It’s not being sad, it’s something else, it’s a feeling that prevents you from leading a normal life, that takes away your desire for everything,” he clarifies. He was referred to a psychiatrist, who prescribed antidepressants. “The drop in libido was total. Absolute lack of appetite. I didn’t even have an erection during the six months of treatment, I had no desire,” he recalls.
“And what do we do when we are informed of this problem?” asked Montejo. “Most doctors tell patients that well, let’s continue and see if the problem goes away. And it is not taken away from him.” The psychiatrist assures that therapeutic strategies exist for these cases, and that doing nothing cannot be done. He recommends trying to lower the dosage of the drugs that cause this problem or, if possible, change them.
The ones most associated with sexual problems are serotonergic, those that affect serotonin receptors, a neurotransmitter whose low levels are associated with depression. This is a group of widely used drugs that can cause these dysfunctions in more than 50% of patients. “When you add serotonin, the desire goes away, and when the desire goes away you can’t fall in love,” Montejo said.
When Carlos told the psychiatrist about these problems, he “didn’t exactly care.” “
To avoid this, the psychiatrist recommends that doctors try therapeutic alternatives that have shown much fewer side effects in this regard, such as those that act on presynaptic receptors, which are those responsible for regulating the release of neurotransmitters before the signal reaches the next neuron . , modulating the amount of serotonin released and thus allowing greater control over side effects, such as sexual dysfunction, without compromising the treatment of depression.
Not only is it advisable for people suffering from depression to maintain a good sex life, but it can also be a protective element to avoid developing these types of problems. Among the many scientifically proven benefits of sex, one is improved sleep. “Prescribe less lorazepam and have more sex, they will sleep happier, it will improve stress and mood,” Montero said.
The list continues: “Regulates menstrual rhythm, improves dysmenorrhea and has an analgesic effect. And not just coital insertion, a hug can already have some of these effects. Sex improves physical and mental fitness and the ratio of BDNF, a growth factor that causes the growth of new neurons in the hippocampus. “If someone has poor sexual activity and is embarrassed, they should tell their partner that their doctor told them their hippocampus is a mess.”
Francisca Molero, president of the Spanish Federation of Sexology Societies, emphasizes that sexual problems and mental health are deeply linked and that the anxiety generated by the anticipation of failure can aggravate the dysfunction. “When I have a sexual problem and I am aware of it, it gets into my head, and when I have relationships I don’t disconnect, the sexual response doesn’t flow and the arousal is blocked.” This not only affects your relationship with your partner, but also your sexual desire, which is inhibited by constant worry.
To break this cycle, Molero advocates a biopsychosocial approach. He explains that while it’s not always possible to change medications that cause sexual dysfunction – such as antidepressants, which “decrease desire and lengthen the time until orgasm is achieved” – it is possible to offer tools to improve sexual abilities. “If the person focuses on their own pleasure and learns to manage their sexual response, this blocked cycle can be broken,” he says.
Depression and sexual dysfunction do not have a one-way relationship. If the former increase intimate problems by 50% to 70%, the latter increase the probability of suffering from depressive disorders by between 130% and 200%, according to studies presented by Verónica Olmo, coordinator of the Semergen Mental Health working group.
The role of primary care
Olmo said family medicine is the first step in ensuring patients’ sexual health, which he also acknowledged is rarely done. The collapse of Primary Care does not help, which due to the pandemic suffered a huge increase in users (which continued even afterwards), combined with a shortage of professionals in this specialty.
These should not be excuses. “Sexuality is another aspect of health, and more than 50% of the population can suffer from sexual dysfunction throughout their lives,” argued Olmo, who invited colleagues to remove the taboo that many of the same GPs have when they talk about this topic with their patients. “There are moral and cultural barriers, an emotional component, multicausality, little pre- and post-graduate training in sexology, these are
And precisely in the approach to depressed people, sex takes on particular importance for all of the above. ”Patients should be asked at least two questions: what their sexual life was like before starting treatment, and whether it meets expectations on all levels, including sexual, and not only for that person, but also for their partner. ” family doctor.
Molero assures that with ”basic training on sexuality”, general practitioners could resolve “80% of their patients’ sexual dysfunctions: “Just as they can give notions of nutrition and physical exercise, there is also a methodology for sexual aspect, which we have been working on for more than 30 years.”
The problem of drugs and sexual problems is not new, but the approach in many consultations does not seem to have advanced much. The lyrics of this song by Joaquín Sabina are almost 40 years old: “Hey, doctor / Give me back the excitement / I haven’t had an erection for five months / I even joined the gym / But they didn’t cure me / Hey, doctor / All the members bloated me / Except the manly one / Hey, doctor / Acupuncture failed this time / Don’t pay your bills? / Leave me as I was, please.” Pablo Linde (EP)
What are the key connections between mental health and sexual health that doctors should consider during consultations?
Ents. He emphasized the importance of addressing sexual health openly during consultations, as it is often intertwined with mental health issues like depression.
Family doctors are in a unique position to create an environment where patients feel safe to discuss their sexual problems and mental health concerns. Olmo urged them to take the initiative to ask about sexual health during routine check-ups, rather than waiting for patients to bring it up themselves.
The relationship between mental health and sexual function is complex, and understanding it can lead to better outcomes for treatment. Addressing sexual dysfunction, especially when it arises as a side effect of medications like antidepressants, should be a priority rather than a taboo. GPs should consider holistic treatment approaches that include adjustments in medication, referrals to specialists, and discussions about lifestyle factors that could improve both mental and sexual health.
Ultimately, tackling the issue of sexual dysfunction requires a cultural shift in how healthcare providers and society view sexuality. By promoting open communication and providing comprehensive care, medical professionals can help alleviate the burden of both sexual dysfunction and mental health issues, leading to a better quality of life for patients.