One of the most common reasons patient's stop taking their medications is due to side-effects. A particularly troubling consequence of many antidepressants and anti-anxiety meds are the effects on sexual function, with some studies estimating up to an 80% occurance. Whether a decrease in libido, arousal, painful intercourse, or lowered orgasmic and erectile capability, this not only has a profound effect on the individual, but on the satisfaction of the couple as well.

Unfortunately, people often discontinue treatments which are very helpful otherwise due to this concern, and feel they must "chose" between their mental well-being and their sexual vitality. The worst case scenario in this choice is symptom relapse.

Although as physicians we have several western treatment options to ameliorate these effects, they don’t always work (or, even worse, they might have their own side effects). It’s led me to be curious about what other options might be "in the pipeline", and I was enthused to find that some that were particularly enticing.

Acupuncture

A recent publication in the Journal of Alternative and Complementary Medicine (Volume 19, Number 11 2013) suggests that activation of certain regions through acupuncture might alleviate sexual dysfunction caused by SSRI’s.

A mix of twenty-nine men and women with no history of sexual difficulty prior to initiation of SSRI’s or SNRI’s were offered 12 sessions of acupuncture by a professional, with needles gently inserted into certain regions (Kidney 3, Governing Vessel 4, Urinary Bladder 23, with Heart 7 and Pericardium 6) commonly associated with sexual dysfunction based on Traditional Chinese Medicine literature.

The outcome of this study revealed effectiveness in both men and women, although the findings for men appeared a bit more pronounced. Female participants noted improvement in libido and lubrication. Men reported improvements in all aspects of sexual functioning, as well as improvement of mood and anxiety.

Cardiovascular Exercise

Following up on the limitations of a prior study in 2012 where researchers discovered that 20 minutes of cardiovascular exercise at 80% max heart rate increased genital arousal of women experiencing sexual side effects as a result of SSRI’s and SNRI’s, the authors released results from their new trial in the journal of Depression and Anxiety (2014). Now, they consider whether 30 minutes of moderately intense exercise (treadmill at 70-85% maximal heart rate) might mitigate sexual side effects from SSRI’s and SNRI’s in women.

Fifty-two women, average age 32, were selected to participate, based on “a change in their sexual function after they started an antidepressant”. Operating under the premise that SSRI’s and SNRI’s can depress sympathetic nervous system activity- ultimately leading to decreased vaginal blood flow (and consequently less genital arousal), it was shown that vigorous exercise for 30 minutes three times a week could increase sexual desire, especially if the sexual “activity” (consensual sex or masturbation) occurred shortly after (within 30 minutes) exercise.

Another notable finding: a key component of behavioral activation- simply scheduling a pleasurable activity (in this case, sex) improved orgasm. Increased desire appear to result from scheduling exercise before sex.