Introduction:
A recent study raises a new issue with long-term antidepressant use, adding another reason for consumers to seek alternatives. The study, conducted by researchers at the University of Pisa, Italy, found that antidepressant drugs affected men and women differently in the areas of feelings of love and sexual intimacy – but, the bottom line is that these drugs adversely affected feelings of commitment and attachment towards their partners in both men and women. This new study raises another question on the real value of antidepressant drugs on quality of life issues.
Background Data:
Since the introduction of Prozac in 1987, antidepressants known as selective serotonin reuptake inhibitors (SSRIs), are now among the world’s most widely prescribed medications, with sales in the U.S alone of about $20 billion per year. These antidepressants also include brands like Zoloft, Paxil, Luvox, Celexa, and Lexapro.
In recent years, the side effects of these drugs, from weight gain and sexual dysfunction to suicidal behavior, have been better defined. In addition, there is growing evidence that in most studies, there is really no difference in efficacy between the placebo and the drug in all but the most severe cases. The presence of unwanted side effects coupled with little real benefit makes these drugs less than an ideal approach.
Approximately 20% of patients experience nausea; 20% headaches; 15% anxiety and nervousness; 14% insomnia; 12% drowsiness; 12% diarrhea; 9.5% dry mouth; 9% loss of appetite; 8% sweating and tremor; and 3% rash. SSRIs also definitely inhibit sexual function. In studies where sexual side effects were thoroughly evaluated, 43% of men and women taking SSRIs reported loss of libido or diminished sexual response.
New Data:
The new study utilized the Sex-Attachment-Love Test (SALT) questionnaire in nearly 200 adults with mild or moderate depression taking either serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs). Questions on the SALT questionnaire are divided into three groups under the sex, attachment, or love domains.
All patients had a diagnosis of mild or moderate depression, had been taking just one antidepressant for at least 6 months, and were involved in what they considered “a loving relationship” (mean length, 150 months) before they had started antidepressant treatment. In addition, 60% of the participants were married, 24% lived with a partner, and 15% lived alone. Also, 93% were heterosexual, and 7% were homosexual.
A total of 76 women and 33 men were taking an SSRI. The most commonly used was paroxetine (multiple brands), followed by escitalopram (Lexapro), citalopram (Celexa) and sertraline (Zoloft). A total of 48 women and 35 men were taking a TCA, with the most commonly used being clomipramine (Anafranil), followed by imipramine (multiple brands), amitriptyline (multiple brands), and trimipramine (Surmontil).
Results showed a significant impairment in sexual desire in women taking TCAs compared with the men, but the men taking SSRIs showed significant impairment in feelings of love, compared to women.
The researchers concluded that the SSRIs seemed to provoke more alterations of some emotional features than TCAs in men, while women seem to be ‘preserved’ by this side effect. The speculation is that since women often feel things deeper than men, SSRIs may not affect them as much in terms of feelings of love. But, there is no question that SSRIs led to impaired sexual desire and when examining specific items from the SALT, the investigators found that, overall, patients taking SSRIs had significantly more “less than before” answers than those taking TCAs to several attachment statements, including the following: “I feel at ease in sharing with my partner thoughts and feelings”, “I address my partner for advice or help”, and “I rely on my partner easily” (P = .001); and to the love statement, “I wish the love I feel for my partner would last forever”.
In general, the patients felt less committed to and more detached from the partner than before the beginning of the treatment. These results are extremely alarming given the importance of intimate relationships to quality of life.
Commentary:
The SSRI antidepressant drugs are thought to works by specifically inhibiting the re-uptake of serotonin at the nerve endings in the brain. As a result, more serotonin is likely to bind to receptor sites on brain cells and transmit the serotonin signal. Serotonin is a very important neurotransmitter derived from the amino acid tryptophan. It is the brain’s own natural antidepressant and tranquilizer. A decrease in serotonin function is thought to be a major cause of depression, anxiety, and insomnia.
Serotonin is not only important in controlling your moods and behavior, it also acts as a kind of chemical traffic cop that regulates the activity of many other neurotransmitters. The level of serotonin present in your brain can have a tremendous impact on how you think, feel, and behave.
Here are some non-drug approaches for depression:
- Psychological therapy has been shown to be as effective as antidepressant drugs in treating moderate depression.
- It is important to rule out the simple organic factors which are known to contribute to low serotonin levels, i.e., nutrient deficiency or excess, drugs (prescription, illicit, alcohol, caffeine, nicotine, etc.), hypoglycemia, consumption, hormonal derangement, allergy, and environmental factors.
- Depression is often a first or early manifestation of low thyroid function. Thyroid hormone appears to be necessary in the conversion of tryptophan to serotonin.
- Elimination of sugar and caffeine has been shown to produce significant benefits in clinical trials in patients with depression. This effect is due to improving the conversion of tryptophan to serotonin as well as other mechanisms.
- Increased participation in exercise, sports, and physical activities is strongly associated with decreased symptoms of anxiety, depression, and malaise indicating an association with higher serotonin levels.
- 5-Hydroxytryptophan (5-HTP) is the direct precursor to serotonin that is able to cross the blood brain barrier and raise brain serotonin levels. As a result, supplementing the diet with 5-HTP has been shown to produce significant benefits in conditions linked to low serotonin including depression, carbohydrate cravings, headaches, and fibromyalgia. The dosage should be started at 50 mg three times per day. If the response is inadequate after two weeks, the dosage can be increased to 100 mg three times per day. Be sure to use 5-HTP in enteric-coated capsules or tablets (pills prepared in a manner so that they will not dissolve in the stomach) significantly reduces the likelihood of nausea.
For more information, consult The Third Edition of the Encyclopedia of Natural Medicine.
Reference:
Marazziti D, Baroni, Dell’Osso L. Emotional blunting following long-term antidepressant treatment. Eur Neuropsychopharmacol. 2014;24(Suppl 2):S447
Dr. Michael Murray
11/4/2014
