Reader’s Question

I have been on antidepressants for more than 20 years. At present I am on 225 mg Effexor XL daily. For the last 10 years I have had no emotional feelings, nor do I have any sexual desires. I can’t even manage an impromptu hug or kiss, which is creating problems in my marriage which in turn causes me to be depressed, and so the vicious circle continues! Do you think by coming off the antidepressants my sexual desires would return, or should I consider asking my GP to prescribe another form of antidepressant?

– Last hope

Our Clinical Psychologist’s Reply

Let me start by saying I’m a psychologist, not a physician or psychiatrist. However, I do see several important issues in your question. First, a loss of emotional responsiveness and sexual interest is very common in antidepressant medications. Some people report a sense of emotional numbness, and while that’s an improvement over constant crying spells — it’s not an improvement if it continues for years. The symptoms you are experiencing are very real.

Second, we do have antidepressants that have fewer sexual side effects and less emotional numbing. We can also see improvement by lowering the dosage or adding another medication. In short, a medication change may be able to fix this.

Lastly, you mentioned that you would talk to your GP about your prescription. This is sometimes an issue. 85% of antidepressants are prescribed by nonpsychiatrists — typically general practice or OB/GYN physicians. Nonpsychiatric physicians often lack experience in using various meds or using meds in combinations. For this reason, you may want to obtain a consultation with a psychiatrist before you abruptly stop medication or even switch antidepressants. A psychiatrist is in the best position to know which meds have the fewest sexual and other side effects.

Most of all, don’t panic. This isn’t your last hope. You have multiple options from this point including discontinuing medication under supervision, reducing meds, changing medications, psychiatric consultation, adding meds, etc. It is very important that all medication activities be approved and monitored by a physician. Good luck as you prepare for this change.