Depression Symptoms Treatment

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Question. I was diagnosed with major depression and have taken several antidepressants that do not work. I have been taking Prozac for about a month and am experiencing a severe decrease in sex drive. I was informed that cyproheptadine, yohimbine, or bethanachol can help, but I can find no information about these medications. Can you tell me about their cost, method of action, side effects, dosage and success rate?

Answer. There are, to my knowledge, few controlled studies of these agents for the treatment of psychotropic-induced sexual dysfunction; mainly, we are dependent on small uncontrolled case reports. Thus, it is hard to speak of “success rates” in any meaningful way. A good reference is the paper by FM Jacobsen, ( J Clin Psychiatry 1992; 53:119-122), discussing the use of yohimbine for Prozac-induced sexual dysfunction. Jacobsen, in a noncontrolled study, found that up to 90% of patients improved. Yohimbine boosts levels of norepinephrine, a chemical needed for normal sexual function (as well as normal mood). It is usually well-tolerated, but can occasionally cause nausea, anxiety, insomnia, or urinary frequency.

Cyproheptadine is a medication that interferes with the chemical serotonin- which is precisely the chemical that Prozac boosts. Thus, while cyproheptadine can counteract Prozac-induced sexual side effects, it can also “undermine” the antidepressant effect of the Prozac (or similar antidepressants). Bethanechol boosts yet another chemical called acetylcholine (as you can tell, sexual function involves a delicate balance of several chemicals), and is sometimes helpful in sexual dysfunction – though not spectacularly so, in my experience.

Other options include adding either a small amount of bupropion (Wellbutrin, another antidepressant) or buspirone (BuSpar) to the Prozac; both of these agents are usually well-tolerated, and may help counteract the Prozac’s sexual side effects. Another option, of course, is to switch to an agent (such as Wellbutrin or Serzone) that is less likely to cause sexual problems in the first place – but these are all options that should be discussed thoroughly with your doctor. As far as costs go, I suggest you check with a couple of pharmacies in your area, since prices can vary considerably.