Effects of Common AD/HD drugs on Sexuality

The following is a reprint of one of the handouts I provided at a presentation on ADHD and Sexuality in January. I have included it here for reference purposes!

Disclaimer: Though I have used the most scientifically accurate materials I can find in this resource, I am NOT a medical professional. Nothing contained here should be construed as medical advice. Please consult with your doctor about any side-effects of your medications and other questions about sexual function.

Stimulants: Stimulants can be a mixed bag when it comes to sex.
The positives:

• They can help us focus—on our partners, on our own physical sensations. Some people orgasm for the first time once they begin taking stimulants!
• They may increase desire and/or "libido," the ability to enjoy pleasure, and sense of well-being, all of which can contribute to enjoyment of sexual feelings.
• They may "increase stamina."

The possible negatives (Side effects for some but not others, in part dependent on the dose.):

• VAGINAL DRYNESS: Stimulants have “ alpha adrenergic agonist effects,” which, for some, may lead to common symptoms such as dry mouth. They also may lead to vaginal dryness and decreased lubrication in women. Vaginal dryness may lead to pain, decreased pleasure, the mistaken impression that a woman is not aroused, even when she is, and/or increased likelihood of vaginal tearing.
  

Interestingly, according to Kaplan and Sadock's Synopsis of Psychiatry, these same adrenergic effects which can cause sexual problems for some are also sometimes helpful in counteracting some of the sexual side effects of SSRI anti-depressants.

• DECREASED BLOOD FLOW: Stimulants also are vasoconstrictors, which means that genitals may not engorge with as much blood as the do when stimulants are not in someone's system. Translation: Men may need more stimulation to get an erect penis, may not get as “hard” as they are used to, may have decreased sensation, and/or may take longer to reach orgasm or ejaculation. (The latter may seem like a positive to some, a negative to others, and neither a positive nor a negative to others.) For women, reduced genital engorgement may mean decreased genital lubrication and/or sensation, and difficulty reaching orgasm.

To increase blood flow and/or decrease dryness you might try…

• Increase water intake.
• Use vaginal and/or anal moisturizers to moisten tissues. (No perfumes or petroleum products. Stick with organic, cold-pressed oils or another moisturizer designed for genital use.)
• Use lubricants for sex to decrease friction. (Water or silicone-based, or organic, cold-pressed, unscented food-quality oils. DO NOT use oil with latex condoms!)
• Increase level of arousal and desire before penetration.
• Do pelvic floor exercises regularly.
• Viagra (Will help with lubrication and engorgement, but sometimes not desire in women.)
• Hormones (may help with lubrication and/or desire)
• TALK TO YOUR DOCTOR! Symptoms may or may not be related to stimulant use, and some of these symptoms may indicate a more serious problem.
  

Anti-depressants: Anti-depressants, especially SSRIs and Tricyclics, are notorious for causing sexual side effects, such as decreased sexual desire, decreased ability to orgasm, decreased ability to ejaculate, and increased difficulty in getting and/or maintaining an erection. Some folks, however, report that decreased anxiety and depression lead to increased sexual drive and enjoyment. Your mileage, of course, may vary.

All information about antidepressants below, unless otherwise cited, is based on research contained in The Science of Orgasm (Komisaruk, Beyer-Flores, and Whipple, 2006):

• The worst offenders of the anti-depressants are Celexa and Paxil (both SSRIs), but all of the SSRIs and Tricyclics, plus Effexor (an Atypical), have strong negative effects on sexual functioning.
• Nardil (an MAOI) may have a moderate effect, but not as strong as some of the other antidepressants.
• The antidepressants which reportedly have no negative effect on sexual function are: Aurorex (an MAOI); Wellbutrin, Remeron, Serzone, Edronax and Desyrel (all Atypical); and BuSpar (Antagonist). (In fact, all of the Atypicals, other than Effexor, had no reported sexual side effects.)
• Bupropion is also associated with statistically significantly less sexual dysfunction than SSRIs, including orgasmic dysfunction*.
• Paxil (and possibly some other SSRIs) may damage sperm which may lead to male infertility, according to a recent statement by the American Society for Reproductive Medicine.
• St. John's Wort "does not seem to produce overt effects on sexual functioning."
• After folks have been on them a while, there is often spontaneous remission of sexual side-effects with MAOIs and SSRIs, but not Tricyclics. If you experience unwanted sexual-side effects, talk with your doctor about the most appropriate way to deal with your symptoms.

* Fava, M; Rush, J; Thase, ME, et al. 15 years of clinical experience with Bupropion HCL: From bupropion to Bupropion SR to Bupropion XL. Prim Care Companion. J Clin Psychiatry. 2005;7:106–13.