— Anonymous St. John’s wort (Hypericum perforatum) is an herb, and 5-hydroxytryptophan (5-HTP) is a derivative of the amino acid tryptophan. Both are sold as dietary supplements and used by many people in an effort to ease depression. Research studies on these substances are mixed: For example, 5-HTP has not been proven to work for depression; however, for mild to moderate depression, studies have shown that taking St. John’s wort can be beneficial. In the case of major depression, though, two large research studies found that St. John’s wort worked no better than a placebo (sugar pill). Also, taking St. John’s wort can cause side effects in some people (including dry mouth, dizziness, anxiety, increased sensitivity to sunlight, and even sexual dysfunction). It can also affect the way the body metabolizes some medications. Before taking any supplement, you should ask your health-care provider to check for any potential drug interactions with medications you are currently taking. You should also ask if either St. John’s wort or 5-HTP is an appropriate alternative medication to improve your depression and anxiety. The loss of sex drive is a side effect often associated with a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), including Celexa (citalopram), Prozac (fluoxetine), and Zoloft (sertraline), among others. There are several ways to try to manage this very real problem, including:
waiting for a tolerance to the medication to develop, which can take up to several monthsreducing the dose of the antidepressant, if possibletaking a drug holiday — reducing or skipping the antidepressant over a weekend or some other set period of timeswitching to a different antidepressant with a lower reported incidence of sexual dysfunction, such as bupropion or mirtazapinefor men, adding a medication such as Viagra, which has been successfully used to treat SSRI-induced sexual dysfunction in men
You should discuss these options with your treating physician so that you know and understand the expected outcome. Your question is all too common with individuals on antidepressants. It also represents one of the challenges of taking any medication: maximizing the treatment benefits while minimizing the side effects. Lexapro falls into the category of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. This class of drugs has fewer side effects than older antidepressants, such as tricyclics (TCAs) or monoamine oxidase inhibitors (MAOIs). Unfortunately, sexual dysfunction is one of these side effects; it is reportedly the number-one reason that patients decide to discontinue taking SSRIs. In reassessing your situation, the first step is to talk to your physician. Discuss the possibilities of reducing your current dose of Lexapro to see if it helps with your sexual functioning, trying a different SSRI, or even switching to a serotonin-norepinephrine reuptake inhibitor (SNRI) to see how you respond to it. Most physicians admit that prescribing medications is as much art as science; as such, trial and error often plays a key role in finding the best “fit” for each individual. Under the guidance of your physician, another option might be to discontinue your antidepressant altogether and try another form of therapy. If you were to consider this, I would urge you to begin individual therapy to help monitor and manage your depression should it return. I would also recommend that you start exercising regularly if you do not already do so. Exercise has been shown to positively influence serotonin and can help ease mild to moderate depression. I hope that one of these options can help you find a balance between the necessary management of your depression and improved sexual functioning and satisfaction. Q3. I am taking mirtazapine. I do not like the side effects of this drug and want to stop taking it cold turkey. I feel like the doctors who put me on it have not been monitoring me appropriately, and therefore I’m taking matters into my own hands. I just want to stop this med. Are there any major withdrawal issues or other negative reactions to stopping it that I should be aware of? — Kari, Connecticut I’m sorry to hear that you feel that you need to take matters into your own hands — treatment with antidepressants goes best when the person taking the medication and their doctor are able to work as a team. Are you sure that it’s not worth it to try one more time to let your doctors know that you are unhappy with how you are feeling on this medication? For the record, mirtazapine (Remeron) — unlike some other antidepressant medications — is not known for being difficult to stop and generally does not require tapering off. The side effects that you do not like should disappear within a few days after you take the final dose of medication; anything after that is more likely to be a reflection of your condition than the medication. Q4. I’m battling the worst case of depression that I’ve ever had, and everyone I’ve talked to says I should be on medication. I’ve heard too many horror stories, though, about people on antidepressants experiencing changes in personality, gaining weight, or having other problems. Is there a safer alternative to antidepressants that I can try before going that route? Depression itself can be like a horror story, including the effects that it can have on your family and other relationships and your workplace performance, as well as the way that it can negatively affect your physical health. And of course, the risk of suicide is associated with severe depression. Although it sounds as if the decision about whether to take an antidepressant medication is not an easy one for you, for most people the consequences of untreated depression far outweigh the risks of taking an antidepressant. That said, antidepressants aren’t for everyone, and there are alternatives. For example, counseling and psychotherapy are effective treatments for many depressed people. In fact, controlled studies that directly compared these treatments showed that the chances that depressed people will respond to cognitive-behavioral therapy or interpersonal psychotherapy were comparable to the chances they’ll respond to antidepressants. One way or the other, it’s important to get some help — perhaps starting by talking with your primary care doctor or a psychotherapist who’s been highly recommended; if you’re still skeptical, your minister or someone you consider wise and experienced in this area may be able to offer advice. If you see your primary care physician and decide not to take an antidepressant, ask him or her to recommend an experienced counselor or therapist who has worked well with other people with depression. (You can also search for psychotherapists in your area on Revolution Health, an Everyday Health partner Web site.) And there are other steps you can take to help yourself — for example, getting regular aerobic exercise and spending time with others doing things that you used to enjoy. You can find more information at Everyday Health Depression Center, including details about antidepressants and other treatments. The Web site of the Depression and Bipolar Support Alliance also has useful information on both treatment and self-help. Q5. I took 62.5mg of Paxil for eight months. It gave me anxiety, for which I had to take Ativan. I then stopped taking Paxil, and I started getting “brain zaps.” They lasted at least a month, and felt like electrical zaps to my brain. Could this be a withdrawal symptom? — Josephine, New Jersey Yes, it is very likely that these sensations were part of your body’s response to the discontinuation of Paxil (paroxetine). Although this type of symptom can be frightening, annoying, and uncomfortable, it’s not dangerous and typically disappears faster than you describe, usually in a week or two. If you take a medication like Paxil again, try to allow four to six weeks for a slower withdrawal to minimize the recurrence of symptoms association with discontinuation. Q6. What do I do when I run out of Effexor(venlafaxine) 300 mg and have to wait until medication comes via snail mail? I know it was my fault not ordering in time before I ran out. What are my alternatives when this happens? Of all the antidepressants that are now in wide use, Effexor is one of drugs that is most likely to be associated with an uncomfortable discontinuation syndrome, perhaps particularly so at doses as high as 300 mg per day. You should do whatever you can to keep from running out of medication because, in addition to the uncomfortable discontinuation symptoms, you may be at higher risk of suffering a full relapse. The simplest answer to your problem is to try to minimize the chance of running out, such as having an automatic reorder with the pharmacy, putting into place a series of prompts or reminders to help you get your orders in on time, or asking a loved one or significant other to help you keep track of this. On occasion, doctors will provide their patients with sample packs of medication (which can be used in a pinch) or will call in a small prescription for enough medication to bridge the gap. If worse comes to worst, you’d be better off reducing the dose for a few days than you would be if you ran out entirely. For example, you could take 150 mg per day, assuming that is the capsule strength that you are prescribed, or, even better, 225 mg per day if you have the 75 mg capsules. Q7. I have read a lot about the benefits of taking Saint John’s wort and vitamin D3 for mild depression. What is your opinion? Are there studies that prove they work? — Ethel, Ohio I don’t know about vitamin D3, but there is a lot of evidence that Saint John’s wort has antidepressant effects, particularly in less severe depression. Although it’s not regulated like a medication, the herb Saint John’s wort should be taken seriously if you’re using it as your antidepressant. This means letting your primary care doctor know that you’re taking it (it can interact with some other medications, reducing their effectiveness) and making sure that you take a full therapeutic dose for an adequate duration. In addition, you should not take it in combination with other antidepressants. Q8. I have been on Cymbalta (duloxetine) for a year now, along with Depakote (divalproex) for mania and Seroquel (quetiapine) for paranoia. Before going on Cymbalta, I was my normal creative self: writing stories, taking pictures, and painting. Then my insurance decided that they were not going to approve the Cymbalta. I had to stop taking it. Now I’m getting suicidal. However, all my creativity is coming back and I feel I can write again. I know I can’t sacrifice my health for my creativity. But can you tell me if there are any anti-depressants that don’t have the effect of killing your artistic abilities? Cymbalta, which is thought to treat depression through two chemical pathways (norepinephrine and serotonin), is one of the newer antidepressants and, because it is still under patent, it is more expensive than many other antidepressants that are now available as generics. Although it is possible that only Cymbalta will work for you, it is more likely that another type of antidepressant will be helpful, so you should talk to your doctor about finding another medication. Among the others, venlafaxine is the closest to Cymbalta. It is available in a patent-protected form (once daily Effexor XR) or a generic form that must be taken several times a day. Of course, the so-called serotonin-selective antidepressants (fluoxetine, sertraline, paroxetine and citalopram are available as generics) or the novel drug bupropion (all forms are available as generics) may work for you, as might a higher dose of Seroquel. Q9. I have been on clomipramine for the past 15 years. I once tried to come off of it, but I ended up in the hospital. I recently found out that I am pregnant (which was not planned), and my doctor has changed me over to imipramine. However, I read that this drug comes with an increased risk of birth defects. I want to stop taking it immediately. My doctor said it was absolutely safe, so now I feel that I can’t trust him. What should I do? — Ann, England The tricyclic antidepressant clomipramine (Anafranil) is probably no more or less risky to your pregnancy than its close cousin imipramine (Tofranil). Imipramine has been has been more widely used, however, so over the past 40 years or so there have been more pregnancies in women on imipramine than on clomipramine. Both are by far likely to be safe for the developing fetus, though neither is absolutely safe when you’re pregnant (not even aspirin or acetaminophen or higher doses of vitamins are absolutely safe). In the United States, these drugs are classified as having a C rating for pregnancy, which means that there are small and nonspecific risks, but no known or clear-cut risks. On the other hand, the risks of untreated depression for pregnancy are much greater than those of your medications. Q10. I’m on 200 mg of Zoloft for depression and 100 mg of Seroquel a night. But I keep telling my doctor that I don’t feel anything. I miss the feelings of love and happiness. What should I do? — Glenda, Virginia Some people do experience a sense of emotional blunting — not feeling anything, as you so aptly describe it — while taking antidepressants such as Zoloft (sertraline), and either a dose reduction or a change to a different type of antidepressant may be helpful. Though it may be difficult for you, you should tell your doctor that you’re not happy with particular side effects of your current medication combination and ask him or her to work with you on finding a better treatment regimen. There are many treatments for depression, and you may not have this problem with other antidepressants or combinations. See more about antidepressants and other treatments for depression. Learn more in the Everyday Health Depression Center.
