Managing Erectile Dysfunction: Considerations for men with depressionRuslan Dorfman, PhD, MBA
Erectile dysfunction affects more than half of all men over 50 years of age. Psychological stress is one of the risk factors for erectile dysfunction, and accounts for 10-20% of cases, particularly before the age of 40. Some men suffering from depression avoid taking antidepressants due to fear of reduced libido and erectile dysfunction (ED), which is a common side effect of some antidepressants. Yet, depression left untreated also increases the risk of ED.
In older men, the risk of ED increases due to underlying blood circulation and heart conditions. Antidepressants and heart medications (such as digoxin, beta-blockers, diuretics and spironolactone) can also cause erectile dysfunction. In this brief, we will describe how a Personalized Medicine approach using genetic testing can help to manage depression and how it can also reduce the risk of ED and severe side effects.
Erectile dysfunction drugs
Sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis) and avanafil (Stendra) are common ED medications and are generally safe. However, the vast majority of men who might benefit from ED medications don’t try these drugs due to stigma. Yet men who do try ED drugs often stop treatment due to significant side effects or lack of efficacy.
If you’re a man experiencing reduced libido or ED, it is essential to assess both mental and heart health with qualified healthcare providers. Ignoring the signs of reduced libido can further impact your mental health.
Personalized antidepressant dosing can help to reduce ED symptoms.
Men under psychological stress may need treatment with an antidepressant to improve mental health status and their libido. If you suffer from depression, you should not avoid antidepressants for fear of erectile dysfunction. The correct drug and dosage can manage depression and sexual function. The risk of ED is associated with excessive SSRI doses. This is where your body’s drug metabolism comes into play. If your body clears SSRI drugs slowly, higher drug concentrations in the blood may cause more substantial depression symptoms and affect your libido. Too low an SSRI dose may reduce ED side effects but exacerbate depression symptoms.
Other types of antidepressants known as SNRIs have less impact on libido. SNRIs include desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), milnacipran (Savella), and levomilnacipran (Fetzima). Bupropion (Wellbutrin), a norepinephrine-dopamine reuptake inhibitor (NDRI) is an antidepressant that has been shown to have fewer sexual side effects.
Medication treatment can be personalized to your body’s inherent metabolism by using pharmacogenetic testing. This helps assess your rate of drug metabolism (based on your genetics) and indicates your predicted response to medications. Pillcheck is a pharmacogenetic testing service that covers over 50 mental health drugs and common ED drugs. Pillcheck helps in guiding drug choice and dosage to fit your body’s metabolism and reduces the risk of ED.
Combining erectile dysfunction drugs with antidepressants
Using ED medications with antidepressants can help to reduce depression symptoms and improve sexual function. However, it is essential to select an antidepressant that can be taken safely with ED drugs.
Drug-drug interactions can cause severe side effects and lead to blurred vision, insomnia, fainting, muscle pain and GI upset. The CYP3A4 liver enzyme metabolizes ED drugs such as sildenafil, vardenafil, tadalafil, and avanafil. Some SNRIs such as desvenlafaxine, milnacipran and levomilnacipran are also metabolized by the same CYP3A4 liver enzyme. Combinations of the ED drug and SNRI will increase drug levels of both types. This leads to severe side effects and should be avoided. Men who have inherently reduced CYP3A4 activity are at higher risk of experiencing side effects when treated with an ED drug in combination with other medication (or even the drinking of grape or pomegranate juice.) Pharmacogenetic tests such as Pillcheck can help to assess whether a dose reduction for ED is required, and/or selection of a different antidepressant to reduce the risk of side effects. Pillcheck clinical pharmacists will advise your doctor on how to adjust treatment to improve depression symptoms, libido, and tolerance to ED drugs, as well as look for interactions with and other medications.
- Reduced sexual function can be caused by psychological stress and/or undiagnosed heart disease.
- Excessive antidepressant or heart medication doses can suppress libido and worsen ED.
- Personalized drug and dose selection, matched to your DNA, can reduce the risk of erectile dysfunction and improve the management of depression and libido.
- Pillcheck pharmacists can advise as to how your treatment can be adjusted to reduce the risk of ED drug-induced side effects and improve your tolerance to treatment.
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