Sedation and Loss of Libido
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Q:  Sedation and Loss of Libido

Hello Dr. Phelps --

I have been battling Bipolar II for many years now. I have been on Depakote, Lamictal and Trilepal in the past. 

I am now on Seroquel and Lamictal. The Seroquel has been terrific for me. Although I am not exactly cured, I do have longer "good" periods than I did on any of the other mood stabilizers. I sleep great and have almost no hypomanic mood shifts.

The problems I have though is the sedation and loss of libido. Although I am dealing with the sedation as best as I can, my loss of libido concerns me. 

Is there anything I can do about this?


Dear Eric -- 
As you have likely suspected yourself, there's really only one way to figure out if that loss of libido belongs to the Seroquel (or, less likely, to the Lamictal) or to the underlying condition (Bipolar II:  perhaps somehow you're spending a lot of time in a phase of it just opposite enough of hypomania to have low libido; or perhaps your idea of libido is based to some extent on your previous hypomanic phases; or perhaps some other mechanism associated with the condition). That is to taper off one medication at a time and see. Sounds like you're not really at the point where you can afford to take that step, and of course whenever you thought you were you'd want to do that in very explicit communication with your psychiatrist so that she/he knows what's going on and you both have a plan in place to recognize worsening and what to do in the short and long run if worsening occurs. The good news is the word "terrific". Figuring out how to best dose the Seroquel to maintain that level of benefit and minimize the sedation issues sounds like what you'll be working on in the short run. With some luck you might see libido recover a bit if the sedation gets reduced somewhat.  Good luck with the whole picture - 
Dr. Phelps


Published January, 2007


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