Experiences Loss of Sexual Function, What Are My Options?
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Q:  Experiences Loss of Sexual Function, What Are My Options?

I have been on Bupropion (Wellbutrin XL300) and Lamotrigine (Epitec 200mg) for 18 months. This isn't enough to control my downs anymore and my psych has suggested that we add Sertraline (Zoloft 50mg). I have taken fluoxetine before and experienced the side effect of total loss of sexual function. I have read that this is a possible side effect of Sertraline as well.

The Lamotrigine already affects my sexual function quite a bit. I take the bupropion and lamotrigine in the morning and the sertraline at night. It seems to me as if I will lose all function again. This is obviously a problem as far as maintaining a health relationship with my partner. What are my options, if any?

Dear Tania --
First of all, there is the grand controversy about whether antidepressants actually work in bipolar disorder, although recent evidence quite strong that they can be effective in bipolar II (which presumably is the type which you have, based on your current medication lists). If you wish, you can read about these
antidepressant controversies on that webpage, for my views on whether they should be used at all (itís pretty technical, that page, but itís pretty detailed as well. )

However, to answer your question, about alternatives to antidepressants that can affect sexual function: well, again, in my view that sees it, because there are at least nine alternatives to antidepressants that don't make bipolar disorder worse like regular antidepressants do, and none of them (well, maybe one) make sexual function worse either. Here is my list, and you can find details on my Nine Alternatives webpage; most of these have at least as much research evidence for their effectiveness in bipolar depression as antidepressants:

Not Pills



Regular physical activity

Psychotherapy (at least three different kinds)

Light therapy (particularly using a Dawn Simulator)


Omega-3 fatty acids (fish oil)

 Low- dose lithium

Thyroid hormones


Lamotrigine (you're already on that)

(the remaining options in this column have such a risk of weight gain, there are only last alternatives)



Decreased sexual function from lamotrigine is extremely uncommon.  But it is frequent for patients to see a dramatic decrease in their sexual activity when they are no longer having hypomanic phases.  (Although they are probably seeing an increase in their sexual activity relative to what happens during their depressed phases).  So you may have to try to carefully distinguish whether or not lamotrigine is really affecting sexual function directly, or only indirectly through its impact on bipolar disorder itself.

Good luck sorting through all of that, and finding a better working solution.

Dr. Phelps

Published May, 2010


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