Are you suffering in silence?

My name is Tom, I manage schizoaffective disorder bipolar type, and for about 4.5 years, early in my recovery, I experienced sexual dysfunction due to my medication side effects. I take an antipsychotic and a mood stabilizer. I suffered in silence, not sure how to talk about it with my doctor, not sure there were any options. I was also court ordered to take my medication, so I was not sure what to do. I started to get diabetes and gained a lot of weight from my medication, so my psychiatrist and medical doctor started talking to me about how they wanted to change my medication. I gathered my courage, and took it a step farther, and told them I would also like to consider something to help me avoid sexual side effects if possible. My psychiatrist said he would look into it, and came up with a pretty good solution.

I know I’m not alone. When I was in institutions I met many men who said they relapsed in their mental health issues after stopping their medication due to frustration with sexual side effects, like not being able to get an erection, not being able to perform a sex act, no ejaculate, or decreased desire. These are common side effects from anti-depressants and antipsychotics. Many men are afraid to talk to their doctors. Sometimes when they tried, doctors did not listen, or did not know what to do. But there are solutions.

For a long time now, the assumption has been that men with mental illness are not interested in sex. They call it a negative symptom. Maybe true for some, but not for me, and not for a lot of men I have talked to. But without sexual relationships what else is missing very often? Hand in hand with a sexual relationship goes companionship with an intimate partner, possibly family life, possibly kids, dating activities, marriage, and more. Often sexual dysfunction is a major contributor to the isolation so many people with mental illness experience.

With the help of a friend who is an Advanced Registered Nurse Practitioner (ARNP), I found 6 scientific articles on the issue, with prescribed solutions, so I know the problem is wide spread even if it is not often talked about. It affects women too, but I don’t know as much about that, and hope a woman will research it and submit an article to the NAMI GS spotlight.

I am not a doctor, not a psychiatrist, or an ARNP. So before changing any of your medication talk to your prescriber. There is a lot to consider with medications, and a change might not be the best thing. For me, I changed my antipsychotic and mood stabilizer to medicines my doctor researched that caused less side effects for me. Then he prescribed Sildenafil to help with any residual erectile dysfunction. In the research articles listed below, I learned that this was a good idea: Sildenafil helps train the body to have lasting sexual function even after the medication is stopped. Sildenafil is just one of a few options available. TALK TO YOUR DOCTOR TO SEE WHAT THEY THINK WOULD BE RIGHT FOR YOU BEFORE MAKING ANY CHANGES. Did I emphasize talking to your doctor before making changes enough? Remember, if you go off your medication or make changes on your own, you risk relapsing to ground zero again and starting over in your recovery. And maybe your current medication will work with the help of a medicine for sexual dysfunction. There are priorities here too; for me, mental stability and function are more important than sexuality. If you are mentally stable on your medication, changing that medication might be the worst thing you could do for your recovery. Instead, consider looking at the benefits of sexual dysfunction medication in concert with your current good medication to find solutions with your doctor.

With sexual interactions can come many complications and responsibilities. There are places that can help with these issues, and can include your treatment team. A little planning can help you avoid problems that might hurt you or your new found love, and allow you to enjoy intimacy while maintaining your recovery.

I have now had an intimate partner for six years. We had a commitment ceremony last summer that was wonderful. She lets me help raise her two wonderful children which greatly enrich my life. By being in a family I am much less isolated; isolation impaired my recovery in mental health before. We care about each other in ways that has helped me recover in my mental health to heights that would not have been achievable without her.

by Tom Gergen

1) Sexual Dysfunction and psychotropic medications, by Glen L. Stimmmel, PharmD, BCPP, and Mary A Gutierez, PharmD, BCPP, CNS Spectrums, 2006:11:8 (Suppl 9): 24-30

2) Impact of Mental Illness on Sexual Dysfunction, by Zvi Zemishlany and Abraham Weizman, Geha Mental health Center, Petah-Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, TelAviv, Isreal, in Adv Pchychosam Med, Basel, Karger, 2008, Vol 29 pp 89-106.

3) A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia, by Anna Maria, N. Costa, Sao Paulo Med J. 2006: 124(5): 291-7.

4) Management of sexual dysfunction due to Antipsychotic drug therapy, by Schmidt HM, Hagen M, Kriston L, Soares-Weiser K, Maayan N, Berner MM. Cochrane Database Syst Rev. 2012 Nov 14: 11:CD003546. Doi: 10.1002/14651858. CD003546. Pub 3.

5) Sildenafil in the treatment of SSRI-induced Sexual Dysfunction: A pilot study, by Marina amis, M.D.: Yatin Patel, M.D.:Geaorge M.Simpson, M.D. in Primary Care Companion J,Lin Psychiatry 1:6, December 99.

6) Sildenafil in the treatment of antipsychotic-induced erectile dysfunction: a randomized, double-blind, placebo-controlled, flexible-dose, two-way crossover trial. By Gopalakrishanan R, Jacob KS, Kruvilla A. Vasantheraj B, and John JK. In Am J Psychiatry. 2006 Mar: 163 (3): 494-9.