Dr Thomas Stuttaford

Long before there were drugs that were effective in treating depression, both men and women found that loss of libido was a prominent symptom.

Many depressed people, whether taking an antidepressant or not, struggle on as they cope with their lives. In the morning they go to work, despite a sense of hopelessness and although they are convinced that there is little chance of achieving pleasure or success in either their domestic or professional lives. They keep going and are feeling rather better by the time they reach home. All they hope is that once in the relative tranquillity of their home they will be left in peace and nothing will be demanded of them.

In bed they realise, with despair, that their partner wants them to throw off the anxieties of the day and return to being the carefree, spontaneous, amorous person they were when they first met. Their partner’s barely concealed demands may be the last knock of the day. Feeling even more useless than when reaching the sanctuary of their bed, the depressed person reacts by rejecting the tentative, loving hand.

Most antidepressants, once they have begun to lift depressed people’s mood, will enable them to again recognise their partners for the kindly and sexually desirable people that they are. The patient may not yet be the life and soul of any party, but between the sheets they may at least be responsive, if not always adventuresome. The role that antidepressants may have in determining a depressed patient’s libido is confused by the near certainty that loss of libido is almost always a symptom of the condition as well as sometimes of its treatment.

The SSRIs (selective serotonin reuptake inhibitors), the popular antidepressants that include such drugs as Prozac (fluoxetine), may usually disperse the depression but even as they do so the patient’s libido, rather than becoming invigorated, may in a minority of cases evaporate. The loss of libido may be associated with delayed orgasm or anorgasmia (the persistent inability to achieve orgasm) in both sexes. In men this side-effect may result in delayed ejaculation or even occasional impotence.

Estimates of the number of people who suffer from a varying degree of loss of libido after antidepressants is uncertain. Some research claims that it is only 1 or 2 per cent. Other studies, some no more than anecdotal reports, suggest higher figures.

The consensus seems to be that the likely incidence of changes in libido when taking SSRIs affects about 20 per cent. The important question is whether the loss of libido is from the antidepressant or because the patient is not yet fully recovered from their depressive phase. So good is libido as a measure of depression that some doctors use it as a means of monitoring the level of depression, even when the patient is not taking antidepressants. You write that your loss of libido makes you “even more depressed”, so we must assume that you are still depressed.

When loss of libido is a side-effect of treatment most doctors try other drugs. There has been some success in using antidepressants, for example, Efexor XL or Cymbalta, that contain a noradrenaline as well as an SSRI. This may give people that little bit of extra zip once they have got rid of the worst of their depressed feelings and enable them to resume a sex life.

Suzi Godson

Sexual difficulties are a well known side-effect of the group of antidepressants known as SSRIs (selective serotonin re-uptake inhibitors). If your treatment has been monitored adequately and you have mentioned your lack of libido to your doctor, he should have suggested that you try a different medication, lowering your dosage and/or taking a “drug holiday” from your tablets.

All these, however, are temporary measures. If you want to restore your libido, you need to take the medicinal plaster off the emotional wounds that made you depressed in the first place. Talk therapy of some kind — psychotherapy, cognitive behavioural therapy, counselling or interpersonal therapy — is probably the best way to do this (contact the British association for counselling and psychotherapy www.bacp.co.uk).

Studies show that exercise is also tremendously effective. In fact, fitness has proved to be so beneficial for a host of mental and physical complaints that GPs can now refer patients to one of more than 800 NHS fitness schemes nationwide. Taking regular exercise will boost your confidence and it’s a great way to kick-start a jaded libido, too.

Physical exertion triggers the release of the sympathetic hormones epinephrine (adrenalin) and beta-endorphins. These are chemicals which if available on the open market would certainly be Class A, yet they are free, legal and completely natural . . . how great is that? And in a rather beautiful piece of evolutionary symmetry, it turns out that normal, run-of- the mill, might-not-last-very-long sex actually counts as exercise. Previously research suggested that exercise had to involve a significant rise in heart rate over a sustained period to be of benefit. In other words, you had to be puffed out and knackered afterwards. However, a ten- year study of 2,400 men from Caerphilly, South Wales , by researchers from the University of Bristol, found that men having three or four orgasms a week halved their risk of having a serious heart attack or stroke.

Improving your diet will help both your depression and your libido. Excess fat and sugar in your diet are guaranteed to leave you feeling about as sexy as a tub of lard. Better nutrition will improve your mood and strengthen your immune system, while losing weight will boost your self-esteem and your pulling potential.

Although there is no one specific cause of depression, loneliness is widely acknowledged to be a key trigger. If you feel that you would benefit from talking to others, try joining a discussion group at www.1in4-forum.org. It was set up to help the one in four people who experience mental health problems during any one year, but it has become a place where people offer each other emotional and practical support.

And your problem is very common. It is hard to put a figure on how many people are affected by a treatment-related drop in libido because it is not something depressed people are in a hurry to talk about. It seems crazy that pharmaceutical companies haven’t managed to iron out what is more than just a glitch in an otherwise effective medication. Five years ago Eli Lily, the makers of Prozac, and the UK company Vernalis began developing a drug called VML 670, which appeared to address this problem. However, in 2004, after a couple of corporate mergers and a product review, VML 670 was abandoned. Now that really is depressing.