Does Viagra help women on antidepressants?

The latest medical studies explained.
July 23 2008 1:37 PM

Happier Sex

Does Viagra help women who take antidepressants?

Viagra
The tiny blue Viagra pill

Problem: Antidepressants like Prozac and Paxil, which work by controlling the availability of the brain chemical serotonin, are the most widely prescribed medications for adults in the United States, accounting for 160 million prescriptions a year. They're hugely important, but about 70 percent of women who take these medications suffer sexual dysfunction as a side effect. This disruption of good sexual function is so distressing that it is a common reason for patients to stop treatment, which often results in a worsening of depressive symptoms and a poorer level of function.

New study: In almost all of the previous studies, when drugs such as Viagra have been tested in women, the results have been disappointing—so disappointing that research in this area has been all but abandoned. But a new paper limits its focus to the effect of Viagra on women with a major depressive disorder. These women were selected because they had a decrease in sexual function because of the antidepressant they were taking but continued to have a strong interest in sex.

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Setup: The women on antidepressants, who ranged in age from 18 to 50, were randomly divided into two groups of about 50. Both groups were given little blue pills that looked exactly like Viagra, but the pills for only one of the groups actually contained the drug. Sexual function in women is hard to measure objectively, so the researchers collected the subjects' subjective take on sexual desire, physical signs of arousal, achievement of orgasm, and enjoyment. The investigators also looked for changes in pain or discomfort with sex and, finally, for something mysterious that they don't define, called "partner." (I know that's confusing; I'll come back to it later.)

Findings: The results were pretty clear. They showed some improvement in sexual function in women receiving little blue pills that didn't contain Viagra (I guess there's just something about little blue pills) but significantly more improvement in women taking the real thing. The researchers also found minor side effects like headaches, flushing, and transient changes in vision—all known to be associated with Viagra—but nothing major.

Implications: Further studies will be needed to determine whether the improvement in sexual function lasts, satisfies the women being treated, and—the bottom line—increases the likelihood that women with major depressive disorders will stick with their antidepressants. But it is certainly noteworthy that, in contrast with previous studies of women whose poor sexual function was caused by something other than an antidepressant, for this particular group Viagra seemed to help.

Caveat: The sample size was small. And the study was sponsored by the manufacturer of Viagra. (Though the paper notes that the manufacturer's only contribution was to provide both kinds of little blue pills and to help pay for the research.)

Conclusion: I keep coming back to the mysterious element of measure called "partner." Whatever that means, it showed significant improvement for the women who took the Viagra. Is it possible that the women sometimes gave those little blue pills to their partners, leading to another kind of change in their sex life?

Sydney Spiesel is a pediatrician in Woodbridge, Conn., and clinical professor of pediatrics at Yale University's School of Medicine.

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