Exercise Before Sex Cuts Antidepressants' Sexual Side Effects

Kenneth Bender

December 06, 2013

Exercise can benefit health and improve mood, and now new research shows that it has the potential to restore sexual desire and function in women adversely affected by sexual side effects related to antidepressant use.

Investigators at the University of Texas at Austin found that a brief, moderate strength and cardiovascular exercise regimen preceding sexual activity was associated with improvement in sexual desire and significantly improved sexual functioning in women with more severe sexual dysfunction related to antidepressants.

Tierney Lorenz, PhD, now at the Kinsey Institute in Bloomington, Indiana, told Medscape Medical News that the study findings could increase the effective utilization of antidepressant medication.

"As a clinician, I want patients to have access to treatments that work. Antidepressants work — they are lifesaving medication," Dr. Lorenz said, "but they don't work if patients are too scared to try them, or take them inconsistently, because of potential sexual side effects."

The study was published online November 1 in Depression and Anxiety.

Natural Setting

Previous studies suggested that exercise has the potential to improve sexual function in depressed women who are not taking medication and that exercise prior to presentation of sexual stimuli could increase sexual arousal in healthy women.

In addition, earlier research conducted by Dr. Lorenz and colleagues suggested that exercise has a positive effect on psychophysiologic measures of sexual arousal in women taking antidepressant medications who were assigned to run a treadmill prior to being shown a sexually explicit film.

Although these findings suggested that exercise may benefit women experiencing antidepressant sexual side effects, the researchers designed the current study to test this hypothesis in a natural setting.

"Laboratory-based psychophysiological measures of women’s sexual arousal may not map onto sexual function, and the link between objective measures of female genital arousal and women’s subjective ratings is modest," the investigators write.

In the 9-week study, 52 women experiencing antidepressant sexual side effects were assigned to engage in sexual activity, defined as "sex with a partner or masturbation," 3 times a week.

After a 3-week baseline period, participants were randomly assigned to a 3-week treatment interval with exercise either 3 times a week separate from, or immediately prior to, the sexual activity; these groups crossed to the other condition in the final 3-week study period.

Assessments were conducted at the end of each 3-week interval with multiple, validated measures of sexual desire, function, and satisfaction, as well as measures of affective, cognitive, and physical symptoms of depression and anxiety.

Participants were given heart rate monitors with time stamps to determine compliance with the level and timing of the exercise regimen, and they recorded each sexual event onto online diaries with time stamp.

In addition, participants were blinded to the hypothesis that exercise occurring immediately prior to sexual activity would have greater efficacy, with all but 1 participant indicating that they assumed that the study was only about the effects of exercise on sexuality.

Clinically Relevant Results

The investigators report a statistically significant increase from baseline in sexual desire measures with the timed exercise. Nontimed exercise appeared to be of less benefit, but not statistically significantly different from the timed exercise.

Timed exercise was also associated with improved measures of global sexual functioning in women with clinical levels of sexual dysfunction at baseline, but the effect was not statistically significant in those with less severe reaction to the medication.

Distinct from the treatment effects associated with the exercise regimen, the researchers also determined that orgasm function was increased from baseline by the regular scheduling of sexual activity ― 3 times weekly in contrast to the pretrial reported average of 1.37 times weekly.

Reported improvements in sexual desire and functioning were independent of the modest changes measured in mental and physical health.

The researchers characterize the improvements between pretrial and the experimental exercise arm as "modest but consistent and clinically relevant."

In addition, they note that inasmuch as there "were no reported adverse effects of exercise, high patient acceptability, and no additional cost burden of care, even moderate efficacy is promising."

Dr. Lorenz noted that these findings support exercise as a behavioral intervention to reduce the burden of antidepressant sexual side effects.

"Until very recently, there hasn't been much that physicians can do to help manage side effects other than swapping medications or adding a sex-specific medication to the regimen. The 'wait it out' approach does not work for most people," she said.

Dr. Lorenz anticipates that she will next test the intervention in more diverse settings.

"It will be critical to see if the same findings hold in a more common clinical situation, in which physicians cannot monitor patient's progress so intensively," she said.

Worth Trying

Commenting on the findings for Medscape Medical News, Alan Gelenberg, MD, chairman, Department of Psychiatry, Penn State College of Medicine, who was not involved in the research, said that "it is an interesting model, good study, and worth trying clinically."

In a study published earlier this year in the Journal of Nervous and Mental Disease, Dr. Gelenberg and colleagues documented high rates of new-onset sexual dysfunction with selected antidepressants and found lower rates of sexual side effects among patients who best responded to the antidepressants.

The authors and Dr. Gelenberg report no relevant financial relationships.

Depress Anxiety. Published online November 1, 2013. Abstract

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