Antidepressant medications prescribed for depression fall into four different classes of drugs:

• serotonin reuptake inhibitors (SSRIs)
• atypical antidepressants
• tricyclic antidepressants
• monoamine oxidase inhibitors (MAOIs)

SSRIs (selective serotonin reuptake inhibitors)

The SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed class of antidepressants. They act on a chemical in the brain called serotonin. The SSRIs include drugs such as Prozac, Zoloft, and Paxil.

The SSRIs are preferred over older classes of antidepressants such as tricyclic antidepressants and MAOIs because their adverse effects are less severe.

Like all antidepressants, SSRIs can cause an increase in suicidal thoughts and behaviors. They also carry a risk for increased hostility, agitation, and anxiety. In adults 65 and older, SSRIs increase the risk for falls, fractures, and bone loss.

The SSRIs can also cause serious withdrawal symptoms if you stop taking them abruptly.

Common side effects of SSRIs include:

Nausea Insomnia Dizziness Weight gain or loss Tremors Sweating

Anxiety and restlessness Decreased sex drive Drowsiness or fatigue Dry mouth Diarrhea or constipation Headaches

Atypical antidepressants

There are a variety of newer atypical antidepressants which target other neurotransmitters either alone or in addition to serotonin.

For example, Wellbutrin blocks the reabsorption of the neurotransmitters dopamine and norepinephrine. On the other hand, trazodone, Cymbalta, Effexor, and Remeron affect both norepinephrine and serotonin (which is why they are sometimes called serotonin and norepinephrine reuptake inhibitors, or SNRIs).

The side effects vary according to the specific drug. However, many of the atypical antidepressants can cause nausea, fatigue, weight gain, sleepiness, nervousness, dry mouth, and blurred vision.

Wellbutrin is less likely to cause sexual side effects than other antidepressants

The atypical medication buproprion, also known by the brand name Wellbutrin, is less likely than the SSRIs to cause sexual dysfunction. It is often prescribed either alone or in addition to an SSRI medication when sexual side effects occur.

Wellbutrin may also be a good choice if fatigue or sleepiness is a major concern, as it tends to be more energizing than other types of antidepressants.

Tricyclic antidepressants

Tricyclics are among the oldest antidepressants. They work by inhibiting the brain’s reuptake or serotonin and norepinephrine. They also partially inhibit the reabsorption of dopamine.

Because the tricyclics have such a broad mechanism of action, they tend to cause more side effects than the other classes of antidepressants. For this reason, the SSRIs and the atypical antidepressants are usually prescribed first.

Tricyclic antidepressants typically take around two weeks to provide symptom relief. Drowsiness is a highly common side effect, particularly in the first few weeks after starting the medication.

The tricyclics cause withdrawal symptoms when discontinued abruptly. Tricyclic antidepressants can also cause an abnormal heart rhythm, so they are not recommended if you have heart problems or seizures.

Common side effects of tricyclic antidepressants include:

Weight gain Loss of sex drive Dizziness and nausea Dry mouth Blurred vision

Constipation Difficulty urinating Sun sensitivity Increased heart rate Disorientation or confusion

MAOIs (Monoamine oxidase inhibitors)

MAOIs (monoamine oxidase inhibitors) are the oldest class of antidepressants. MAOIs have severe interactions with certain foods, drinks, and medications. Combining MAO inhibitors with foods or drinks containing tyramine can result in dangerously high blood pressure, which can lead to a stroke or heart attack. Because of this danger, MAOIs are not typically chosen as a first-line depression treatment.

If your doctor prescribes an MAOI, you will have to carefully monitor what you eat and what drugs you take. Items that are restricted include many cheeses, chocolate, wine, and beer.

Common side effects of MAOIs include:

Dizziness Insomnia Weight gain

Headaches Sexual problems Daytime sleepiness

Reprinted with permission for personal or non-profit use. Visit www.helpguide.org to see the article with links to related articles.  This material is for information and support; not a substitute for professional advice.

Many people want and need to be close to others as they grow older. This includes the desire to continue an active, satisfying sex life as they grow older. But, with aging, there may be changes that can cause problems.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes sometimes affect the ability to have and enjoy sex. A woman may notice changes in her vagina. As a woman ages, her vagina can shorten and narrow. Her vaginal walls can become thinner and also a little stiffer. Most women will have less vaginal lubrication. These changes could affect sexual function and/or pleasure. Talk with your doctor about these problems.

As men get older, impotence (also called erectile dysfunction—ED) becomes more common. ED is the loss of ability to have and keep an erection for sexual intercourse. ED may cause a man to take longer to have an erection. His erection may not be as firm or as large as it used to be. The loss of erection after orgasm may happen more quickly, or it may take longer before another erection is possible. ED is not a problem if it happens every now and then, but if it occurs often, talk with your doctor.

What Causes Sexual Problems?

Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and enjoy sex. Problems in your relationship can also affect your ability to enjoy sex.

Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Joint replacement surgery and drugs may relieve this pain. Exercise, rest, warm baths, and changing the position or timing of sexual activity can be helpful.

Chronic pain. Any constant pain can interfere with intimacy between older people. Chronic pain does not have to be part of growing older and can often be treated. But, some pain medicines can interfere with sexual function. You should always talk with your doctor if you have unwanted side effects from any medication.

Diabetes. This is one of the illnesses that can cause ED in some men. In most cases, medical treatment can help. Less is known about how diabetes affects sexuality in older women. Women with diabetes are more likely to have vaginal yeast infections, which can cause itching and irritation and make sex uncomfortable or undesirable.

Heart disease. Narrowing and hardening of the arteries can change blood vessels so that blood does not flow freely. As a result, men and women may have problems with orgasms, and men may have trouble with erections. People who have had a heart attack, or their partners, may be afraid that having sex will cause another attack. Sexual activity is often safe. Always follow your doctor’s advice.

Incontinence. Loss of bladder control or leaking of urine is more common as we grow older, especially in women. Extra pressure on the belly during sex can cause loss of urine, which may result in some people avoiding sex. This can be helped by a change in positions. The good news is that incontinence can usually be treated.

Stroke. The ability to have sex is sometimes affected by a stroke. A change in positions or medical devices may help people with ongoing weakness or paralysis to have sex. Some people with paralysis from the waist down are still able to experience orgasm and pleasure.

Dementia. Some people with dementia show increased interest in sex and physical closeness, but they may not be able to judge what is appropriate sexual behavior. Those with severe dementia may not recognize their spouse, but still seek sexual contact. This can be a confusing problem for the spouse. A doctor, nurse, or social worker with training in dementia care may be helpful.

What Else May Cause Sexuality Problems?

Surgery. Many of us worry about having any kind of surgery—it may be even more troubling when the breasts or genital area are involved. Most people do return to the kind of sex life they enjoyed before surgery.

Hysterectomy is surgery to remove a woman’s uterus. Often, when an older woman has a hysterectomy, the ovaries are also removed. The surgery can leave both men and women worried about their sex lives. If you’re afraid that a hysterectomy will change your sex life, talk with your gynecologist or surgeon.

Mastectomy is surgery to remove all or part of a woman’s breast. This surgery may cause some women to lose their sexual desire or their sense of being desired or feeling feminine. In addition to talking with your doctor, sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Society’s (ACS) “Reach to Recovery” can be helpful for both women and men. If you want your breast rebuilt (reconstruction), talk to your cancer doctor or surgeon.

Prostatectomy is surgery that removes all or part of a man’s prostate because of cancer or an enlarged prostate. It may cause urinary incontinence or ED. If removal of the prostate gland (radical prostatectomy) is needed, talk to your doctor before surgery about your concerns.

Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, appetite suppressants, drugs for mental problems, and ulcer drugs. Some can lead to ED or make it hard for men to ejaculate. Some drugs can reduce a woman’s sexual desire or cause vaginal dryness or difficulty with arousal and orgasm. Check with your doctor. She or he may prescribe a different drug without this side effect.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

Am I Too Old To Worry About Safe Sex?

Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.

Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. To protect yourself, always use a condom during sex. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner or if you are having unprotected sex.

For women with vaginal dryness, lubricated condoms or a water-based lubricating jelly with condoms may be more comfortable. A man needs to have a full erection before putting on a condom. Talk with your doctor about ways to protect yourself from all sexually transmitted diseases. Go for regular check-ups and testing. Talk with your partner. You are never too old to be at risk.

Can Emotions Play A Part?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do. Many older couples find greater satisfaction in their sex life than they did when they were younger. They have fewer distractions, more time and privacy, no worries about getting pregnant, and intimacy with a lifelong partner.

Some older people are concerned about sex as they age. A woman who is unhappy about how her looks are changing as she ages may think her partner will no longer find her attractive. This focus on youthful physical beauty may get in the way of her enjoyment of sex. Men may fear that ED will become a more common problem as they age. Most men have a problem with ED once in awhile. But, if you worry too much about that happening, you can cause enough stress to trigger ED.

Older couples face the same daily stresses that affect people of any age. They may also have the added concerns of age, illness, retirement, and other lifestyle changes, all of which may lead to sexual difficulties. Try not to blame yourself or your partner. You may find it helpful to talk to a therapist. Some therapists have special training in helping with sexual problems. If your male partner is troubled by ED or your female partner seems less interested in sex, don’t assume he or she is no longer interested in you or in sex. Many of the things that cause these problems can be helped.

What Can I Do?

There are things you can do on your own for an active sexual life. Make your partner a high priority. Take time to enjoy each other and to understand the changes you both are facing. Try different positions and new times, like having sex in the morning when you both may be well rested. Don’t hurry—you or your partner may need to spend more time touching to become fully aroused. Masturbation is a sexual activity that many older people, with and without a partner, find satisfying.

Some older people, especially women, may have trouble finding a romantic or sexual partner. That’s because women tend to live longer than men. To meet new people, try activities that other seniors enjoy. Some ideas include mall walking, volunteer jobs, adult education classes at a community college, or day trips sponsored by your city or county recreation department.

Don’t be afraid to talk with your doctor if you have a problem that affects your sex life. He or she may be able to suggest a treatment. For example, the most common sexual difficulty of older women is painful intercourse caused by vaginal dryness. Your doctor or a pharmacist can suggest over-the-counter vaginal lubricants or moisturizers to use. Water-based lubricants are helpful when needed to make sex more comfortable. Moisturizers are used on a regular basis, every 2 or 3 days. Or, your doctor might suggest a form of vaginal estrogen.

If ED is the problem, it can often be managed and perhaps even reversed. There are pills that can help. They should not be used by men taking medicines containing nitrates, such as nitroglycerin. The pills do have possible side effects. Other available treatments include vacuum devices, self-injection of a drug, or penile implants.

Physical problems can change your sex life as you get older. But, you and your partner may discover you have a new closeness. Talk to your partner about your needs. You may find that affection—hugging, kissing, touching, and spending time together—can make a good beginning.

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Reprinted from the National Institute on Health. Visit NIHSeniorHealth (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health information for older adults. Special features make it simple to use. For example, you can click on a button to have the text read out loud or to make the type larger.