Attention deficit hyperactivity disorder, or ADHD, is a psychiatric disorder with three components: poor attention span, hyperactivity and impulsivity. Stimulants such as Ritalin and Adderall are the main treatment for ADHD, also called ADD when the H-- hyperactivity--is not present. Antidepressants and even anti-hypertensives are also used to treat ADHD, and each class of drugs has different side effects as well as different results in treating symptoms.
Stimulants including methylphenidate--brand name Ritalin--and dextroamphetamine and amphetamine--brand name Adderall--are the most common treatment for ADHD. Stimulants do not have a direct effect on sexual function. However, by increasing attention during sex both to the act and the partner, libido may be increased and sex may be more frequent.
Antidepressants are often used to treat ADHD, either alone or in conjunction with stimulants. One class of antidepressants, selective serotonin reuptake inhibitors or SSRIs, are used to treat ADHD. They include paroxetine--brand name Paxil; citalopram, or Celexa; fluoxetine, or Prozac; fluvoxamine, or Luvox; sertraline, or Zoloft; and escitalopram, or Lexapro. SSRIs can increase sexual arousal or even cause spontaneous orgasms, although this is rare.
It's estimated that 30 percent to 40 percent of all patients who take SSRIs have sexual side effects, including low libido. Some patients with ADHD have abnormally high sex drives, and don't complain about the reduction in libido accompanied by SSRI treatment.
Norepinephrine reuptake inhibitors or NRIs used to treat ADHD include atomoxetine--brand name Strattera; mazindol, or Mazanor and Sanorex; reboxetine, or Edronax; and viloxazine, or Vivalan. These drugs may also cause cause sexual dysfunction, including decreased libido.
Tricyclic antidepressants include desipramine, or Norpramin; imipramine, or Tofranil; and amitriptyline or Elavil. These drugs are also associated with sexual dysfunction, such as decreased sex drive.
Monoamine oxidase inhibitors, or MAOIs, are one of the last drugs to be prescribed for ADHD. They include socarboxazid, or Marplan; moclobemide, or Aurorix or Manerix; phenelzine, or Nardil; selegiline, or Eldepryl or Emsam; and tranylcypromine, or Parnate. These drugs are also associated with sexual dysfunction.
Benzodiazepenes are most often used to treat anxiety but are sometimes used in conjunction with stimulants to treat ADHD. Benzodiazepenes include clonazepam (Klonopin), diazepam (Valium), triazolam (Halcion), and temazepam (Restoril), and are associated with decreased sex drive (Reference 4).
Antihypertensives are drugs originally used to treat hypertension (high blood pressure), and include clonidine (Catapres), guanfacine (Tenex), and propranolol (Inderal). Clonidine and propanolol are associated with decreased libido (Reference 5).
Erectile dysfunction is the inability to initiate or maintain an erection suitable for sexual performance. Clonidine and propanolol are associated with erectile dysfunction. SSRIs are also associated with erectile dysfunction. Benzodiazepenes cause erectile dysfunction.
Inability to or Delayed Orgasm
Serotonin and norepinephrine reuptake inhibitors, or SNRIs, include venlafaxine, or Effexor; duloxetine, or Cymbalta; desvenlafaxine, or Pristiq; and milnacipram, or Ixel. According to "The Clinical Handbook of Psychotropic Drugs," 2007 edition, by Bezchlibnyk-Butler and Jeffries, SNRIs--especially Effexor--cause sexual side effects in more than 30 percent of patients, including delayed orgasm and inability to orgasm. These sexual side effects cause many patients to discontinue treatment with SNRIs. SSRIs are also well known to cause delayed ejaculation and inability to orgasm.
No Side Effects
Atypical antidepressant bupropion hydrochloride--brand name Wellbutrin--is the antidepressant that causes the least sexual dysfunction, perhaps because it works by increasing dopamine as opposed to serotonin levels.
- The Merck Manual
- "Counseling Boys and Men with ADHD," George Kapalka; 2010
- "ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment," Margaret Weiss, Lily Trokenberg Hechtman and Gabrielle Weiss; 1999
- "Practical Management of the Side Effects of Psychotropic Drugs," Richard Balon; 1999
- "Male Sexual Dysfunction: Pathophysiology and Treatment." Fouad R. Kandeel; 2007