From the Guidelines
It's concerning that you're experiencing a significant decrease in sexual desire even three years after stopping amitriptyline, and I strongly recommend consulting with a healthcare provider for a thorough evaluation to determine the underlying cause of this issue. While amitriptyline can cause sexual side effects like decreased libido during treatment, these effects typically resolve within weeks to months after discontinuation 1. The persistence of your symptoms suggests other factors may be involved, such as underlying health conditions (like hormonal imbalances, depression, or other medical issues) or possibly other medications you might be taking.
Some key points to consider:
- Hormonal imbalances can contribute to decreased libido, and testing for hormone levels may be necessary 1.
- Certain antidepressants, including SSRIs, can cause post-SSRI sexual dysfunction (PSSD) with symptoms persisting after discontinuation, although amitriptyline is a tricyclic antidepressant rather than an SSRI 1.
- Lifestyle modifications, such as smoking cessation, weight loss, and increased physical activity, can improve erectile and sexual function 1.
- Treatment for sexual dysfunction should include a multidimensional approach, addressing underlying issues and potentially involving referrals to specialists, such as urologists or sexual health specialists 1.
I strongly advise against self-medication and emphasize the importance of proper diagnosis for effective treatment. Your doctor may order blood tests to check hormone levels and evaluate other potential causes, and they may consider referral to a specialist in sexual health if appropriate. By working with a healthcare provider, you can determine the best course of action to address your decreased sexual desire and improve your overall quality of life.
From the Research
Possible Causes of Lowered Sexual Desire
- The use of amytriptiline, also known as amitriptyline, has been associated with sexual dysfunction, including decreased libido 2.
- A systematic review of the literature found that amitriptyline impacted arousal and libido more than orgasm and ejaculation in male patients, but mainly libido in female patients 2.
- The frequency of sexual dysfunction (SD) in patients taking amitriptyline was found to be 5.7%, with SD being six-fold higher in men than women 2.
- Another study found that sexual dysfunction is a frequent, potentially distressing, adverse effect of antidepressants, including amitriptyline, and a leading cause of medication non-adherence 3.
Factors Influencing Sexual Desire
- The causes of decreased libido are complex and multifactorial, requiring attention and a careful history to isolate the primary origin 4.
- Dissatisfaction with the relationship or marriage is the most common factor in patients with depressed desire, but organic causes must also be considered 4.
- Hormonal imbalances, such as hypogonadism, can also contribute to decreased libido, and treatment with testosterone replacement therapy has been shown to improve libido and erectile function 5.
Long-Term Effects of Amitriptyline on Sexual Desire
- The study found that the frequency of SD in patients taking amitriptyline gradually decreased at 8 weeks after treatment 2.
- However, it is possible that the effects of amitriptyline on sexual desire can persist even after treatment has stopped, as seen in the case of post-SSRI sexual dysfunction 3.
- More research is needed to fully understand the long-term effects of amitriptyline on sexual desire and function.