¿Problemas sexuales al tomar antidepresivos?
¡Cuántas veces he atendido las quejas con respecto a la pérdida de apetito y las dificultades para alcanzar el orgasmo de mis pacientes cuando están tomando antidepresivos! La inmensa mayoría de los antidepresivos más utilizados tienen efectos secundarios en este área y reducen notablemente tanto las ganas de sexo como la capacidad de disfrutar con el mismo.
Por fin comienza a investigarse sobre cómo reducir este importante inconveniente. Quiero compartir el abstract de un interesante artículo sobre cómo mejorar la vida sexual de las mujeres que toman antidepresivos. Articulo publicado en Neuropsychopharmacology and Neuroscience Group del Dr. Luis Mariani.
Exercise Improves Sexual Function In Women Taking Antidepressants
Depression and Anxiety Journal
Background
In laboratory studies, exercise immediately before sexual stimuli improved sexual arousal of women taking antidepressants [1]. We evaluated if exercise improves sexual desire, orgasm, and global sexual functioning in women experiencing antidepressant-induced sexual side effects.
Methods
Fifty-two women who were reporting antidepressant sexual side effects were followed for 3 weeks of sexual activity only. They were randomized to complete either three weeks of exercise immediately before sexual activity (3×/week) or 3 weeks of exercise separate from sexual activity (3×/week). At the end of the first exercise arm, participants crossed to the other. We measured sexual functioning, sexual satisfaction, depression, and physical health.
Results
Exercise immediately prior to sexual activity significantly improved sexual desire and, for women with sexual dysfunction at baseline, global sexual function. Scheduling regular sexual activity significantly improved orgasm function; exercise did not increase this benefit. Neither regular sexual activity nor exercise significantly changed sexual satisfaction.
Conclusions
Scheduling regular sexual activity and exercise may be an effective tool for the behavioral management of sexual side effects of antidepressants.
Division of Medicine
Director of SINEWS MTI
Founding Partner
Psychiatrist
Children, adolescents and adults
Languages: English and Spanish
The battle over homework: the guidelines to successfully end
At SINEWS, we advise parents to imagine that they are a coach. A coach doesn’t run with the player, nor eat the same calories, nor by any means suffer the same injuries. A trainer has two fundamental functions: organize and advise the athlete with the objective of attaining the best performance.
The concept of performance is very important.
In this country, we have a productivity problem and that problem can begin to be solved by educating in efficiency. It is very important that we begin to adapt positions that seems radical like advising moms and dads to not allow their son/daughter to finish their homework if they exceed the amount of time in which they were meant to done.
At SINEWS we are against kids not having time to play- they cannot enjoy their free time as they wish, but above all, we want to prevent that they become accustomed to “warming the seat.”
Some frequent mistakes during homework time are:
- Sitting down in a chair next to our son/daughter (this gesture transmits many negative messages: they don’t know how to do it alone, don’t worry, I’ll take care of it, it is not your responsibility- it’s ours…) Don’t give them the fishing rod- show them how to fish.
- Correcting exercises at home. It is proven that we all learn from our mistakes. The objective is not to do the exercises perfectly- it is to try to do them in order to be aware of our difficulties. The teacher dedicates time in class to go over homework where he/she attends to and takes care of this task much better.
- Allow kids to dedicate the entire afternoon to study and do homework.
But, let’s go back to the model of the trainer. This concept marks the difference between doing homework with our children and supervising that they get it done.
In the case of children who are schooled in a language that the parents do not dominate, this model is the solution that allows our children to not lose the opportunity to become bilingual. We don’t need to know English or German because we don’t do homework with them.
Some guidelines to help us follow this model are:
- The sacred agenda: get our children used to having a school agenda or a little notebook always on their desk in order to write their homework, lessons to study, work to hand in and dates of upcoming tests.
- Allow them (within limits) to have time to rest after school. It is better if it is with their friends or a park close by where they can play and move a little bit (this improves their concentration when they come home.) It could be during the same time as a sports or hobby-related after school activity.
- Work conditions: just like one doesn’t train for soccer in skates, or after inhaling a dish of cocido, to study, it is necessary to: work in our room or a place in the house that is not heavily trafficked, turn off the cell phone and forget about tuenti. We will take much longer to finish and have time to disconnect afterwards.
- Organizing work:
- When we get home, we should go over with them what they have to do and ask them how much time they think that they need for each assignment. (For example, math: 10 mins, read the science chapter and write an outline: 20 mins…) A clock on top of the table will help our son/daughter control time.
- Decide the order of the tasks: start with a short one so that the child can get an easy one underway in order to warm up and in continuation do the most difficult one in order to get it over with. Reserve time at the end (before the break and when finishing) something light and entertaining.
- Establishing breaks: Knowing when it’s time to rest will make the child not feel like they have a long hurdle ahead of them. A reference point: it is not possible to maintain attention in uninterrupted form for more than 40 mins.
- Supervise work and encourage: It’s about facilitating that the child completes the established time frame to do work. (We come near their room to ask them how it’s going, if he has a question, we decide if it’s better for him to ask the teacher or resolve it ourselves, we advise him that his 10 minutes are up…), confirming that they have done the exercise and outline (without correcting!).
- At some point, we have to confirm with him/her that they have corrected their homework from the day before in class ask where they made mistakes.
- We encourage and reward their effort and efficiency just as a coach would, leaving them feel confidence in themselves and their ability to do their work well and fast. We play a bit with them (even PSP or Wii), we let them connect with their friends or watch TV…
In order to do this, it is not necessary to know English nor have a high school level in Math.
Of course, things get complicated if our son/daughter has some difficulty learning and is schooled in another language. They could need extra help and we may not have the sufficient dominance in their academic language. In these cases, it would be ideal to have a support teacher who will show our son/daughter how to study and help them in the language that they are being schooled.
At SINEWS we offer specialized academic support at home and in various languages such as English or German.
Division of Medicine
Director of SINEWS MTI
Founding Partner
Psychiatrist
Children, adolescents and adults
Languages: English and Spanish
Estoy embarazada, tengo crisis de ansiedad y me han recetado medicación ¿Puede afectar ésto al bebé?
Question
Mi consulta es la siguiente, antes hago una pequeña introducción sobre las causas.
El 10 de Octubre de este año, he perdido un bebé en el 7 mes de gestación. A los 6 meses con la pérdida posiblemente no superada por lo que estoy viviendo ahora, me he quedado embarazada de nuevo, coincidiendo en el mismo mes y casi fecha en que me había quedado la primera vez, es como vivir un embarazo paralelo mes a mes.
A partir de la semana 14 de embarazo he comenzado con crisis de ansiedad, para ellas en principio mi ginecólogo me prescribió lorazepam. Pero no todos los días me funcionaba a no ser que tomara mucha cantidad diaria, lo cual, no me atrevía a hacer y había días que me llegaron a dar 3 y más crisis de ansiedad seguidas. Con lo cual, mi médico de familia me remitió a psiquiatría por urgencias, uno de estos días de crisis.
El psiquiatra me ha recetado fluoxetina (20 mg) en combinación con lorazepam (medio cada 8 horas,pero yo intento tomar medio por la mañana y medio por la noche),hasta q la fluoxetina en un mes me haga el efecto absoluto. Después como mucho dejar medio lorazepam para dormir, si lo necesito. Y a ser posible en el octavo mes ir retirando paulatinamente. Él me dijo que no me preocupara, que la medicación no haría daño al feto.
Incluso si no consigo retirarla antes del parto.Pero yo cada día al tomarla, me siento culpable y no puedo evitar llorar. ¿De verdad no hago daño a la niña con la medicación?. Y lo que más me preocupa, aunque al nacer y de bebé parezca q está bien, ¿Cuándo vaya creciendo tendrá un desarrollo psicomotriz,intelectual,psicológico,de crecimiento, de comportamiento, neurológico,……normal, o está medicación le ha podido afectar a su cerebro ahora en desarrollo y darnos cuenta de más mayor?
Todo esto me tortura día a día. El problema es que mi grado de ansiedad y miedos era tan alto, que reconozco que sin medicar también la podía perjudicar.
Muchas gracias por anticipado.
Answer
Estimada futura mamá:
Es muy natural que tengas ansiedad después de tu pérdida.
Sin embargo, cada gestación es distinta y la probabilidad de que todo salga bien es altísima. Sobre tu preocupación con respecto a la medicación, tengo dos tipos de información que pueden resultarte útiles:
Primero *mi propia experiencia profesional* con antidepresivos y en particular Fluoxetina, ya que yo sólo utilizo dos medicamentos de este tipo durante la gestación y la Fluoxetina es mi preferido.
Durante mis 13 años de experiencia profesional he prescrito este fármaco a varias decenas de mujeres embarazadas. Muchas de ellas eran pacientes mías antes de quedarse encinta y han seguido a tratamiento conmigo posteriormente, con lo que conozco los detalles de cómo van creciendo y desarrollándose sus bebés.
Es verdad que no son miles de casos, pero NUNCA he visto ningún niño o niña con malformaciones ni NINGÚN problema de desarrollo. En mi consulta tengo guardadas muchas fotos de estos niños que me van ofreciendo las mamás para que su experiencia ayude a tranquilizar a otras mujeres con el mismo miedo que ellas tenían al comenzar a medicarse.
Por otro lado, los datos científicos:
Es necesario aclarar que la investigación respecto al riesgo de los distintos fármacos durante el embarazo no es totalmente fiable por un motivo obvio: no se pueden distribuir aleatoriamente los grupos de madres a estudio y proporcionarles a unas la medicina y a otras no y ver qué pasa. Ningún comité ético aprobaría un disparate así, claro está.
Sin embargo, con la información de la que se dispone actualmente, existe una clasificación internacional del riesgo de las medicaciones durante el embarazo que se puede consultar y en la que puedes encontrar ambas sustancias:
https://www.1aria.com/sections/activPreventivas/MedicamentosEmbarazo.aspx
En el caso de la Fluoxetina el grado de seguridad es muy aceptable y se tiene mucha experiencia. El mayor riesgo ocurre durante el primer trimestre en que se ha observado (sólo algunos estudios recientes, otros no han encontrado nada) un aumento muy leve de malformaciones cardiovasculares.
Decir esto sin indicar que la probabilidad de que tomando el fármaco se produzca un problema de este tipo sigue siendo minúscula puede alarmar.
Con la Fluoxetina también son importantes las últimas semanas antes del parto, se debe reducir la dosis al máximo o eliminar en el mes previo a dar a luz.
En el caso del Lorazepam, es la benzodiacepina que menos atraviesa la placenta, la que menos llega a la sangre del bebé. En líneas generales es una buena opción durante un tiempo limitado, hasta que la Fluoxetina comience a hacer efecto y se pueda retirar. Como todos los fármacos, es más seguro cumplido el primer trimestre. Estoy segura de que en cuanto llegues al mes de tratamiento con Fluoxetina la ansiedad estará mucho más controlada y podrás quitarte el Lorazepam sin esfuerzo.
Como conclusión decirte que miles de mujeres embarazadas necesitan tomar estas medicaciones y que cuando el médico (especialista en psiquiatría) indica el fármaco se puede confiar en que la relación riesgo-beneficio es positiva. Como tú muy bien dices, el propio estrés tiene un impacto físico con sus riesgos para el embarazo y las consecuencias para el bebé de afrontar un postparto deprimida también.
A este respecto, muchas investigaciones confirman que las mamás deprimidas no son capaces de estimular al bebé durante un período tan crítico para el desarrollo y que el vínculo madre-hijo se deteriora.
Relájate, toma tu medicación para estar mejor, para disfrutar de tu embarazo y para que cuando tu niña te conozca te encuentres bien.
Un abrazo y mis mejores deseos,
Dra. Orlanda Varela.
Division of Medicine
Director of SINEWS MTI
Founding Partner
Psychiatrist
Children, adolescents and adults
Languages: English and Spanish
Is it a frequent factor that bilingual children suffer more migrane attacks?
Question
Is it a frequent factor that bilingual children suffer more migrane attacks?
Answer
Dear Mr. Samuel,
I´ll begin with the conclusion:
There is no scientific evidence, at this point, that demonstrates a relationship between migraines and the use of more than one language.
As a doctor (psychiatrist, but doctor), when I read your question, I reviewed my knowledge of headaches. We know that there are genetic causes (there is a high probability of heredity), environmental causes (certain types of nutrients or hormonal factors such as menstruation, etc…), and triggers from certain mental activities (reading, writing, listening….)
Also, my knowledge of the bilingual brain lead me to believe that none of the changes that occur through the use of more than one language could affect the appearance of migraines. This is because bilingualism increases the density of connections and the distribution of linguistic activity in the brain (the areas used to communicate) but we haven´t detected changes in its structure nor in relation to its vascular or electrical functioning.
Next, I reflected upon on our experience:
After five years of attending to more than 1,000 bilingual families a year, we never proposed this question, nor has any family ever asked us about it. Therefore, according to our experience, we haven´t noticed a higher frequency or intensity of migraines in our bilingual patients (regardless of their age) versus monolingual patients.
Nevertheless, we weren´t satisfied by our experience, alone.
Our team searched through PubMed, the most important database of bio-sanitary publications in the world, without finding any results relating to migraines and bilingualism.
Finally, we contacted one of the most renowned bilingual experts in the world: Francois Grosjean. He confirmed that there is no higher prevalence nor frequency in migraines of bilingual people versus monolingual people.
In conclusion, it is more probable that there does not exist a relation between migraines and bilingualism. If it does, it has not been demonstrated, nor studied at this moment in time.
I hope to have been able to help you relieve this, “headache” and encourage you to continue educating your child/children bilingually without worrying about causing or worsening their migraines.
Warm regards and thank you for trusting us in resolving your doubt,
Dra Orlanda Varela
Child and Adults Psychiatrist
Partner and Cofounder at SINEWS Multilingual Therapy Institute
Division of Medicine
Director of SINEWS MTI
Founding Partner
Psychiatrist
Children, adolescents and adults
Languages: English and Spanish