In 2015, the U.S. Food and Drug Administration (FDA) approved the use of the drug sildenafil (brand name Viagra) for the treatment of clinical anxiety.1 In response, the American Psychiatric Association, the Anxiety and Depression Association of America, and the Society of University Psychiatry published guidelines for the evaluation and treatment of patients with anxiety associated with sexual activity.2
Based on the limited clinical trial data at the time,3 the guidelines recommended against the use of Viagra in patients with severe anxiety disorders or those who were on opioid medication. However, the data supporting these recommendations were largely theoretical rather than clinical, and many people with anxiety experience some side effects when taking Viagra. Based on this, how can men with anxiety symptoms take Viagra? What are the potential side effects of Viagra in patients with anxiety?
Benefits Of TAKING Viagra
Although Viagra has been proven to be safe and effective for treating erectile dysfunction, men with anxiety generally experience benefits when taking the drug.4-7 These benefits include:
- Anxiety reduction
- Improved sexual function
- Anxiety relief during sexual activity
- Increased sexual desire
- Improved well-being
What Are The Side Effects Of TAKING Viagra?
Based on the limited data at the time,3 the risks associated with taking Viagra in patients with anxiety are minimal. Nevertheless, as with any new drug, there are theoretical risks that need to be considered, such as vasodilation (increased blood flow to the male genitals) and increased blood pressure, which could potentially lead to an increased risk of heart attack or stroke.3
Additionally, some people experience side effects when taking traditional anxiolytics (medications used to treat anxiety) with Viagra; namely, nausea, drowsiness, and dizziness.3 These effects are primarily due to the fact that sildenafil interacts with various sites in the brain that are also targeted by traditional anxiolytics (such as gamma-aminobutyric acid, serotonin, and dopamine).
Although the risks associated with taking Viagra in patients with anxiety appear minimal, it is still best to discuss this with one’s physician before starting any new medication, especially if one is already taking other medications for anxiety or depression. In this way, potential interactions between different medications can be considered, and additional risks and benefits can be weighed against one another.
How Does Viagra Work?
Many people assume that sildenafil works in a similar way to other medications used to treat erectile dysfunction, particularly the phosphodiesterase type 5 (PDE5) inhibitors tadalafil and vardenafil. In fact, sildenafil was originally developed to be an analog of vardenafil, and the two drugs were found to be highly effective in treating erectile dysfunction.8,9
PDE5 inhibitors are thought to increase the amount of “cGMP” (cyclic guanosine monophosphate) in the penis, which in turn results in increased blood flow to the corpora cavernosa and corpus spongiosum during sexual arousal. Inhibition of PDE5 has been shown to result in an increase of cGMP in multiple areas of the brain, including the hippocampus, dorsal striatum, and cerebral cortex.10 The latter two areas are responsible for sexual function and are thought to be involved in the mediation of anxiety related to sexual activity.10,11
Is There Any Difference Between Viagra And Other Prescription Drugs For Anxiety?
Although sildenafil is the first FDA-approved drug for the treatment of anxiety, it is not the only drug in its class. Drugs in this class have been shown to reduce anxiety when administered to patients, and some may even be more effective than sildenafil at treating anxiety associated with sexual activity.12-14
For example, vardenafil has been shown to be more effective than sildenafil at treating anxiety associated with sexual activity in a clinical trial.12 Additionally, in a study involving healthy men, vardenafil was linked with an improvement in anxiety and an increase in the strength of erections compared with placebo.12 Similarly, tadalafil was found to be more effective than sildenafil at treating sexual dysfunction in patients with anxiety.13
These studies suggest that vardenafil, tadalafil, and possibly even sildenafil could be considered as viable alternatives to treat men with anxiety due to their demonstrated efficacy. However, it is still important to rule out potential drug interactions and contraindications before choosing a medication from this class.
What Should I Tell My Sex Companion About My Anxiety?
Due to the risks of anxiety associated with sexual activity, men with anxiety generally do not wish to discuss their condition with their sex partners. However, those who are comfortable doing so can let their partners know about their condition to help improve their experience.15 Here are some suggestions: