Long Term Safety and Efficacy of Ginkgo Biloba Extract in the Treatment of Anti- Depressant-Induced Sexual Dysfunction

 Alan Jay Cohen, M.D. 
Diplomat of the American Board of Psychiatry and Neurology, Assistant Clinical Professor of Psychiatry at the University of California, San Francisco

Introduction:

Recent reports have described a new treatment approach for
antidepressant-induced sexual dysfunction (ASD) (Cohen, 1996,1997). The discovery of Ginkgo biloba extract's (GBE) ability to reverse antidepressant-induced sexual dysfunction was reported in patients studied over a 6-8 week period. No long term observations have been made for safety and efficacy in patients taking Ginkgo biloba extract (GBE) for ASD.

The experience of five patients who have used GBE for the treatment of ASD safely and effectively over 24 months is described. 

Methods

Five patients treated for DSM-IV diagnosis of Depression with an SSRI (fluoxetine or sertraline) developed sexual dysfunction during the course of their treatment. The three men in the study reported anorgasmia, decreased libido, and erectile failure. The two women had anorgasmia, delayed orgasm and decreased libido. Each patient was started on a course of GBE 60 mg. (50:1 extract) twice a day. There were no contraindications for the use of GBE, such as use of anticoagulants, coagulopathy,nor allergy to GBE. 

Doses were titrated to 120 mg. twice a day over a 4 week period. Patients were assessed by clinical interview and subject reporting on the following parameters: change in libido, ability to achieve orgasm, and erectile competence.

Results

Sexual dysfunction was effectively reversed by GBE 240 mg. per day in each patient. Each patient chose to continue the treatment for an open ended period with clinical monitoring of symptoms. Three patients described brief periods of discontinuation of the GBE with a concomitant return of the ASD. The male patients, ages 45, 42, and 38, each had a
single episode of non- psychotic major depression. The women, 48 and 49, had recurrent, unipolar depression, non-psychotic. Both women also had Hashimoto's thyroiditis. Their thyroid indices were normal on replacement T-4. 

There were no other medical conditions, nor substance abuse problems. Adverse reactions to the GBE were minimal and did not disrupt the treatment. Some gastro- intestinal complaints and lightheadedness were reported. No abnormal bleeding nor bruising occurred.

Discussion:

GBE has been used for centuries in traditional Chinese medicine. It has recently been described to be beneficial to dementia patients in a 52 week study (Lebars, et al 1997). Cohen(1997) described its use in the treatment of ASD. This is the first documented report of the long term safety and efficacy of GBE in the treatment of ASD. The mechanism of
action of GBE involves inhibition of platelet- activating factor(PAF), prostaglandin agonist effects, and neuroreceptor modulation( Braquet 1991, Kleijnen !992). 

Conclusion: 

ASD is a major problem in clinical practice (Gitlin 1997). Treatment compliance may suffer with resultant morbidity and mortality. In this small series of patients GBE appears to be a safe and effective long term remedy for ASD. However, further controlled trials are recommended. 

References:

1. Cohen, A.(1996) "Treatment of Antidepressant- Induced Sexual Dysfunction with Ginkgo Biloba Extract" New Research Report from The Proceedings of The American Psychiatric Association Annual Meeting Abstract #716 . 
2. Cohen, A., Bartlik, B. (1997) " Treatment of Sexual Dysfunction with Ginkgo Biloba Extract" Scientific Reports -Paper Session from The Proceedings of The APA Annual Meeting .
3. LeBars, P., et al. (1997) "A Placebo-Controlled, Double-Blind, Randomized Trial of an Extract of Ginkgo Biloba for Dementia" JAMA; 278: 1372-1332. 
4.Braquet, P. Hosford,D.(1991) "Ethnopharmacology and the Development of Natural PAF Antagonists as Therapeutic Agents" J. Ethno- pharmacology, ; 32:135-139. 
5. Kleijnen,J. , Knipschild, P. (1992) "Ginkgo Biloba" Lancet ; 340:1136-39. 
6. Gitlin, M. (1997) "Sexual Side Effects of Psychotropic Medications" in Psychiatric Clinics of North America , Annual of Drug Therapy vol. 4 pg. 61-90.

Courtesy of Alan J. Cohen M.D.