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Depression Drug's Side Effect Has Users Aroused

November 07, 1995|JOHN SCHWARTZ | THE WASHINGTON POST

A drug used for the treatment of depression seems to have a remarkable effect on some people who take it: When they yawn, they have an orgasm.

Yes, men and women alike.

Yes, really.

The "yawngasm" effect is no doubt quite a boost to the antidepressant qualities of the drug, clomipramine (marketed under the brand name Anafranil by its manufacturer, Ciba Pharmaceuticals).

One woman in a Canadian study of the drug's "unusual" side effect asked, according to researchers, "how long she would be 'allowed' to take the drug." She "sheepishly admitted that she hoped to take the medication on a long-term basis." She even found that she could induce an orgasm by deliberately yawning.

With the kind of wry understatement rarely seen in medical literature, the researchers concluded that the side effect "can influence patient-compliance with the prescribed medication regimen."

Go ahead. Yawn. Now, don't you feel cheated?

Before you line up for your prescription, it's worth noting that other patients report clomipramine side effects that are not quite as entertaining. In clinical trials, 42% of men taking the drug--often prescribed to treat obsessive-compulsive disorder--experienced what the company terms "ejaculatory failure," and 20% experienced impotence.

Thus, clomipramine is a little like a pharmacologic version of "The Lady or the Tiger?": You might get something very, very bad, or something very, very good.

About 85% of those men on the drug who developed sexual dysfunction "chose to continue on Anafranil so that they could continue to get the benefits of the therapy," said Linda Mayer, a patient Ciba spokeswoman who has had to do an awful lot of talking about orgasms lately.

Those using the drug who, to paraphrase Mel Reynolds, hit the Lotto, are few. Mayer, however, could not give specific numbers. She said the occurrence is "rare"; when asked to quantify, she responded that "rare is rare."

The Food and Drug Administration could shed little more light on the frequency of the yawngasm effect. The FDA's database for reporting side effects is geared toward the tragic and is ill-suited to tease out instances of unexpected pleasure. Still, the agency has received a handful of clomipramine reports in recent years, including at least one that mentions "spontaneous orgasm while yawning."

Medical experts can't explain the side effect, although some have voiced theories. Yawning is a complex physiological activity that spurs alertness by bringing a surge of fresh, oxygenated blood to the brain and causes the release of stimulatory neurotransmitters--the chemicals that send signals between brain cells.

Researchers have noted that the hormone ACTH (a pituitary hormone that stimulates steroid production) induces stretching and yawning--as well as spontaneous erections and ejaculation--when injected into the cerebrospinal fluid of mammals, and so might be somehow involved in the effect.

The amazing thing to Ciba's Mayer is the timing of this recent surge of interest.

"We were surprised to be getting calls on this all of a sudden," she said, since the scientific paper first describing the unusual side effect appeared more than a decade ago.

*

The story surfaced in August, always a slow news month. A 1983 paper from the Canadian Journal of Psychiatry was revived and posted in an online discussion group that deals with "urban legends" such as poodle-in-microwave stories. An editor at the British magazine New Scientist wrote it up, snappy and short. Then in a media version of a sports arena "wave," Reuter distributed a wire story that relied heavily on the New Scientist article, which was picked up by National Public Radio, which was followed up by CBS News and "Hard Copy."

None of them, according to Mayer, mentioned that they were peddling old news.

The celebrated side effect underscores an important fact about the medicines we take: Although patients and even doctors often see drugs as "magic bullets" that knock out a single symptom and leave the rest of the body alone, "There is no drug out there that doesn't have side effects," said David Flockhart, a pharmacologist at the Georgetown University School of Medicine who has studied the drug and even taken it as part of his research.

No luck for Flockhart, by the way; he reports that the single dose he took knocked him out for two hours and then left him seriously disoriented for a while. "I never took another dose," he said.

*

What if the use of clomipramine catches on? This could be the future:

* Warren Christopher appears as People magazine's annual "Sexiest Man Alive" cover boy.

* Millions flock to lectures on condo time shares.

* The next Ken Burns series on PBS gets rated X.

* Club Med opens its latest retreat--in Lapland.

* CBS and Fox in bidding war for TV rights to chess championships.

* Tina Brown's New Yorker returns to those 30,000-word articles on wheat.

* The Unabomber manifesto sold in plain brown wrapper.

* "Ladies and gentlemen, President Lamar Alexander."

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