A recent article published in Psychiatric Times reviews options for the management of antidepressant-induced sexual dysfunction. According to this review, sexual side effects may occur in 40% to 70% of patients treated with serotonin reuptake inhibitors (SRIs) and is a common reason for poor compliance with treatment and eventual discontinuation. When sexual side effects occur, they tend to emerge early, are persistent, and rarely resolve spontaneously.
While men most commonly experience premature ejaculation (31%), performance anxiety (18%), and low sexual desire (15%), the most common complaints in women are low sexual desire (32%), inability to achieve orgasm (26%), and sex not being pleasurable (23%). Because women are more vulnerable to major depression, experience greater severity of SRI-associated sexual side effects, and are more likely to use of SSRIs, there is a clear need for effective strategies for the management of treatment-emergent sexual side effects.
Case reports or open-treatment case series have indicated that certain agents, including bupropion, buspirone, mianserin, cyproheptadine, Ginkgo biloba, amantadine, and loratadine, may be effective for treating SRI-induced sexual side effects; however, only a small number of double-blind, placebo-controlled trials have addressed the management of SRI-associated sexual side effects and have generally not supported the use of these agents.
Dr. Nurnberg notes that the only agents that have shown efficacy for the treatment of sexual side effects are the selective type 5 phosphodiesterase inhibitors (PDE5Is). This class of medications includes sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra).
These agents have been shown to be effective for the management of sexual side effects in men; it improves not only erectile dysfunction but has positive effects on desire, delayed ejaculation/ orgasm, and overall satisfaction. At this time, the use of sildenafil and other PDE5Is for antidepressant-induced sexual side effects in women is off-label. Several studies have explored the use of PGE5Is in women with SRI-induced sexual dysfunction and have demonstrated that women receiving sildenafil (50 or 100 mg administered as needed before sexual activity) reported significant improvements in sexual dysfunction.
The evidence reviewed here suggests that the PDE5Is may effectively manage SRI-associated sexual dysfunction and support antidepressant treatment adherence in men and women. The message to physicians prescribing antidepressants or other medications with associated sexual dysfunction is to tell their patients not to stop the primary drugs if sexual adverse effects occur, but instead, encourage the patient to discuss these effects, and further assure them that these adverse effects can often be addressed without stopping medication.
Ruta Nonacs, MD PhD
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