Major depressive disorder, antidepressants, and sexual dysfunction

J Clin Psychiatry. 2006:67 Suppl 6:33-7.

Abstract

Sexual dysfunction is a common problem with a number of causes, including psychosocial factors, general medical illness, psychiatric disorders, and psychotropic and nonpsychiatric medications. It is especially prevalent among patients with poor emotional health and has been strongly associated with antidepressant medications. Selective serotonin reuptake inhibitors (SSRIs) in particular have demonstrated a higher incidence of sexual dysfunction than other antidepressants that work through different mechanisms of action. Further supporting the relationship between sexual dysfunction and antidepressant mechanism of action, data from a number of studies indicate that bupropion, nefazodone, and mirtazapine alleviate symptoms of sexual dysfunction and are as effective as SSRIs at controlling depressive symptoms. Although a number of strategies besides drug substitution have been utilized to help manage antidepressant-induced sexual dysfunction, many patients remain suboptimally treated; as many as 42% of patients were found to passively wait for spontaneous remission. The addition of antidotal therapy has been proven to be among the effective management strategies for sexual dysfunction. However, due to a lack of systematic data, additional studies are warranted to further investigate these findings.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / pharmacology
  • Antidepressive Agents / therapeutic use
  • Antidepressive Agents, Second-Generation / therapeutic use
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Bupropion / therapeutic use
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / psychology
  • Humans
  • Mianserin / analogs & derivatives
  • Mianserin / therapeutic use
  • Mirtazapine
  • Piperazines
  • Sexual Dysfunctions, Psychological / chemically induced*
  • Sexual Dysfunctions, Psychological / drug therapy*
  • Triazoles / therapeutic use

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Second-Generation
  • Antidepressive Agents, Tricyclic
  • Piperazines
  • Triazoles
  • Bupropion
  • Mianserin
  • nefazodone
  • Mirtazapine