Sexual dysfunction associated with major depressive disorder and antidepressant treatment

Expert Opin Drug Saf. 2014 Oct;13(10):1361-74. doi: 10.1517/14740338.2014.951324. Epub 2014 Aug 22.


Introduction: There is a well-established relationship between sexual functioning and quality of life. Depression can cause sexual dysfunction (SD) and its treatment can often lead to restoration of sexual functioning. Use of antidepressants has also been associated with SD, with implications for treatment compliance and creation of further distress for the patient.

Areas covered: This review evaluates available information regarding SD related to both depression and antidepressant treatment, including literature up to June 2014. It includes eligible published studies that investigated antidepressant-associated SD (AASD).

Expert opinion: Depression and SD have a bidirectional association. When screening for depression, baseline sexual functioning should be assessed with validated rating scales. If sexual side effects develop with antidepressant treatment, management options include waiting for spontaneous remission, decreasing the medication dose, switching to an alternative drug or adding an augmentation agent or antidote. Research suggests that bupropion and newer antidepressants exhibit a more favorable SD profile compared with other antidepressants, especially selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors. Bupropion, mirtazapine and buspirone have been studied as augmentation agents/antidotes or substitution agents in management of AASD. Future studies validating genetic factors could enable personal genotyping to guide individualized treatment and also facilitate the development of enhanced therapeutic guidelines to avoid or manage AASD.

Keywords: antidepressant associated sexual dysfunction; major depressive disorder; selective serotonin reuptake inhibitors; serotonin and norepinephrine reuptake inhibitors; sexual dysfunction; treatment emergent sexual dysfunction.

Publication types

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

MeSH terms

  • Animals
  • Antidepressive Agents / administration & dosage
  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / therapeutic use
  • Depressive Disorder, Major / complications*
  • Depressive Disorder, Major / drug therapy
  • Genetic Predisposition to Disease
  • Humans
  • Medication Adherence
  • Practice Guidelines as Topic
  • Psychiatric Status Rating Scales
  • Quality of Life
  • Sexual Dysfunction, Physiological / chemically induced
  • Sexual Dysfunction, Physiological / epidemiology
  • Sexual Dysfunction, Physiological / etiology*


  • Antidepressive Agents