New directions in the treatment of antidepressant-induced sexual dysfunction

This article reviews options in the treatment of antidepressant-induced sexual dysfunction (SD).

With adoption of structured interviews concerning sexual function, researchers have become increasingly aware that a substantial proportion of patients experience untoward sexual side effects from their antidepressants. As many as half of patients treated with selective serotonin reuptake inhibitors report delayed orgasm (ejaculation), and virtually all patients treated with clomipramine experience anorgasmia. Treatments proven to be effective include yohimbine, sildenafil citrate, buspirone, or other adjuncts, or a temporary drug holiday. SD is most effectively diagnosed and treated in the setting of an empathic physician-patient relationship, which includes frank discussions about sexuality.

Although depressed patients do care about their sexual function, they may be reluctant, for fear of embarrassment, to report SD spontaneously to their physicians. SD is probably underreported and may result in covert noncompliance and attendant relapse into depression. Physicians thus need to assess sexual function during initial evaluation and throughout treatment. The importance of sexual function to sexually active patients with major depression should be weighed carefully when planning antidepressant therapy. A number of viable options exist to prevent or treat SD, including use of relatively new or novel antidepressants and appropriate adjunctive regimens.