Management of Antidepressant-Induced Sexual Dysfunction: A Literature Review

Although selective serotonin reuptake inhibitors (SSRIs) are the mainstay of treatment for various psychiatric conditions, including but not limited to major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, and bulimia nervosa, sexual side effects from these medications are common. These side effects include decreased libido, difficulty with arousal and erection, and delayed or absent orgasm, which can be troubling for many patients and impact adherence to treatment and quality of life. This is an important distinction from decreased libido that can be seen in the natural course of depression; the sexual dysfunction discussed in this paper is due to an adverse effect of SSRIs. The goal of this narrative review is to explore the effectiveness of switching antidepressant therapy or adding adjunctive medications or herbal supplements in alleviating antidepressant-induced sexual dysfunction (AISD). An electronic literature search was performed on PubMed to identify full-text, English-language articles that discussed antidepressant-induced sexual dysfunction (AISD). Selected articles were published between 1996 and 2023. Replacing one antidepressant class for another with a more favorable side effect profile (e.g., mirtazapine, nefazodone, and vortioxetine) may be effective for some patients, especially if the initial antidepressive treatment was not sufficient in controlling the symptoms caused by the primary mental illness. Several adjunctive medications and supplements also show promise in the management of AISD, including bupropion and saffron (Crocus sativus). Findings surrounding other adjunctive treatments are promising, though more robust studies are needed. Evidence for switching to vilazodone to treat AISD is conflicting, as is data surrounding the effect of Ginkgo biloba on AISD. Data surrounding AISD management is increasing, but remains relatively scarce. Further studies are necessary to understand AISD's pathophysiology and current interventions. Development and use of other drugs, supplements, and nonpharmacological agents should be explored in this patient population to broaden effective management options for AISD.