Selective serotonin reuptake inhibitor-induced sexual dysfunction: clinical and research considerations

Antidepressants, including the tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs), cause sexual dysfunctions such as decreased sexual desire, erectile difficulties and delayed ejaculation. Such sexual side-effects affect quality of life and may result in non-compliance with medication and the associated risk of recurrence of depression. Depression may also be associated with sexual disturbances, especially reduced libido. It is important to unravel the origin of sexual problems during depression and determine whether they were present before depression started, whether they are associated with the depression, or whether they are an effect of medication. Baseline measurements, objective measures and accurate instruments are all essential for scientific research into the sexual side-effects of antidepressants. Various human factors that may influence measurements of sexual behaviour must also be taken into account. Considering all these provisos, the ejaculation delaying effects of the SSRIs (fluvoxamine, fluoxetine, paroxetine and sertraline) have been investigated in a double-blind, placebo-controlled study in men with rapid ejaculation. The SSRIs were given at their recommended daily dosages for 6 weeks and the men measured their intravaginal ejaculation latency time at home using a stopwatch. The results showed a clear difference between the SSRIs, fluvoxamine having by far the least disturbing effect on ejaculation.