Antidepressants and Sexual Dysfunction: Mechanisms and Clinical Implications

Abstract

Introduction: Depression is one of the more prevalent mental disorders in the United States, with estimates as high as 6.7% of Americans affected annually. Consequently, antidepressant use in the United States is also widespread. Both depression and its treatments are associated with sexual dysfunction (SD) in men and women, including orgasm and arousal problems, hypoactive sexual desire, premature ejaculation, erectile difficulties, and dyspareunia. Sexual dysfunction is frequently cited as a reason for nonadherence or discontinuation of treatment for depression. Aim: The objective of our review is to aid physicians, including primary care physicians, psychiatrists, and urologists/gynecologists, in the multidisciplinary approach to treating patients with SD and depression. Methods: Our review focuses on articles published within the last 10 years on SD and depression in adults, with an emphasis on the relationship of treatments for depression on SD. Summary: Different classes of antidepressants vary in their ability to cause sexual side effects. Results: Treatment with selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) is associated with SD. Use of other antidepressants, such as bupropion, mirtazapine, nefazodone, and vilazodone, have been associated with less SD compared with SSRIs; furthermore, some of the mentioned antidepressants have been used in the treatment of SD induced by SSRIs and SNRIs.