SSRI Sexual Dysfunction
Sexual side effects are the most frequent antidepressant side effect reported by primary care patients. In a study involving 2,163 adults who had undergone at least eight weeks of treatment with antidepressants, 79% showed some degree of sexual dysfunction. Dysfunction varies from decreased libido to inability to obtain orgasm, and erectile difficulty.
In both men and women, antidepressant-induced sexual side effects largely result from increased serotonin (5-HT) neurotransmission via reuptake blockade of serotonin transporters. Antidepressants that primarily increase dopamine and norepinephrine neurotransmission produce markedly fewer sexual side effects.
This provides the rationale for treatment using bupropion and other agents that simultaneously increase norepinephrine and dopamine signaling. It also suggests the theoretical basis for developing novel antidepressants that increase 5-HT and dopamine signaling. These findings are clinically relevant for patients who develop sexual side effects. And also attain substantial clinical improvement or remission of depression with serotonergic agents.
Serotonergic antidepressants produce the highest rates of sexual side effects.
Other possible mechanisms for SSRI sexual side effects include decreased dopaminergic transmission, cholinergic and alpha-adrenergic blockade. And inhibition of nitric oxide synthase 1, and prolactin elevation.
The American Psychiatric Association recommends we need to ask men and women whether sexual side effects are occurring with these medications.
Sexual dysfunction is under-reported if it is not specifically examined by clinicians. Because patients will not report sexual side effects due to embarrassment or perhaps due to lack of recognition of those symptoms as medication-related.
The association between major depressive disorder and sexual dysfunction is bidirectional. Moreover, estimated prevalence rates of antidepressant-induced sexual side effects are very high for several antidepressants. But the estimation of true prevalence is complicated by the high prevalence of sexual dysfunction in all patients. With mood disorders and by the under-reporting of sexual side effects.
Baseline sexual functioning should be assessed with validated rating scales at the same time depression is evaluated.