Abstract
Women's sexual response is certainly a composite of psychosocial and biological influences. Greater understanding of the biochemical mechanisms of action of psychotropic medications, particularly antidepressants, is useful in determining sexual side effects of these medications and how to treat them. Receptor binding of neurotransmitters may affect libido, arousal, and orgasm in women. Serotonin drugs, which increase prolactin release, can cause a decrease in sexual desire and inhibited orgasm by 5-HT2c and possibly 5-HTlb stimulation. Dopamine reuptake inhibitors may enhance desire. Possibly 5-HT3 blockers may also stimulate desire, as may 5-HT1a stimulation. Drugs that enhance nitric oxide (e.g., sildenafil) may potentiate arousal, while drugs that inhibit it (such as paroxetine) decrease arousal. Probably not every person has exactly the same receptor sensitivity, so some effects may outweigh others. Still, venlafaxine, nafazodone, bupropion, and mirtazapine are likely to cause less sexual dysfunction than paroxetine, citalopram, fluvoxamine, sertraline, and fluoxetine, in that order. It is important to take this information into consideration during any part of a woman's life, but particularly during the premenstrual period, pregnancy and postpartum, and menopause, when sexual dysfunction may already be more prevalent.