Depression, antidepressants and sexual functioning in men

In recent years, increased attention has been focused on antidepressant-associated sexual dysfunction, largely because of the widespread use of serotonin specific reuptake inhibitors (SSRIs) and the recognition that their side-effects can have a negative impact on treatment compliance. Yet the relationship between the depressive illness, the antidepressant medication used to treat it and treatment of emergent sexual dysfunction is complicated and multifactorial. For example, when a depressed man treated with an antidepressant medication seeks treatment for a sexual dysfunction, the clinician is faced with the responsibility of deciphering whether the sexual dysfunction is the result of a pre-existing medical disorder, a symptom of depression or a treatment-emergent adverse effect of antidepressant medication. In order to do this, the clinician needs to be knowledgeable about the salient aspects of normal sexual functioning, and the influences of age, depression and antidepressant medications. In this review, we discuss normal sexual functioning and dysfunction in men, the relationship between depression and sexual functioning, possible mechanisms for SSRI-associated sexual dysfunction and evolving pharmacologic treatment strategies.