Pharmaceutical management of sexual dysfunction in men on antidepressant therapy

ABSTRACT

Introduction

Sexual dysfunction (SD) and depression have a bidirectional relationship. The rising prescription of antidepressants, especially those with a serotonergic effect, is associated with increased SD. Sexual dysfunction reduces compliance and increases risk of recurrence of depressive episodes. Various strategies have been studied to manage antidepressant-induced SD.

Areas covered

This review covers the identification of symptoms of antidepressant-induced SD, prevalence of symptoms in association with commonly used antidepressants, and the main lines of management, with a focus on pharmacological strategies.

Expert opinion

The management of antidepressant-induced SD aims to reduce the unwanted sexual adverse effects while maintaining an acceptable control of depressive symptoms. It should implicate a multidisciplinary approach and determination of baseline sexual function and SD risk factors. In spite of several methodological issues, antidepressants can be divided into low- and high-risk categories with regard to the possibility of developing SD. In patients interested in sexual activity, it is recommended to start with low-risk antidepressants. Otherwise, encourage the patient to wait for tolerance and then switch to low-risk. In selected cases, dose reduction or a drug holiday may be applied. The adjunctive use of a PDE5i can help in a significant number of patients. Randomized controlled trials are needed to set high-level evidence-based recommendations.

KEYWORDS:

• antidepressant therapy
• depression
• sexual dysfunction

Article highlights

• Antidepressants have central and autonomic action and is associated with high risk of developing sexual dysfunction.

• The rate and severity of SD differ widely among antidepressants due to differential effect on central neurotransmitters.

• Treatment according to state of patient’s sexual activity and modification of concurrent treatment is a reasonable option to avoid adverse effect.

• Baseline sexual function and cardiovascular risk factors in addition to assessment of sexual adverse effects are important during the follow up period.

• Treatment of antidepressant-induced SD includes waiting for spontaneous remission, reducing dose, drug holidays, switching to lower risk drug, or adjunctive treatment with antidotes.

• The field of managing antidepressant-induced SD lack high-quality evidence. Further, many strategies that are currently used need to be re-investigated in wide scale randomized controlled trials.

Abbreviations

ED: Erectile DysfunctionEF: erectile functionSD: Sexual DysfunctionSF: sexual functionIHD: ischemic heart diseaseSSRI: selective serotonin reuptake inhibitorPDE5i: phosphodiesterase 5 inhibitorsCI: confidence intervalIIEF: international index of erectile function

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.