A Comparison of Sexual Side Effects of Antidepressants With and Without Naltrexone

ABSTRACT

Objective: The aim of the study was to compare the rate of sexual side effects of the selective serotonin reuptake inhibitor paroxetine versus the tricyclic antidepressant desipramine and to examine the effect of co-prescription of naltrexone on sexual side effects among participants in a randomized clinical trial. Methods: This was a secondary analysis (N = 88) of veterans who participated in a 12-week trial. All veterans were randomized into one of four treatment groups: (a) desipramine/naltrexone, (b) desipramine/placebo, (c) paroxetine/naltrexone, and (d) paroxetine/placebo. The main outcome measure was the frequency of sexual side effects consisting of “decreased sex drive” and/or “impotence” reported by veterans at each weekly visit. Results: Approximately 61% of the veterans reported sexual side effects at least once during the trial, and 26.4% reported sexual side effects throughout the study. There were no significant differences in the frequency of sexual side effects among the four treatment groups. The results were similar when the comparison was made between the two antidepressant groups. There were no significant differences in the reporting of sexual side effects between those receiving desipramine and paroxetine. Also, the comparison between naltrexone and placebo did not alter the results. Conclusions: This is the first study to compare frequency of sexual side effect reporting between paroxetine and desipramine. We found no statistically significant differences in sexual side effect reporting between the two antidepressants. Also, the addition of naltrexone did not show any beneficial effect on the sexual side effect profile.

KEYWORDS:

• Sexual side effects
• paroxetine
• desipramine
• naltrexone
• PTSD
• alcohol use disorder
• comorbidity

Acknowledgments

This study was conducted with the invaluable help of the VA VISN I MIRECC Study Group, Department of Psychiatry, Bedford VAMC: Marylee Losardo, MSPA, and Barbara E. Rofman, RN, MS; Department of Psychology, Bedford VAMC: Charles E. Drebing, PhD; Department of Psychiatry, VA CT Healthcare, West Haven Campus: Kathryn Keegan, RN, Diana Limoncelli, BA, Colette McHugh-Strong, JD, Alison Oville, BA, Christine Sicignano, BA, J. Serrita Jane, PhD, and Erin O'Brien, PsyD. We also wish to thank Jessica Dasher, BA, and J. Serrita Jane, PhD, for their editorial help with this manuscript.

Disclosures

Drs. Tapa and Ralevski have no conflict of interest to report. Dr. Petrakis has served as a consultant for Alkermes over the past year.

Funding

Support was provided by VISN I Mental Illness Research Education and Clinical Center (PI: Rounsaville), the VA Alcohol Center (PI: Krystal), and the Clinical Neuroscience Division of the VA National Center for PTSD (PI: Krystal).