antidepressants and female sexual dysfunction

Last edited 03/2023 and last reviewed 03/2023

Antidepressants and Female Sexual Dysfunction
  • study evidence shows that those with diagnoses of depression had a 50% to 70% risk for development of sexual dysfunction, even after adjusting for common comorbidities (1)
    • prevalence of sexual dysfunction in patients with major depression is high
    • antidepressant drugs appear to aggravate such problems, with certain classes of drug better tolerated than others

  • relative to men, women are at increased risk for depression and anxiety, as well as increased risk of sexual dysfunction (2)
    • sexual dysfunction is more prevalent for women (43%) than men (31%)

  • antidepressants and sexual dysfunction (3)
    • evidence shows that rates of sexual dysfunction attributable to antidepressants were approximately 40%, rates of sexual dysfunction associated with placebo were approximately 14%

    • sexual dysfunction is a common side effect of antidepressants, particularly of selective serotonin reuptake inhibitor (SSRIs) and serotonin norepinephrine reuptake inhibitor (SNRIs) medications (4)

    • wide variability across studies, antidepressant types, and phase of sexual response: for example, only about 2% of patients taking bupropion reported arousal dysfunction compared with about 82% of patients taking citalopram

    • most commonly reported adverse sexual effects in women taking antidepressants are problems with sexual desire (72%) and sexual arousal (83%)

    • approximately 42% of women taking selective serotonin reuptake inhibitors report problems having an orgasm

    • although men generally report higher rates of antidepressant-related adverse effects in sexual desire and orgasm, women are more likely to report sexual arousal dysfunction, particularly when taking selective serotonin reuptake inhibitors

    • onset of adverse sexual effects (across all phases) occurs within about 1 to 3 weeks of initiating a treatment regimen, whereas the antidepressant effects do not consistently appear until approximately 2 to 4 weeks after starting a medication

    • management of adverse sexual effects
      • a thorough assessment will focus on (4):
        • eliminating confounding factors for sexual dysfunction, eg, age or alcohol/substance use
        • excluding a comorbid physical complaint, eg, side effects of drugs used to manage diabetes or hypertension may be a cause of sexual dysfunction
        • excluding ongoing, or residual, symptoms of depression

      • pharmacological (dose reduction, drug discontinuation or switching, augmentation, or using medications with lower adverse effect profiles)
        • evidence supports starting treatment with an antidepressant that has a better adverse sexual effect profile, such as bupropion or mirtazapine, particularly in patients concerned about their sexual functioning and in those with sexual dysfunction at baseline (3)
        • study evidence has shown that switching to vortioxetine, an antidepressant with a multimodal mechanism of action, was associated with significant improvements in sexual function scores compared with switching to escitalopram, while maintaining antidepressant efficacy (3)
        • may include switching from an SSRI to non-SSRI antidepressant (4)
        • is evidence from systematic review of randomized, controlled trials into the management of antidepressant-induced sexual dysfunction that the addition of sildenafil will improve erectile dysfunction in men (4)
          • benefit to women has yet to be comprehensively proven

      • behavioral (exercising before sexual activity, scheduling sexual activity, vibratory stimulation, psychotherapy)

      • complementary and integrative (acupuncture, nutraceuticals)

      • or some combination of these modalities

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