Treatment-emergent Sexual Dysfunctions Due to Antidepressants: A Primer on Assessment and Management Strategies

Overview

Journal Indian J Psychiatry

Specialty Psychiatry

Date 2024 Aug 5

PMID 39100123

Authors

Adarsh Tripathi

Aditya Agrawal

Mohita Joshi

Affiliations

Soon will be listed here.

Abstract

Antidepressants (ADs) are among the most commonly prescribed drugs worldwide. Persons with mental illness taking ADs commonly report sexual dysfunction (SD) related to treatment. A brief discussion on the neurobiology of sexual functioning and mechanism of treatment-emergent SD (TESD) was performed. The incidence of prevalence of TESD in various studies has been reviewed. TESD impacts patients as it frequently leads to nonadherence, while psychiatrists have challenges in proceeding forward with treatment in such patients. Assessment of patients with suspected TESD is described with a focus on practical tips for clinicians. Five strategies (watchful waiting, drug holiday, downward titration, switching, and add-on therapy) to manage TESD have been extensively discussed with evidence in the literature. Each strategy comes with its own bag of advantages and drawbacks, which have been pointed out for simplicity. A detailed discussion on individual pharmacological strategies is given, and options for non-pharmacological management that can be tried are enlisted. Common clinical case scenarios have been discussed to incorporate the implementation of this literature.

References

Mahmoud A, Hayhurst K, Drake R, Lewis S, Barnes T . The ANNSERS (Antipsychotic Non-Neurological Side Effects Rating Scale): Validation of Sexual Side-Effect Measurement. Ther Adv Psychopharmacol. 2013; 1(4):97-100. PMC: 3736922. DOI: 10.1177/2045125311417041. View

Rothschild A . Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry. 1995; 152(10):1514-6. DOI: 10.1176/ajp.152.10.1514. View

Gautam S, Jain A, Gautam M, Vahia V, Grover S . Clinical Practice Guidelines for the management of Depression. Indian J Psychiatry. 2017; 59(Suppl 1):S34-S50. PMC: 5310101. DOI: 10.4103/0019-5545.196973. View

Reichenpfader U, Gartlehner G, Morgan L, Greenblatt A, Nussbaumer B, Hansen R . Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug Saf. 2013; 37(1):19-31. DOI: 10.1007/s40264-013-0129-4. View

Sovner R . Treatment of tricyclic antidepressant-induced orgasmic inhibition with cyproheptadine. J Clin Psychopharmacol. 1984; 4(3):169. DOI: 10.1097/00004714-198406000-00033. View

Clayton A, Warnock J, Kornstein S, Pinkerton R, Sheldon-Keller A, McGarvey E . A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry. 2004; 65(1):62-7. DOI: 10.4088/jcp.v65n0110. View

Keller A, McGarvey E, Clayton A . Reliability and construct validity of the Changes in Sexual Functioning Questionnaire short-form (CSFQ-14). J Sex Marital Ther. 2005; 32(1):43-52. DOI: 10.1080/00926230500232909. View

Serretti A, Chiesa A . Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009; 29(3):259-66. DOI: 10.1097/JCP.0b013e3181a5233f. View

Taylor M, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K . Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database Syst Rev. 2013; (5):CD003382. DOI: 10.1002/14651858.CD003382.pub3. View

10.

Evliyaoglu Y, Yelsel K, Kobaner M, Alma E, Saygili M . Efficacy and tolerability of tadalafil for treatment of erectile dysfunction in men taking serotonin reuptake inhibitors. Urology. 2011; 77(5):1137-41. DOI: 10.1016/j.urology.2010.12.036. View

11.

Gelenberg A, McGahuey C, Laukes C, Okayli G, Moreno F, Zentner L . Mirtazapine substitution in SSRI-induced sexual dysfunction. J Clin Psychiatry. 2000; 61(5):356-60. DOI: 10.4088/jcp.v61n0506. View

12.

Jacobsen P, Mahableshwarkar A, Chen Y, Chrones L, Clayton A . Effect of Vortioxetine vs. Escitalopram on Sexual Functioning in Adults with Well-Treated Major Depressive Disorder Experiencing SSRI-Induced Sexual Dysfunction. J Sex Med. 2015; 12(10):2036-48. DOI: 10.1111/jsm.12980. View

13.

Nurnberg H, Hensley P, Gelenberg A, Fava M, Lauriello J, Paine S . Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA. 2002; 289(1):56-64. DOI: 10.1001/jama.289.1.56. View

14.

Waldinger M . Psychiatric disorders and sexual dysfunction. Handb Clin Neurol. 2015; 130:469-89. DOI: 10.1016/B978-0-444-63247-0.00027-4. View

15.

Clayton A, Croft H, Handiwala L . Antidepressants and sexual dysfunction: mechanisms and clinical implications. Postgrad Med. 2014; 126(2):91-9. DOI: 10.3810/pgm.2014.03.2744. View

16.

Koutouvidis N, Pratikakis M, Fotiadou A . The use of mirtazapine in a group of 11 patients following poor compliance to selective serotonin reuptake inhibitor treatment due to sexual dysfunction. Int Clin Psychopharmacol. 1999; 14(4):253-5. DOI: 10.1097/00004850-199907000-00008. View

17.

Ramasubbu R . Switching to moclobemide to reverse fluoxetine-induced sexual dysfunction in patients with depression. J Psychiatry Neurosci. 1999; 24(1):45-50. PMC: 1188976. View

18.

Bernik M, Vieira A, Nunes P . Bethanecol chloride for treatment of clomipramine-induced orgasmic dysfunction in males. Rev Hosp Clin Fac Med Sao Paulo. 2005; 59(6):357-60. DOI: 10.1590/s0041-87812004000600008. View

19.

Fruhauf S, Gerger H, Schmidt H, Munder T, Barth J . Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav. 2013; 42(6):915-33. DOI: 10.1007/s10508-012-0062-0. View

20.

Khan A, Cutler A, Kajdasz D, Gallipoli S, Athanasiou M, Robinson D . A randomized, double-blind, placebo-controlled, 8-week study of vilazodone, a serotonergic agent for the treatment of major depressive disorder. J Clin Psychiatry. 2011; 72(4):441-7. DOI: 10.4088/JCP.10m06596. View