Antidepressant Sexual Side Effects
Questions often arise in practice regarding antidepressant-associated sexual side effects. The chart below lists types of sexual side effects, antidepressants less likely to cause sexual side effects, and interventions to consider. Most interventions are not supported by high-level evidence, and a trial-and-error approach will be needed, keeping in mind the risks of the intervention vs risks of nonadherence due to intolerable sexual side effects.
Question |
Answer/Pertinent
Information |
What sexual side effects can be caused by antidepressants? |
Sexual side effects are most common with SSRIs and SNRIs.1,3,5 Serotonergic medications may affect sexual function via an effect on the autonomic nervous system.5 Sexual side effects of SSRIs and SNRIs include problems with arousal (including erectile dysfunction), desire, and orgasm.5,6
Tricyclic antidepressants (particularly amitriptyline, clomipramine, and imipramine), can cause problems with desire, female lubrication, and orgasm.10 Sexual side effects occur within the first three weeks of treatment, before a therapeutic effect is noticeable, placing patients at risk for nonadherence.5 |
Which antidepressants are least likely to cause sexual side effects? |
Bupropion1,5
Mirtazapine1,5
Duloxetine may pose a lower risk of sexual side effects than SSRIs or venlafaxine.10 Vortioxetine3
Vilazodone5
|
What PRIMARY interventions can be recommended to address sexual side effects? |
Consider:
|
What SECONDARY interventions can be recommended to address sexual side effects? |
Consider:
|
What interventions are not helpful and should be AVOIDED in patients with antidepressant-associated sexual side effects? |
AVOID:
|
Levels of Evidence
In accordance with our goal of providing Evidence-Based information, we are citing the LEVEL OF EVIDENCE for the clinical recommendations we publish.
Level |
Definition |
Study Quality |
A |
Good-quality patient-oriented evidence.* |
|
B |
Inconsistent or limited-quality patient-oriented evidence.* |
|
C |
Consensus; usual practice; expert opinion; disease-oriented evidence (e.g., physiologic or surrogate endpoints); case series for studies of diagnosis, treatment, prevention, or screening. |
*Outcomes that matter to patients (e.g., morbidity, mortality, symptom improvement, quality of life).
RCT = randomized controlled trial; SR = systematic review [Adapted from Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:548-56. http://www.aafp.org/afp/2004/0201/p548.pdf.]
Prepared by the Editors of Therapeutic
Research Center (370107).
References
- U.S. Department of Defense. Department of Veterans Affairs. VA/DoD clinical practice guideline or the management of major depressive disorder. April 2016. https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFINAL82916.pdf. (Accessed December 6, 2020).
- Hellerstein DJ, Flaxer J. Vilazodone for the treatment of major depressive disorder: an evidence-based review of its place in therapy. Core Evid 2015;10:49-62.
- Alvarez E, Perez V, Artigas F. Pharmacology and clinical potential of vortioxetine in the treatment of major depressive disorder. Neuropsychiatr Dis Treat 2014;10:1297-307.
- Francois D, Levin AM, Kutscher EJ, Asemota B. Antidepressant-induced sexual side effects: incidence, assessment, clinical implications, and management. Psychiatr Ann 2017;47:154-60.
- Lorenz T, Rullo J, Faubion S. Antidepressant-induced female sexual dysfunction. Mayo Clin Proc 2016;91:1280-6.
- Taylor MJ, Rudkin L, Bullemor-Day P, et al. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database Syst Rev 2013;(5):CD003382.
- Clinical Resource, Choosing and Switching Antidepressants. Pharmacist’s Letter/Prescriber’s Letter. July 2020.
- Clinical Pharmacology powered by ClinicalKey. Tampa (FL): Elsevier. 2020. http://www.clinicalkey.com. (Accessed December 7, 2020).
- Montejo AL, Prieto N, de Alarcon R, et al. Management strategies for antidepressant-related sexual dysfunction: a clinical approach. J Clin Med 2019;8:1640.
- Clayton AH, Alkis AR, Parikh NB, Votta JG. Sexual dysfunction due to psychotropic medications. Psychiatr Clin North Am 2016;39:427-63.
Cite this document as follows: Clinical Resource, Antidepressant Sexual Side Effects. Pharmacist’s Letter/Prescriber’s Letter. January 2021.