Antidepressants and female sexual dysfunction

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

Reference:

• Bonierbale M, Lançon C, Tignol J. The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France. Curr Med Res Opin. 2003;19(2):114-124.
• Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6): 537-544
• Lorenz T, Rullo J, Faubion S. Antidepressant-Induced Female Sexual Dysfunction. Mayo Clin Proc. 2016 Sep;91(9):1280-6. doi: 10.1016/j.mayocp.2016.04.033.
• Higgins A, Nash M, Lynch AM. Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug Healthc Patient Saf. 2010;2:141-50.