SSRI and sexual dysfunction

FREE subscriptions for doctors and students... click here
You have 3 more open access pages.

  • selective serotonin reuptake inhibitors (SSRIs) are a common cause of drug-induced hyperprolactinaemia
    • SSRIs are associated with an approximate eight-fold increased risk of development of galactorrhoea compared with other antidepressants

  • also delayed orgasm or ejaculation is a possible adverse effect in men treated with SSRIs

  • monoamine oxidase inhibitors and tricyclic antidepressants have also been rarely reported to cause galactorrhoea or hyperprolactinaemia

Sexual dysfunction and SSRIs

  • sexual dysfunction occurs through several brain pathways involving increases in serotonin (5-HT), decreases in dopamine (DA) and inhibition of nitric oxide synthase
    • increases in cortico-limbic 5-HT result in decreased sexual desire, ejaculation and orgasm selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction occurs in 30%-80% of patients and is a main cause of treatment discontinuation

  • management
    • check PRL - SSRIs can cause drug-induced hyperprolactinaemia

    • seek expert advice

    • pharmacologic methods to reduce sexual dysfunction involve dose reduction, augmentation, or switching medication
      • since dose reduction is the least disruptive strategy it should be considered first, particularly in a responder (1)

      • altering 5-HT receptor antagonism and agonism can have favourable sexual effects, but may cause other adverse event
        • mirtazapine antagonizes 5-HT2 and 5-HT3 receptors and it has been successfully used as an add-on therapy for antidepressant-induced sexual dysfunction
          • however associated with a relatively high rate of weight gain
        • other possible augmentation therapies that have been used include cyproheptidine and buspirone

      • phospho-diesterase inhibitors e.g. sildenafil have demonstrated evidence for the reversal of SSRI-induced sexual side effects in men

      • DA release enhances sexual function
        • evidence supports adjunctive bupropion XL for reversing SSRI-induced sexual dysfunction in men and women across the domains of desire, arousal and orgasm

      • several antidepressants, including bupropion, moclobemide, and mirtazapine have little to no effect on sexual function compared with placebo when used as a monotherapy

      • evidence suggests exercise can improve sexual function in SSRI-induced sexual dysfunction

Reference:

  • Rizvi SJ1, Kennedy SH.Management strategies for SSRI-induced sexual dysfunction. J Psychiatry Neurosci. 2013 Sep;38(5):E27-8.

 

Last reviewed 01/2018

Links: