With serotonergic antidepressants dominating the treatment of depressi
ve disorders, antidepressant-induced sexual side effects have emerged
as a major clinical issue. Surprisingly, the effects of depression on
sexuality are less well established and more variable than previously
thought. It is likely that antidepressants with strong serotonergic ef
fects--selective serotonin reuptake inhibitors, clomipramine, and mono
amine oxidase inhibitors--are associated with higher rates of sexual s
ide effects, compared to other antidepressant classes. Orgasmic and ej
aculation difficulties are prominent with these medications, although
alterations in libido, arousal, and erectile function are also common.
Treatment of these side effects includes both general strategies and
specific antidotes, such as cyproheptadine, yohimbine, dopamine agonis
ts, and buspirone.