Effects of SSRIs on sexual function: A critical review

Sexual problems are highly prevalent in both men and women and are affected by, among other factors, mood state, interpersonal functioning, and psycho tropic medications. The incidence of antidepressant-induced sexual dysfunct ion is difficult to estimate because of the potentially confounding effects of the illness itself, social and interpersonal comorbidities, medication effects, and design and assessment problems in most studies. Estimates of s exual dysfunction vary from a small percentage to more than 80%. This artic le reviews current evidence regarding sexual side effects of selective sero tonin reuptake inhibitors (SSRIs). Among the sexual side effects most commo nly associated with SSRIs are delayed ejaculation and absent or delayed org asm. Sexual desire (libido) and arousal difficulties are also frequently re ported, although the specific association of these disorders to SSRI use ha s not been consistently shown. The effects of SSRIs on sexual functioning s eem strongly dose-related and may vary among the group according to seroton in and dopamine reuptake mechanisms, induction of prolactin release, antich olinergic effects, inhibition of nitric oxide synthetase, and propensity fo r accumulation over time. A variety of strategies have been reported in the management of SSRI-induced sexual dysfunction, including waiting for toler ance to develop, dosage reduction, drug holidays, substitution of another a ntidepressant drug, and various augmentation strategies with 5-hydroxytrypt amine-2 (5-HT2), 5-HT3, and alpha(2) adrenergic receptor antagonists, 5-HT1 A and dopamine receptor agonists, and phosphodiesterase (PDE5) enzyme inhib itors. Sexual side effects of SSRIs should not be viewed as entirely negati ve; some studies have shown improved control of premature ejaculation in me n. The impacts of sexual side effects of SSRIs on treatment compliance and on patients' quality of Life are important clinical considerations.