Management of sexual side effects of antidepressant therapy

Sexual dysfunction occurs in over one third of the general population and h as many causes, including psychosocial factors, general medical illness, no npsychiatric medication, psychiatric disorders, and psychotropic medication s. Psychosocial causes are the most prevalent, but many frequently used med ications, such as diuretics, beta-blockers, and H-2-blockers, can also caus e sexual dysfunction. Sexual dysfunctions occur in many psychiatric disorde rs, including mood disorders, schizophrenia, substance abuse, and anxiety d isorders. In addition, over half the patients with major depression will ha ve some sexual dysfunction. Although much attention has been paid to sexual dysfunction associated with the selective serotonin reuptake inhibitors (S SRIs), many other commonly used psychotropics are associated with a variety of sexual dysfunction, including haloperidol, benzodiazepines, stimulants, and drugs of abuse. With regard to SSRIs, sexual dysfunction occurs in 50% or more of such patients, which is substantially higher than the rates rep orted in the Physicians' Desk Reference. The reason for this discrepancy is that patients will not spontaneously report sexual problems and must be qu estioned about such problems directly. A variety of strategies exist to man age antidepressant-induced sexual dysfunction, including waiting, reducing the antidepressant dose, use of drug holidays, use of adjunctive pharmacoth erapy, and switching antidepressants Use of an antidepressant with a low pr evalence of sexual side effects, such as bupropion, nefazodone, and mirtaza pine, may also be considered.