Care of the sexually active depressed patient

There are several possible causes of sexual dysfunction in depressed patien ts. A core symptom of depression is anhedonia, including loss of libido. Th erefore, determining a cause of sexual dysfunction in a depressed patient c an be very difficult, and the differential diagnosis must include a primary sexual dysfunction, sexual dysfunction associated with general medical and psychiatric disorders, and sexual dysfunction associated with treatments f or psychiatric disorders. Of particular clinical interest is sexual dysfunc tion associated with different classes of antidepressant drugs, such as tri cyclic antidepressants, selective serotonin reuptake inhibitors, or venlafa xine. Sexual dysfunction's pharmacologic basis is thought to be stimulation of 5-HT2 receptors. Antidepressant-induced sexual dysfunction, most freque ntly presenting as a reduction in libido or delayed orgasm, may not pose a large burden for patients in acute treatment. However, in long-term treatme nt, patients are generally well, and anything that interferes with sexual f unctioning will be a greater problem and will contribute strongly to noncom pliance. Different strategies are advised when dealing with sexual dysfunct ion in depressed patients treated with antidepressant drugs: waiting for a spontaneous resolution of a problem, reduction in antidepressant drug dosag es, drug holidays, adjunctive pharmacotherapy, or switching antidepressants . Perhaps the best way is to avoid sexual dysfunction by starting treatment with an antidepressant with proven acute and long-term efficacy that is de void of sexual side effects, for example, mirtazapine, bupropion, or nefazo done.