Objective: This article reviews options in the treatment of antidepressant-
induced sexual dysfunction (SD).
Background: With adoption of structured interviews concerning sexual functi
on, researchers have become increasingly aware that a substantial proportio
n of patients experience untoward sexual side effects from their antidepres
sants. As many as half of patients treated with selective serotonin reuptak
e inhibitors report delayed orgasm (ejaculation), and virtually all patient
s treated with clomipramine experience anorgasmia. Treatments proven to be
effective include yohimbine, sildenafil citrate, buspirone, or other adjunc
ts, or a temporary drug holiday. SD is most effectively diagnosed and treat
ed in the setting of an empathic physician-patient relationship, which incl
udes frank discussions about sexuality.
Conclusions: Although depressed patients do care about their sexual functio
n, they may be reluctant, for fear of embarrassment, to report SD spontaneo
usly to their physicians. SD is probably underreported and may result in co
vert noncompliance and attendant relapse into depression. Physicians thus n
eed to assess sexual function during initial evaluation and throughout trea
tment. The importance of sexual function to sexually active patients with m
ajor depression should be weighed carefully when planning antidepressant th
erapy. A number of viable options exist to prevent or treat SD, including u
se of relatively new or novel antidepressants and appropriate adjunctive re
gimens.