New directions in the treatment of antidepressant-induced sexual dysfunction

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.