Patients with depressive disorders frequently have concurrent sexual proble
ms. The sexual dysfunction is often masked by the mood disorder, and many p
atients have difficulty discussing these problems openly. Thus, sexual dysf
unction often is detectable only by careful inquiry. The relationship betwe
en sexual dysfunction and depressive disorders is further complicated by an
tidepressant therapy, which itself may cause sexual dysfunction, increasing
the risk of noncompliance and relapse. This article reviews studies indica
ting that antidepressants may cause 30% to 40% of patients who take them to
develop some degree of sexual dysfunction. Management strategics for allev
iating sexual dysfunction as a complication of antidepressant treatment are
discussed in terms of supporting research studies as well as practicality.
Spontaneous resolution of antidepressant-induced sexual dysfunctions rarel
y occurs, and dose reductions may jeopardize the antidepressant effect. Ant
idotes, drug holidays, and timing sexual relations with respect to antidepr
essant dose are effective for some patients, but only a few of these strate
gies have been studied with double-blind paradigms. Switching to antidepres
sants that cause sexual dysfunction at lower rates and data comparing rates
of sexual dysfunction among antidepressants are discussed.