Changes in sexual function during acute and six-month fluoxetine therapy: A prospective assessment

Sexual dysfunction has been reported as an unwanted effect associated with selective serotonin reuptake inhibitors therapy, but the nature and frequen cy of such effects have not been characterized systematically. Sexual funct ion was assessed in depressed patients participating in a multicenter trial of acute and continuation fluoxetine therapy using a 4-item self-rated sca le. Patients were evaluated at study entry, after 13 weeks of fluoxetine 20 mg daily, and during 25 weeks of continuation therapy with fluoxetine 20 m g daily, fluoxetine 90 mg weekly, or placebo. In a 13-week open-label trial , among 501 patients who met Diagnostic and Statistical Manual of Mental Di sorders criteria for depression, 51.6% of women and 40.6% of men reported i mprovement, 35.0% of women and 41.9% of men reported no change, and 13.4% o f women and 17.4% of men reported worsening in overall sexual function. Dur ing double-blind continuation therapy, there were no statistically signific ant differences in change in sexual function between treatments. Worsened s exual function that occurred during continuation treatment was strongly ass ociated with sexual dysfunction, and improvement in sexual functioning rela ted to the antidepressant effects of fluoxetine may be more common than dru g-associated deterioration in sexual function. Among patients who report wo rsening, effects may be most pronounced on orgasm. Deterioration in sexual function does not appear to be a late-onset drug-specific event, but is str ongly related to worsening depressive symptoms.