SSRI-INDUCED SEXUAL DYSFUNCTION - FLUOXETIME, PAROXETINE, SERTRALINE,AND FLUVOXAMINE IN A PROSPECTIVE, MULTICENTER, AND DESCRIPTIVE CLINICAL-STUDY OF 344 PATIENTS

The authors analyzed the incidence of sexual dysfunction (SD) with dif ferent selective serotonin reuptake inhibitors (SSRIs; fluoxetine, flu voxamine, paroxetine, and sertraline) and hence the qualitative and qu antitative changes in SD throughout time in a prospective and multicen ter study. Outpatients (192 women and 152 men; age = 39.6+/-11.4 years ) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, d elayed ejaculation, inability to ejaculate, impotence, and general sex ual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SS RIs or treatment associated with benzodiazepines, previous heterosexua l or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously repor ted (14%). There were some significant differences among different SSR Is: paroxetine provoked more delay of orgasm or ejaculation and more i mpotence than fluvoxamine, fluoxetine and sertraline (chi(2), p < .05) . Only 24.5% of the patients had a good tolerance of their sexual dysf unction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and th eir sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients expe rienced substantial improvement in sexual function when the dose was d iminished or the drug was withdrawn. Men showed more incidence of sexu al dysfunction than women, but women sexual dysfunction was more inten se than men's. In only 5.8% of patients, the dysfunction disappeared c ompletely within 6 months, but 81.4% showed no improvement at all by t he end of this period. Twelve of 15 patients experienced total improve ment when the treatment was changed to moclobemide (450-600 mg/day), a nd 3 of 5 patients improved when treatment was changed to amineptine ( 200 mg/day).