This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Antidepressants and female sexual dysfunction

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Antidepressants and Female Sexual Dysfunction

  • study evidence shows that those with diagnoses of depression had a 50% to 70% risk for development of sexual dysfunction, even after adjusting for common comorbidities (1)
    • prevalence of sexual dysfunction in patients with major depression is high
    • antidepressant drugs appear to aggravate such problems, with certain classes of drug better tolerated than others

  • relative to men, women are at increased risk for depression and anxiety, as well as increased risk of sexual dysfunction (2)
    • sexual dysfunction is more prevalent for women (43%) than men (31%)

  • antidepressants and sexual dysfunction (3)
    • evidence shows that rates of sexual dysfunction attributable to antidepressants were approximately 40%, rates of sexual dysfunction associated with placebo were approximately 14%

    • sexual dysfunction is a common side effect of antidepressants, particularly of selective serotonin reuptake inhibitor (SSRIs) and serotonin norepinephrine reuptake inhibitor (SNRIs) medications (4)

    • wide variability across studies, antidepressant types, and phase of sexual response: for example, only about 2% of patients taking bupropion reported arousal dysfunction compared with about 82% of patients taking citalopram

    • most commonly reported adverse sexual effects in women taking antidepressants are problems with sexual desire (72%) and sexual arousal (83%)

    • approximately 42% of women taking selective serotonin reuptake inhibitors report problems having an orgasm

    • although men generally report higher rates of antidepressant-related adverse effects in sexual desire and orgasm, women are more likely to report sexual arousal dysfunction, particularly when taking selective serotonin reuptake inhibitors

    • onset of adverse sexual effects (across all phases) occurs within about 1 to 3 weeks of initiating a treatment regimen, whereas the antidepressant effects do not consistently appear until approximately 2 to 4 weeks after starting a medication

    • management of adverse sexual effects
      • a thorough assessment will focus on (4):
        • eliminating confounding factors for sexual dysfunction, eg, age or alcohol/substance use
        • excluding a comorbid physical complaint, eg, side effects of drugs used to manage diabetes or hypertension may be a cause of sexual dysfunction
        • excluding ongoing, or residual, symptoms of depression

      • pharmacological (dose reduction, drug discontinuation or switching, augmentation, or using medications with lower adverse effect profiles)
        • evidence supports starting treatment with an antidepressant that has a better adverse sexual effect profile, such as bupropion or mirtazapine, particularly in patients concerned about their sexual functioning and in those with sexual dysfunction at baseline (3)
        • study evidence has shown that switching to vortioxetine, an antidepressant with a multimodal mechanism of action, was associated with significant improvements in sexual function scores compared with switching to escitalopram, while maintaining antidepressant efficacy (3)
        • may include switching from an SSRI to non-SSRI antidepressant (4)
        • is evidence from systematic review of randomized, controlled trials into the management of antidepressant-induced sexual dysfunction that the addition of sildenafil will improve erectile dysfunction in men (4)
          • benefit to women has yet to be comprehensively proven

      • behavioral (exercising before sexual activity, scheduling sexual activity, vibratory stimulation, psychotherapy)

      • complementary and integrative (acupuncture, nutraceuticals)

      • or some combination of these modalities

Reference:


Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.