Pharmaceutical management of sexual dysfunction in men on antidepressant therapy

Introduction Sexual dysfunction (SD) and depression have a bidirectional relationship. The rising prescription of antidepressants, especially those with a serotonergic effect, is associated with increased SD. Sexual dysfunction reduces compliance and increases risk of recurrence of depressive episodes. Various strategies have been studied to manage antidepressant-induced SD. Areas covered This review covers the identification of symptoms of antidepressant-induced SD, prevalence of symptoms in association with commonly used antidepressants, and the main lines of management, with a focus on pharmacological strategies. Expert opinion The management of antidepressant-induced SD aims to reduce the unwanted sexual adverse effects while maintaining an acceptable control of depressive symptoms. It should implicate a multidisciplinary approach and determination of baseline sexual function and SD risk factors. In spite of several methodological issues, antidepressants can be divided into low- and high-risk categories with regard to the possibility of developing SD. In patients interested in sexual activity, it is recommended to start with low-risk antidepressants. Otherwise, encourage the patient to wait for tolerance and then switch to low-risk. In selected cases, dose reduction or a drug holiday may be applied. The adjunctive use of a PDE5i can help in a significant number of patients. Randomized controlled trials are needed to set high-level evidence-based recommendations.

Automated summary

Sexual dysfunction (SD) and depression have a bidirectional relationship. Various strategies have been studied to manage antidepressant-induced SD. The management aims to reduce the unwanted sexual adverse effects while controlling depressive symptoms. It involves a multidisciplinary approach and determination of baseline sexual function and SD risk factors. Antidepressants can be categorized into low- and high-risk based on the possibility of developing SD. Low-risk antidepressants are recommended for patients interested in sexual activity. The adjunctive use of a PDE5 inhibitor can be beneficial. More randomized controlled trials are needed for evidence-based recommendations.