Antidepressants and sexual dysfunction: epidemiology, mechanisms and management

Antidepressivi e disfunzione sessuale: epidemiologia, meccanismi e strategie di trattamento

A. Chiesa, A. Serretti

Istituto di Psichiatria, Università di Bologna



The first choice treatment for the management of major depression (MD) consists in the use of antidepressant drugs. Early reports about such drugs, including mainly tricyclic antidepressants and mono-amino oxidase inhibitors mainly focused on their potential lethal effects. However, with the increasing use of drugs with a safer profile such as selective serotonine reuptake inhibitors (SSRIs), serotonine and norepinephrine reuptake inhibitors (NSRIs) and other classes, attention shifted to side effects that could undermine compliance to treatment, such as sexual side effects. The aim of the present paper is to review current evidence about sexual dysfunction related to antidepressants and its epidemiology, to prompt targeted investigation by the clinician and to provide available information about the biological mechanisms of antidepressant-related sexual dysfunction as well as the main strategies to manage this side effect.


Medline, ISI web of science, the Cochrane collaboration database and references of retrieved articles were searched for original studies and review articles focusing on the epidemiology, measurement instruments, biological informations and management strategies of antidepressant-related sexual dysfunction. Search strategy included the following terms: “antidepressants”, names of every single antidepressant drug each in turn, “epidemiology”, “biology”, “scales” and “management” along with “sexual dysfunction” or “sexual side effects”. When a review or a meta-analysis addressing a specific topic of investigation was available, we focused on such review and not on single published studies. Studies written in English published up to November 2009 were considered.


Current studies suggest that antidepressant- induced sexual dysfunction should be always distinguished from sexual dysfunction related to other causes such as MD or other psychiatric disorders, medical conditions and psychological problems. Clinicians should use specific scales designed to investigate sexual dysfunction including the ASEX, CSFQ, PRESexDQ and RSI (Table I) or at least ask directly about sexual dysfunction because, otherwise, patients tend to scarcely report such side effect. Major evidence suggests that most common drugs associated with sexual dysfunction are SSRIs, clomipramine and venlafaxine. Further studies suggest that imipramine, duloxetine and phenelzine could be associated to sexual dysfunction as well, even though to a lesser extent in comparison to the drugs mentioned above. On the other hand, bupropion and, though less extensively studied, mirtazapine, moclobemide, amineptine, agomelatine, nefazodone and transdermal selegiline do not seem to be associated to sexual dysfunction (Table II). Biological studies showed that the incidence of sexual dysfunction could be directly related to the ability of a drug to enhance serotonergic transmission. Main strategies for the management of antidepressants induced sexual dysfunction include switching or adding drugs that do not cause sexual dysfunction such as bupropion or adding sildenafil or tadalafil for erectile dysfunction.


Sexual dysfunction is a considerable issue that should be carefully considered when an antidepressant is given. Clinicians should purposely investigate such side effects both before and after the prescription of a given antidepressant and should be aware of strategies to manage sexual dysfunction.

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