Sexual side effects caused by antidepressants are completely recognized, but this represents a practical problem of managing to physicians. Erectile dysfunction, diminished libido and delayed/attenuated or absent orgasm (dysorgasmia or anorgasmia) are the most common sexual side effects reported because of antidepressant treatment.
However, sexual side effects caused by antidepressants are also a very challenge to clinicians, since they have to distinguish between sexual dysfunction (SD) associated with depression, treatment-emergent SD and pre-existing SD exacerbated by treatment.
Making the difference between these situations is quite important, since treatment strategies are not the same for the above mentioned SDs. Sexual dysfunction associated with depression may be treated raising the antidepressant dose, however, this would be particularly inappropriate for a treatment-emergent SD, in which case the appropriate thing is to lower the dose.
For managing appropriately antidepressant-induced sexual dysfunction, experts recommend that clinicians may attempt to alleviate the sexual side effects of a drug though a reduction of the dose and/or a change to an alternative therapy that may be less likely to cause sexual side effects. These strategies are more likely to be used in patients who are not responding fully to treatment and also risk sacrificing the therapeutic benefit of treatment.
Nonpharmacologic interventions are also recommended by experts. Behavioral and cognitive-behavioral techniques employed by sex therapists are the most common, although there are no studies evaluating their success in patients taking antidepressants.
There exist a number of medications quite useful in the treatment of sexual dysfunction associated with antidepressants. Under experts’ opinion, the most common medications for antidepressant-induced sexual dysfunction fall into three categories:
- Dopaminergic agents, such as amantadine and pramipexole.
- a2-adrenergic receptor antagonists such as yohimbine.
- Serotonin 5-HT2 or 5-HT3 receptor antagonists, including granisetron, nefazodone and cyproheptadine.
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