Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management
- Michael Hirsch, MD
Michael Hirsch, MD
- Instructor in Psychiatry
- Harvard Medical School
- Robert J Birnbaum, MD, PhD
Robert J Birnbaum, MD, PhD
- Assistant Professor of Psychiatry
- Harvard Medical School
Selective serotonin reuptake inhibitors (SSRIs) can reduce libido in women and men, disrupt arousal (lubrication in women and erectile function in men), cause anorgasmia in women, and increase ejaculation latency in men [1,2]. The frequency of sexual side effects may vary among the different SSRIs. Although it is not known how SSRIs impair sexual functioning, the symptoms appear to be dose dependent  and genetic polymorphisms may be involved .
Sexual side effects can occur with other antidepressants, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs); however, there are more studies of sexual dysfunction secondary to SSRIs . Unipolar major depression can also impair sexual functioning, and treatment with an SSRI can improve satisfaction .
This topic reviews the management of sexual dysfunction caused by SSRIs. The pharmacology, administration, and other side effects of SSRIs are discussed separately. (See "Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects".)
INCIDENCE OF SEXUAL DYSFUNCTION
The estimated incidence of SSRI-induced sexual dysfunction ranges from approximately 15 to 80 percent [2,5-7]. As an example:
●A 14-week, prospective observational study (Sequenced Treatment Alternatives to Relieve Depression [STAR*D]) of 1473 patients treated with citalopram found that :
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