Sexual dysfunction and antidepressants

Question 1

Sexual dysfunction and antidepressants:

Approaches to the issue that are evidence based?

Answer 1

1) Wait
2) reduce dose
3) Switch agents
4) non pharmacological treatments

Question 2

Sexual dysfunction and antidepressants:

Benefits of waiting if sexual dysfunction occurs?

Answer 2

Resolution or at least moderate improvement occurs within 4 - 6 months while on the same agent in 6 - 12% of patients
most appropriate for those with only mild dysfunction

Question 3

Sexual dysfunction and antidepressants:

Considerations when reducing dose?

Answer 3

• there is evidence to suggest that a 50 reduction in dose could improve sexual dysfunction for approximately 2/3rds of patients*
• decline in condition must be considered when using this approach
• dose reductions should be small and slow if below minimum recommended therapeutic dose

Question 4

Sexual dysfunction and antidepressants:

Is there benefit switching agents?

Answer 4

• the best benefit is from switching to a different antidepressant with lower sexual dysfunction risk
• avoid escitalopram and paroxetine due to higher risk if possible
• those with lowest impact are moclobemide, agomelatine, bupropion, reboxetine, mirtazapine and vortioxetine

Question 5

Sexual dysfunction and antidepressants:

What could be recommended non pharmacologically?

Answer 5

If there is a larger suspected psychological component

• CBT
• Couples therapy

Exercise before sexual activity
-30 minutes of moderate intensity three times a week before sexual activity improves desire and function but has no effect on orgasm or sexual satisfaction