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. 2022 Jul;21(7):913-930.
doi: 10.1080/14740338.2022.2049753. Epub 2022 Apr 19.

Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management

Joan Winter  1 , Kimberly Curtis  1 , Bo Hu  1 , Anita H Clayton  1
Affiliations

Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management

Joan Winter et al. Expert Opin Drug Saf. 2022 Jul.

Abstract

Introduction: Sexual dysfunction (SD) is a symptom of depression in ≈70% of patients presenting with major depressive disorder (MDD). Antidepressant medications (AD) and adjunctive treatments may further contribute to SD and complicate evaluation and management.

Areas covered: A systematic literature search of PubMed, Ovid MEDLINE and Cochrane databases for MDD, SD, classes of antidepressants, etc. was performed with a focus on 2014 to June 2021. SSRIs are associated with 70% treatment-emergent sexual dysfunction (TESD), SNRIs and tricyclics have rates of TESD of 40-45%, and antidepressant medications without SRI effects or with additional unique mechanisms of action have rates similar to placebo (<10%). Appropriate assessment at baseline and throughout treatment, consideration of patient preferences in prescribing, addressing modifiable factors (comorbid medical/psychiatric conditions, substances, relationship difficulties), and utilizing management strategies of switching to an AD with less SD, adding an antidote/adjunctive therapy or lowering the dose are discussed.

Expert opinion: MDD and antidepressant treatment contribute to SD in a high percentage of patients. Treating to remission reduces SD as a symptom of depression. Frequent assessment and _targeted management strategies may be effective in preventing or addressing SD. Secondary outcomes like impact on adherence, relationships and self-image should also be considered.

Keywords: MDD; Major depressive disorder; SNRIs; SSRIs; TESD; antidepressants; sexual dysfunction; treatment-emergent sexual dysfunction.

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