Clinical Inquiries

How do antidepressants affect sexual function?

Author and Disclosure Information

 

References

EVIDENCE-BASED ANSWER:

Patients treated with selective serotonin reuptake inhibitors (SSRIs) and the serotonin/norepinephrine reuptake inhibitor (SNRI) venlafaxine have significantly higher rates of overall sexual dysfunction—including desire, arousal, and orgasm—than patients treated with placebo (strength of recommendation [SOR]: B, randomized controlled trials [RCTs] with heterogeneous results). Patients treated with bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), have rates of overall sexual dysfunction comparable to placebo (SOR: B, RCTs with heterogeneous results).

EVIDENCE SUMMARY

In a meta-analysis of 31 studies with 10,130 patients, researchers reported that the total rate of sexual dysfunction (SD) associated with selective serotonin reuptake inhibitors (SSRIs) was significantly higher than the placebo rate of 14.2% (TABLE).1 The SSRIs citalopram, fluoxetine, paroxetine, and sertraline as well as the SNRI venlafaxine, had significantly greater rates (70%-80%) of reported total sexual dysfunction, including desire, arousal, and orgasm, than placebo.

Bupropion has sexual dysfunction rates comparable to placebo

Other SSRIs (fluvoxamine, escitalopram), the tricyclic antidepressant imipramine, and the SNRI duloxetine also had total SD rates significantly greater than placebo. However, the rates of dysfunction with these agents are often lower than the dysfunction rates of SSRIs such as sertraline and citalopram, and thus, may be viewed as falling into an intermediate risk category. The total SD rates for the NDRI bupropion were comparable to the placebo rate.1

With few exceptions, all drugs associated with overall SD were associated with significant dysfunction affecting the sexual components of desire, arousal, and orgasm. The results of this meta-analysis should be interpreted with some degree of caution because methods of assessing SD varied within individual studies.

AHRQ weighs in

An Agency for Healthcare Research and Quality (AHRQ) review of antidepressants found that paroxetine, citalopram, and venlafaxine, when compared with other antidepressants (fluoxetine, fluvoxamine, nefazodone, sertraline), generally were associated with more reports of SD, specifically complaints of erectile dysfunction in men and decreased vaginal lubrication in women. 2 The number needed to treat one additional person with general sexual functioning satisfaction was 6 (95% CI, 4-9) with buproprion.2

RECOMMENDATIONS

The American College of Physicians’ clinical practice guidelines suggest that although SD is likely underreported, the NDRI bupropion has consistently shown lower rates of associated dysfunction than the SSRIs fluoxetine and sertraline.3 Conversely, the SSRI paroxetine has shown higher rates of adverse sexual events than other SSRIs, such as fluoxetine and fluvoxamine, and the serotonin reuptake inhibitor/antagonist nefazodone.3

Evidence-based answers from the Family Physicians Inquiries Network

Recommended Reading

Poor sleep quality associated with poor cannabis cessation outcomes
MDedge Family Medicine
Chronic cocaine abuse tied to ‘profound metabolic alteration’ in men
MDedge Family Medicine
ASTRO outlines five radiation oncology practices that should be curtailed
MDedge Family Medicine
ED in type 1 diabetes often resolves
MDedge Family Medicine
For neoadjuvant androgen suppression in prostate cancer, 8 is enough
MDedge Family Medicine
Single-fraction radiotherapy used in just 3% of prostate cancer candidates
MDedge Family Medicine
Gender-specific biomarker thresholds urged in MI diagnosis
MDedge Family Medicine
Endocrine societies release 'Choosing Wisely' recommendations
MDedge Family Medicine
Quitting smoking shows benefit into old age
MDedge Family Medicine
Boom in self-referrals by urologists who have added IMRT services
MDedge Family Medicine