Sexual Functioning and SSRIs

This article reviews the literature concerning the relationship between sexual functioning and selective serotonin reuptake inhibitors (SSRIs). Reduced sexual functioning is a common depressive symptom that typically improves after successful antidepressant treatment. On the other hand, sexual dysfunction has been observed in a substantial proportion of patients treated with all classes of antidepressants. In particular, SSRI use has been shown to be associated with sexual dysfunction. A number of pharmacologic interventions have been found to be helpful in anecdotal case reports. Unfortunately, the lack of placebo-controlled studies in this area limits our ability to draw firm conclusions on the efficacy of such interventions. Three classes of drugs have primarily been used to counteract sexual side effects of SSRIs: serotonin receptor antagonists, α₂-adrenergic receptor antagonists, and dopaminergic agents. An open trial from our group suggests the potential usefulness of oral sildenafil in the treatment of antidepressant-associated sexual side effects, but further studies are needed.