Stay Alert for Sexual Dysfunction With Antidepressants

Many patients on antidepressants (SSRIs, SNRIs, etc) have sexual side effects…but are reluctant to talk about them.

The main concerns include decreased sexual desire, orgasm problems, and erectile dysfunction. These often lead to nonadherence.

Ask open-ended questions about general side effects…GI upset, headache, etc. Mention sexual side effects along with the others…to help patients feel comfortable.

Explain that it’s often worth sticking with meds for a month or two to see if symptoms improve. Anxiety or depression can also lead to reduced sexual desire…and treating the underlying condition may help.

If patients aren’t willing to wait or side effects persist, consider decreasing the antidepressant dose if possible.

If that doesn’t do the trick or isn’t an option, generally advise switching…especially if the antidepressant doesn’t seem to be helping.

It’s okay to try switching to another SSRI or SNRI.

But think of bupropion or mirtazapine as having the least sexual dysfunction concerns. If needed, use our chart, Choosing and Switching Antidepressants, for strategies to cross-taper meds.

Trintellix (vortioxetine) or Viibryd (vilazodone) also seem to be lower-risk options.

On the other hand, adding a med to treat sexual dysfunction may be worth a try if patients are doing well on their antidepressant.

For patients with low desire, suggest adding bupropion 150 mg/day…and aim for a target dose of 300 mg/day.

Or consider a PDE5 inhibitor (sildenafil, etc) for patients with erectile dysfunction…or orgasm problems in patients of any gender.

Don’t rely on other add-ons…such as buspirone, olanzapine, or supplements (ginkgo, maca, etc). These have little to no benefit.

Plus there are no data that adding Addyi (flibanserin) helps antidepressant-induced sexual dysfunction.

Don’t recommend skipping antidepressant doses or a “weekend holiday”…due to possible risk of discontinuation symptoms.