Sir: Serotonin reuptake inhibiting antidepressants (SRIs) are reported to cause decreases in sexual desire, arousal, and orgasm. Augmentation strategies proposed to reduce SRI-induced sexual dysfunction include cyproheptadine, 1-3 yohimbine, 1,4,5 amantadine, 1,6,7 stimulants, 8 buspirone, 9 bupropion, 10,11 and Ginkgo biloba. 12 Drug holiday also has been forwarded as a treatment option. 13 Spontaneous remission of SRI-induced sexual dysfunction is uncommon: reports suggest that this occurs in from 5.8% of patients within 6 months 14 to 9.8% of patients followed up to 38 months on continuing treatment. 15 Sildenafil, a phosphodiesterase type 5 inhibitor, has recently been released to treat male erectile disorder of organic, psychogenic, or mixed origin that may have included a variety of medications including antidepressants. 16 To date, there have been no reports on its use specifically in SRI-induced sexual dysfunction. We report here the first cases of sildenafil used to treat this disorder. Case 1. Mr. A, a 20-year-old white man, had a psychiatric history significant for major depression, recurrent obsessivecompulsive disorder, and panic disorder with agoraphobia. Brief trials of venlafaxine, bupropion, paroxetine, mirtazapine, and fluvoxamine were unsuccessful in controlling his psychiatric symptoms. Mr. A then obtained a remission of symptoms with fluoxetine, 20 mg q.d., and clonazepam, 0.5 mg b.i.d. There was no report of sexual dysfunction prior to initiation of fluoxetine. However, within 4 weeks of starting fluoxetine, Mr. A experienced anorgasmia and an almost total inability to obtain an erection. A 2-week trial of bupropion SR, 150 mg b.i.d., to reverse his sexual dysfunction was unsuccessful. After an attempt on sildenafil, 50 mg, was unsuccessful, the dosage was increased to 100 mg of sildenafil 1 hour prior to anticipated sexual activity. Mr. A described his response as being "80% to 110%" improved ability to achieve erection and orgasm. The reason he reported a "110%" response was because of his perceived diminished refractory stage after orgasm. He noted only minor side effects of elevated heart rate, flushing, and brief instances when it seemed he was looking through a blue filter or haze.Case 2. Mr. B, a 46-year-old white man, had a psychiatric history significant for major depression and attentiondeficit/hyperactivity disorder, which had responded to a combination of sertraline, 25 mg b.i.d., and methylphenidate, 50 mg daily in divided doses. He complained of intermittent male erectile disorder and delayed ejaculation beginning with successive prior trials of venlafaxine, bupropion, and nefazodone, none of which controlled the disorders, as well as during his successful trial of sertraline. He also reported hypertension, coronary artery disease, and hypercholesterolemia that had been treated with atorvastatin, 10 mg q.d., and amlodipine, 5 mg q.d., many months prior to the development of sexual dysfunction. Mr. B had no improvement of erectile dysfunction on bupropion, 100 mg at 5 p.m....