Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: A large-scale retrospective study of 596 psychiatric outpatients

Abstract

In the present study, a large-scale retrospective case review was undertaken to assess the incidence and type of sexual dysfunctions associated with serotonin reuptake inhibitor (SRI) therapy, in addition to the effects of three pharmacological antidotes (yohimbine, amantadine, cyproheptadine) on SRI-induced sexual dysfunctions. A retrospective chart review was conducted on 596 patients treated with SRIs in an outpatient psychiatric practice between July 1991 and September 1994. Patients who reported new-onset sexual dysfunction during this time were categorized as having SRI-induced sexual dysfunctions. Sexual difficulties were characterized by type and duration, and the background characteristics and psychiatric diagnoses of all patients were recorded. Psychiatric outcome and sexual functioning at follow-up were independently assessed by a single psychiatrist by means of a 4-point rating scale. Sexual dysfunction symptoms were clearly associated with SRI administration in 97 (16.3%) cases. The most common problems reported were orgasmic delay or anorgasmia and hypoactive sexual desire. Sexual difficulties were more frequent among men (23.4%) and married patients of both sexes (22.3%), whereas psychiatric diagnosis and type of SRI were unrelated to the occurrence of sexual problems. Of the patients with sexual dysfunction, 45 (46.4%) opted for a trial of antidote therapy with yohimbine, amantadine, or cyproheptadine. All three antidotes were found to be safe and relatively effective, although yohimbine was significantly more effective than amantadine or cyproheptadine in reversing SRI-induced sexual dysfunction.

Avoidant romantic attachment and female orgasm: testing an emotion-regulation hypothesis

“…While such heritable variation raises the prospect that natural/sexual selection has played some role in the evolution of female sexual responsiveness, the very data highlighting genetic influences simultaneously calls attention to nonheritable factors contributing to variation in female orgasm during sex. Nonheritable factors implicated to date in female orgasmic frequency include SSRI antidepressants (Ashton, Hamer, & Rosen, 1997), self-image, previous negative sexual experiences, emotional intimacy, sexual stimuli, and relationship and emotional satisfaction (Basson, 2001;Waite & Joyner, 2001). We argue here that a largely nonheritable aspect of psychological functioning, namely avoidant romantic attachment, may also contribute to individual differences in female orgasmic frequency.…”

The relationship between depression and erectile dysfunction

“…Antidepressants may cause sexual side effects in the drive phase (eg, decreased libido, although this is difficult to distinguish from the decrease in sexual satisfaction associated with pervasive anhedonia), the arousal phase (eg, erectile dysfunction, although the relationship to preexisting organic factors and to major depression complicates this association), and the release phase (eg, delayed orgasm or anorgasmia). With serotonergic medications such as selective serotonin reuptake inhibitors, orgasmic delay appears to be most common, followed by decreased libido and then arousal difficulties [15]. Painful ejaculation occurs in some men taking tricyclic antidepressants [16].…”

Influence of weight reduction by sibutramine on female sexual function

“…Indeed, those who take selective serotonin reuptake inhibitors (SSRIs), the drugs of which are most commonly prescribed for depression, reported diminished sexual desire, arousal, sensitivity and orgasm. 3 Dose-dependent sexual dysfunction is one of the most commonly reported side effects of treatment with SSRI antidepressants 4,5 and has been reported with the use of SSRI, fluoxetine (Prozac s ). Although not approved for use as a weight-loss agent, treatment with fluoxetine has also been shown to result in weight loss over the short term.…”