Antidepressant-related erectile dysfunction: management via avoidance, switching antidepressants, antidotes, and adaptation.
The ideal antidepressant would control depression with no adverse effect on sexual function. Erectile dysfunction and other sexual dysfunction associated with antidepressant medication treatment are problems with many antidepressants and can lead to patient dissatisfaction and decreased compliance with treatment. A computerized MEDLINE search (English language, 1966-2003) was performed using the terms antidepressive agents, erectile dysfunction, and sexual dysfunction. Emphasis was placed on studies with specific sexual function measurements taken before and after treatment and placebo control. Mixed mediator, nonserotonergic antidepressants that block postsynaptic serotonin type 2 receptors (nefazodone, mirtazapine) or that primarily increase dopamine or norepinephrine levels (bupropion) were thought to be good choices for avoiding antidepressant-associated sexual dysfunction or for switching patients in whom antidepressant-associated sexual dysfunction emerged. Comparisons with serotonin reuptake inhibitors (SRIs) have revealed less desire and orgasm dysfunction with nonserotonergic bupropion, less orgasm dysfunction with nefazodone, and superior overall satisfaction with sexual functioning with bupropion or nefazodone. However, most of these studies have design flaws that make evidence-based claims of efficacy difficult to substantiate. Agents proposed for antidote use in antidepressant-associated sexual dysfunction have either not been studied in men or not proved efficacious in randomized placebo-controlled trials. Switching to and augmentation with bupropion or nefazodone have also not clearly shown efficacy in controlled trials and require care and monitoring to avoid SRI discontinuation symptoms and loss of antidepressant efficacy. Few proposed treatment options, apart from avoidance, have proved effective for antidepressant-associated sexual dysfunction, which can have negative consequences on depression management.
Labbate
Lawrence A
LA
Department of Psychiatry and Behavioral Science, Medical University of South Carolina and Veterans Administration Medical Center, Charleston, SC, USA. labbatel@musc.edu
Croft
Harry A
HA
Oleshansky
Marvin A
MA
D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy*; D004316:Doxepin / Q000009:adverse effects / Q000627:therapeutic use; D004361:Drug Tolerance; D007172:Erectile Dysfunction / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D020912:Moclobemide / Q000009:adverse effects / Q000627:therapeutic use; D009948:Orgasm / Q000187:drug effects; D010879:Piperazines; D012075:Remission, Spontaneous; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use
D000928:Antidepressive Agents; D016642:Bupropion; D004316:Doxepin; D008803:Mianserin; D000078785:Mirtazapine; D020912:Moclobemide; D010879:Piperazines; D017367:Selective Serotonin Reuptake Inhibitors; D014230:Triazoles; C051752:nefazodone