Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials.
BACKGROUND
This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication.


METHODS
Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction.


RESULTS
Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo.


CONCLUSIONS
The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.
Taylor
Matthew J
MJ
University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. matthew.taylor@psych.ox.ac.uk
Rudkin
Lisa
L
Hawton
Keith
K
D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D010879:Piperazines / Q000627:therapeutic use; D010919:Placebos; D011687:Purines; D016032:Randomized Controlled Trials as Topic; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced* / Q000628:therapy*; D000068677:Sildenafil Citrate; D013450:Sulfones; D014665:Vasodilator Agents / Q000627:therapeutic use
D000928:Antidepressive Agents; D010879:Piperazines; D010919:Placebos; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate