title: Management of antidepressant-induced sexual dysfunction.
abstract: OBJECTIVE
  Antidepressant-induced sexual dysfunction is a common, troublesome complication of antidepressant treatment that patients often fail to report, which can have major consequences, including non-adherence to treatment with resultant relapse of depressive illness. The aim of this paper is to review the extent, causation and evidence-based management of antidepressant-induced sexual dysfunction to inform clinical practice.
  
  
  CONCLUSIONS
  The preponderance of evidence suggests that antidepressant s can be divided into high risk (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors) and low risk (agomelatine, bupropion, moclobemide and reboxetine) categories with regard to propensity for antidepressant-induced sexual dysfunction, although there is disagreement, particularly about mirtazapine, and methodological issues militate against definitive findings. Antidepressant-induced sexual dysfunction is dose-dependent to an extent, but patient vulnerability factors are also relevant. There are significant differences in antidepressant-induced sexual dysfunction between men and women. It is important to ask antidepressant -treated patients about sexual dysfunction as few self-report; this may well contribute to antidepressant non-adherence. Consider using an antidepressant with low risk of antidepressant-induced sexual dysfunction for initial treatment. When antidepressant-induced sexual dysfunction has developed, try to persuade the patient to wait in case tolerance develops. Then consider changing to a lower risk or use of high/low risk antidepressant combinations but pharmacological expertise is required. Adjunctive sildenafil can help in both sexes.
authors.affiliation: Monash University and; Centre of Mental Health Education and Research at Delmont Private Hospital, Glen Iris, VIC, Australia nicholas.keks@monash.edu.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Keks
authors.affiliation: Monash University, Eastern Health and; Centre of Mental Health Education and Research at Delmont Private Hospital, Glen Iris, VIC, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Hope
authors.affiliation: Psychotropic Drug Advisory Service at the Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Culhane
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects*; D019468:Disease Management; D006801:Humans; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced* / Q000628:therapy*; D020018:Sexual Dysfunctions, Psychological / Q000139:chemically induced* / Q000628:therapy*
chemical_list: D000928:Antidepressive Agents
keywords: antidepressants; anxiety; clinical management; depression; sexual dysfunction