Antidepressant With Least Sexual Side Effects

Antidepressant With Least Sexual Side Effects

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Significantly Different Adverse Sexual Effects Caused by Various Antidepressants
FROM THE FAMILY PRACTICE INQUIRIES NETWORK

JOHN SMUCNY, M.D., AND MICHAEL S. PARK, Department of Family Medicine State University of New York Upstate Medical University Syracuse, N.Y.

Am Fam Physician. 2004;69(10):2419-2420
In patients being treated for depression, which antidepressants have a low risk of sexual side effects?
Bupropion (Wellbutrin), nefazodone (Serzone), amitriptyline (Elavil), and moclobemide (Manerix, a reversible inhibitor of monoamine oxidase type A not available in the United States) have been shown to cause less sexual dysfunction than selective serotonin reuptake inhibitors (SSRIs). [Strength of recommendation: B, based on individual randomized controlled trials (RCTs)] Among SSRIs, fluvoxamine (Luvox) may cause less sexual dysfunction than sertraline (Zoloft). [Strength of recommendation: B, single RCT] No other differences between or within classes of antidepressants have been demonstrated in RCTs.
> = “ is associated with a greater incidence of the measured outcome than”; SSRI = selective serotonin reuptake inhibitor .
*— Not available in the United States .
note : No significant difference was found for the following: sertraline vs. citalopram (Celexa); paroxetine (Paxil) vs. fluvoxamine or fluoxetine; amitriptyline vs. amoxapine (Asendin) or mirtazapine (Remeron); clomipramine (Anafranil) vs. fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram; phenelzine (Nardil) vs. imipramine (Tofranil) .
Information from references 1 through 4 .
The incidence of sexual side effects between different antidepressants in adults with depressive or anxiety disorders has been reported by 25 RCTs, most of which were included in two recent descriptive systematic reviews. 1 , 2 [References 1 and 2—Evidence level 1A] Bupropion led to less sexual dysfunction (or to more sexual satisfaction) than sertraline or fluoxetine in four trials. The number needed to harm (NNH), that is, the number of patients who have to take the drug for one patient to experience sexual dysfunction, ranged from two to 17, depending on the type of dysfunction. 1 , 2 Nefazodone led to less sexual dysfunction (or to more sexual satisfaction) than sertraline in two trials (NNH: two to seven). 1 – 3 [Reference 3—Evidence level 1B] Moclobemide led to less sexual dysfunction than four SSRIs in one trial (NNH: five) and to greater sexual desire than doxepin (Adapin) in one trial (number needed to treat: eight). 2 – 4 [Reference 4—Evidence level 1B] The acompanying table 1 – 4 summarizes the different adverse sexual effects and the agents that cause them.
There were no other consistent differences between classes of antidepressants. One trial reported less sexual dysfunction resulting from amitriptyline than from sertraline (NNH: seven), but numerous trials have not shown differences between clomipramine (Anafranil) and other SSRIs. 1 , 2 One trial showed less sexual dysfunction resulting from fluvoxamine than from sertraline (NNH: six), but no differences between other SSRIs have been demonstrated. 1 , 2 Limitations to many of the published studies include small sample sizes, failure to control for baseline differences in sexual function between groups of patients, and lack of uniform means of inquiring into sexual adverse effects.
Guidelines issued by the American Psychiatric Association 5 (APA) and the American College of Physicians–American Society of Internal Medicine 6 (ACP–ASIM) do not provide specific recommendations regarding which antidepressant to prescribe to minimize sexual dysfunction. [References 5 and 6—Evidence level 1A] The APA notes that SSRIs can carry a risk of sexual side effects, whereas the ACP–ASIM states that the data are insufficient to estimate incidence rates, thus making quantitative comparisons among antidepressants impossible.
Bupropion appears to be the best antidepressant for use in patients who are concerned about drug-related sexual dysfunction. Amitriptyline may be a less expensive and suitable alternative, but it has other worrisome adverse effects. Nefazodone may have a low incidence of sexual dysfunction, but it has been associated with hepatotoxicity and was withdrawn from the Canadian and European markets. Moclobemide is not available in the United States.
JOHN SMUCNY, M.D., MICHAEL S. PARK,
State University of New York Upstate Medical University Syracuse, N.Y.
Address correspondence by e-mail to John Smucny, M.D., smucnyj@upstate.edu . Reprints are not available from the authors .
Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:1577-89.
Montgomery SA, Baldwin DS, Riley A. Antidepressant medications: a review of the evidence for drug-induced sexual dysfunction. J Affect Disord. 2002;69:119-40.
Ferguson JM, Shrivastava RK, Stahl SM, Hartford JT, Borian F, Ieni J, et al. Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline. J Clin Psychiatry. 2001;62:24-9.
Philipp M, Tiller JW, Baier D, Kohnen R. Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults. The Australian and German Study Groups. Eur Neuropsychopharmacol. 2000;10:305-14.
American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry. 2000;157(4 suppl):1-45.
Snow V, Lascher S, Mottur-Pilson C. Pharmacologic treatment of acute major depression and dysthymia. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 2000;132:738-42.
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Moclobemide* (Manerix) doxepin (Adapin)
Fluoxetine (Prozac) >bupropion (Wellbutrin); sertraline (Zoloft) >nefazodone (Serzone)
Sertraline, fluoxetine >bupropion; sertraline >nefazodone
Sertraline >fluvoxamine (Luvox), nefazodone; SSRI >moclobemide

Antidepressant Trintellix Has Fewer Sexual Side Effects, Study Finds

© 2022 SMSNA for Patients. All Rights Reserved
Sexual problems – such as low desire, poor arousal, and orgasm difficulties - are common side effects of some antidepressants. However, patients experiencing these effects may have a new alternative.
The U.S. Food and Drug Administration (FDA) has approved new labelling for a drug called Trintellix (vortioxetine), which may relieve depression symptoms with fewer sexual side effects.
Trintellix is prescribed to adults with major depressive disorder (MDD).
Researchers conducted an 8-week trial involving 447 patients who had been managing MDD with one of the following selective serotonin reuptake inhibitors (SSRIs): citalopram, paroxetine, or sertraline. The participants were also experiencing sexual side effects from their medication.
For the study, the participants switched their medication to either Trintellix or escitalopram. They also completed a sexual function assessment questionnaire at the start of the study and again eight weeks later.
When researchers analyzed the data, they found that the patients who took Tintrellix had better scores on the questionnaire. This meant that their sexual function improved over the study period.
In addition, the patients’ improvements with depression were maintained.
"Sexual dysfunction is one of the most common and bothersome side effects patients with depression struggle with when prescribed an SSRI," said lead investigator Dr. Anita Clayton in press statement.
She added, "We designed the study to specifically look at these troublesome side effects. Changing to a medication with potentially fewer sexual side effects, while not losing progress in treating depression, provides an important option for patients with depression."
“Expanded label shows Trintellix effective for SSRI-emergent sexual dysfunction”
“Label Update Shows Vortioxetine as Effective for Treatment-Emergent Sexual Dysfunction”
“Vortioxetine Beats Escitalopram in Improving SSRI-Induced Sexual Dysfunction”
“New Data Added to TRINTELLIX® (vortioxetine) Labeling Demonstrated Superiority Over Escitalopram in Improving SSRI-Induced Sexual Dysfunction in Patients with Major Depressive Disorder”
(Press statement. October 22, 2018)

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Bupropion, sometimes known by its brand name, Wellbutrin, is an antidepressant that is categorized as a dopamine reuptake inhibitor--it increases the amount of dopamine available within the brain by blocking its ability to be reabsorbed. It is thought that by inhibiting the reuptake of both dopamine and another brain chemical, norepinephrine, symptoms of depression improve.
Mirtazapine is another kind of antidepressant medication 2. According to The National Institutes of Health website, Medline Plus, sexual side effects, such as a loss of libido, do not occur while taking this medication, but patients may feel dizzy, anxious or confused 2.
Venlafaxine is known as a serotonin-norepinephrine reuptake inhibitor--it blocks the reuptake, or absorption, of both serotonin and norephinephrine 3. While sexual dysfunction may occur, loss of libido is a rare side effect; according to the medical reference "UpToDate," only about 5 percent of patients will experience this unpleasant effect.
“UpToDate”; Bupropion; Lexi-Comp, Inc.; 2010 Medline Plus: Mirtazapine Medline Plus: Venlafaxine “UpToDate”; Mirtazapine; Lexi-Comp, Inc.; 2010 “UpToDate”; Venlafaxine; Lexi-Comp, Inc.; 2010
Copyright © 2022 Leaf Group Ltd., all rights reserved. // Leaf Group Lifestyle
Depression is a common mental health problem that is often treated by a class of medication called serotonin-specific reuptake inhibitors, or SSRIs. Examples of SSRIs include fluoxetine--Prozac--and sertraline--Zoloft. This group of medications may cause the side effect of sexual dysfunction, including a loss of libido, or sexual drive. However, there are several antidepressant medications that do not generally cause a change in libido; these may be preferred by patients being treated for depression who are worried about changes in their sexual function.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Bupropion, sometimes known by its brand name, Wellbutrin, is an antidepressant that is categorized as a dopamine reuptake inhibitor--it increases the amount of dopamine available within the brain by blocking its ability to be reabsorbed. The exact mechanism of action of burpropion is unclear. It is thought that by inhibiting the reuptake of both dopamine and another brain chemical, norepinephrine, symptoms of depression improve.
Side effects relating to sexual dysfunction do not occur; however, headaches, weight loss and nausea may be potential side effects that patients should be aware of when taking this medication.
Mirtazapine is another kind of antidepressant medication 2 . It is thought to work by blocking a type of cell receptor known as the alpha-two receptor. This blockade causes an increase in the amounts of both serotonin and norepinephrine neurotransmitters; these are both chemicals within the brain which are thought to be associated with depression.
According to The National Institutes of Health website, Medline Plus, sexual side effects, such as a loss of libido, do not occur while taking this medication, but patients may feel dizzy, anxious or confused 2 3 . Somnolence, or excessive sleepiness, occurs in more than half of patients taking this medication. Constipation, nausea, and vomiting may also occur. In very rare cases, heart problems and seizures may occur.
Venlafaxine is known as a serotonin-norepinephrine reuptake inhibitor--it blocks the reuptake, or absorption, of both serotonin and norephinephrine 3 . This medication is another possibility for patients who are experiencing side effects from SSRI medications.
While sexual dysfunction may occur, loss of libido is a rare side effect; according to the medical reference "UpToDate," only about 5 percent of patients will experience this unpleasant effect. More commonly, venlafaxine causes headache; dizziness; insomnia or its opposite, excessive sleepiness; and nausea 3 . This latter side effect is especially common with venlafaxine, occurring in nearly two-thirds of patients who are taking this medication 3 .
Shira Goldenholz has been writing since 2001. She has edited a neurosciences coursebook and co-authored an article published in the "Journal of Child Neurology." She has contributed to a report on children's mental health and has written for an autism website. She holds a medical degree from the University of Wisconsin-Madison and a Master in Public Health from Boston University.

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Antidepressant With Least Sexual Side Effects

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