Ssri With Least Sexual Side Effects

Ssri With Least Sexual Side Effects

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I'm worried about the sexual side effects from antidepressants. What can be done to prevent or reduce such side effects?
Answer From Daniel K. Hall-Flavin, M.D.

Taylor MJ, et al. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database of Systematic Reviews. 2013; doi:10.1002/14651858.CD003382.pub3.
Baldwin DS, et al. Impact of antidepressant drugs on sexual function and satisfaction. CNS Drugs. 2015; doi:10.1007/s40263-015-0294-3.
Chokka PR, et al. Assessment and management of sexual dysfunction in the context of depression. Therapeutic Advances in Psychopharmacology. 2018; doi:10.1177/2045125317720642.
Montejo AL, et al. Sexual side-effects of antidepressant and antipsychotic drugs. Current Opinion in Psychiatry. 2015; doi:10.1097/YCO.0000000000000198.
Lorenz T, et al. Antidepressant-induced female sexual dysfunction. Mayo Clinic Proceedings. 2016; doi:10.1016/j.mayocp.2016.04.033.
Kovich H, et al. Common questions about the pharmacological management of depression in adults. American Family Physician. 2015; https://www.aafp.org/afp/2015/0715/p94.html. Accessed Nov. 22, 2019.
La Torre A, et al. Sexual dysfunction related to psychotropic drugs: A critical review ― Part I: Antidepressants. Pharmacopsychiatry. 2013; doi:10.1055/s-0033-1345205.

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Antidepressants Which cause the fewest sexual side effects

Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations.
Sexual side effects are common with antidepressants in both men and women, so your concern is understandable. Effects on sexual function can include:
The severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. For some people, sexual side effects are minor or may ease up as their bodies adjust to the medication. For others, sexual side effects continue to be a problem.
Antidepressants with the lowest rate of sexual side effects include:
Antidepressants most likely to cause sexual side effects include:
If you're taking an antidepressant that causes sexual side effects, your doctor may recommend one or more of these strategies:
Stopping medication because of sexual side effects is a common problem, and for most people this means depression returns. Work with your doctor to find an effective antidepressant or combination of medications that will reduce your sexual side effects and keep your depression under control.
If you're pregnant or trying to become pregnant, tell your doctor, as this may affect the type of antidepressant that's appropriate.
Be patient. Everyone reacts differently to antidepressants, so it may take some trial and error to identify what works best for you.
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Sexual problems are highly prevalent in both men and women and are affected by, among other factors, mood state, interpersonal functioning, and psychotropic medications. The incidence of antidepressant-induced sexual dysfunction is difficult to estimate because of the potentially confounding effects of the illness itself, social and interpersonal comorbidities, medication effects, and design and assessment problems in most studies. Estimates of sexual dysfunction vary from a small percentage to more than 80%. This article reviews current evidence regarding sexual side effects of selective serotonin reuptake inhibitors (SSRIs). Among the sexual side effects most commonly associated with SSRIs are delayed ejaculation and absent or delayed orgasm. Sexual desire (libido) and arousal difficulties are also frequently reported, although the specific association of these disorders to SSRI use has not been consistently shown. The effects of SSRIs on sexual functioning seem strongly dose-related and may vary among the group according to serotonin and dopamine reuptake mechanisms, induction of prolactin release, anticholinergic effects, inhibition of nitric oxide synthetase, and propensity for accumulation over time. A variety of strategies have been reported in the management of SSRI-induced sexual dysfunction, including waiting for tolerance to develop, dosage reduction, drug holidays, substitution of another antidepressant drug, and various augmentation strategies with 5-hydroxytryptamine-2 (5-HT2), 5-HT3, and alpha2 adrenergic receptor antagonists, 5-HT1A and dopamine receptor agonists, and phosphodiesterase (PDE5) enzyme inhibitors. Sexual side effects of SSRIs should not be viewed as entirely negative; some studies have shown improved control of premature ejaculation in men. The impacts of sexual side effects of SSRIs on treatment compliance and on patients' quality of life are important clinical considerations.

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