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Antidepressant Induced Sexual Dysfunction

See Also
1. Erectile Dysfunction Causes
Causes
1. See Medication Induced Sexual Dysfunction
2. Tricyclic Antidepressants
3. MAO inhibitors
4. Selective Serotonin Reuptake Inhibitor (SSRI)
  1. Fluoxetine (54% Incidence sexual dysfunction)
  2. Sertraline (56% Incidence sexual dysfunction)
  3. Paroxetine (65% Incidence sexual dysfunction)
Management: Approach
1. Observe for 4 to 6 weeks for adverse effects to subside
2. Adjust current Antidepressant dosing
  1. Decrease Antidepressant dosage
  2. Alter timing of daily dose
  3. Consider 2 day drug holiday
    1. Sertraline (Zoloft)
    2. Paroxetine (Paxil)
    3. Not effective for Fluoxetine (Prozac)
3. Consider adjunctive therapy (see below)
4. Substitute another Antidepressant
  1. Minimal to no sexual dysfunction
    1. Nefazodone (Serzone)
    2. Bupropion (Wellbutrin)
  2. Low risk of sexual dysfunction (10-15%)
    1. Fluvoxamine (Luvox)
    2. Citalopram (Celexa)
    3. Venlafaxine (Effexor)
Management: Adjunctive therapy to improve sexual function
1. Approach to specific sexual dysfunction problems
  1. Orgasm: all of the agents below
  2. Libido: Amantadine, Buspar, Periactin, Yohimbine
  3. Erection: Amantadine, Buspar, Periactin, Yohimbine
2. As Needed dosing
  1. Sildenafil (Viagra) 25-50 mg PO 0.5 to 4 hours before
    1. Numberg (2003) JAMA 289:56
  2. Amantadine 100 to 400 mg PO prn 2 days before coitus
  3. Bupropion 75-150 mg PO prn 1 to 2 hours before coitus
  4. Buspar 15-60 mg PO prn 1 to 2 hours before coitus
  5. Periactin 4-12 mg PO prn 1 to 2 hours before coitus
  6. Dexedrine 5-20 mg PO prn 1 to 2 hours before coitus
  7. Yohimbine 5.4-10.8 mg prn 1 to 2 hours before coitus
3. Daily Dosing
  1. Amantadine 75-100 mg PO bid to tid
  2. Bupropion 75 mg PO bid to tid
  3. Buspar 5-15 mg PO bid
  4. Dexedrine 2.5 to 5 mg bid to tid
  5. Pemoline 18.75 mg PO qd
  6. Yohimbine 5.4 mg PO tid
References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.