III. 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)

IV. 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 289:56-64 [PubMed]
    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

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