Antidepressant-Induced Sexual Dysfunction During Treatment With Moclobemide, Paroxetine, Sertraline, and Venlafaxine
J Clin Psychiatry 2000;61(4):276-281
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Recent reports suggest that adverse
effects on sexual function occur in up to 50% of patients who are
treated with selective serotonin reuptake inhibitor (SSRI)
antidepressants. Previously cited low rates were more likely a
function of underreporting than underoccurrence. There is less
evidence about rates of dysfunction with serotonin-norepinephrine
reuptake inhibitor (SNRI) and reversible inhibitor of monoamine
oxidase A (RIMA) antidepressants. The purpose of this report is
to evaluate disturbances in sexual drive/desire and
arousal/orgasm in 107 patients who met criteria for major
depressive disorder and received treatment with either
moclobemide, paroxetine, sertraline, or venlafaxine.
Method: All consenting eligible patients who met
DSM-IV criteria for major depressive disorder completed the
Sexual Functioning Questionnaire, version 1 (SFQ) and were
assessed using the 17-item Hamilton Rating Scale for Depression
(HAM-D) prior to and after 8 or 14 weeks of antidepressant
therapy. Analyses were carried out to examine the effect of
gender, drug type, pretreatment level of sexual dysfunction, and
drug response on reported sexual dysfunction.
Results: Compared with women, men experienced a
significantly greater level of drug-related impairment in
drive/desire (p < .05), whereas there were no statistically
significant differences in levels of arousal/orgasm impairment
between men and women. The reported impairment in drive/desire
items for men ranged from 38% to 50% and from 26% to 32% for
women. No differences were found across the 4 antidepressants in
men, whereas in women, rates of dysfunction were generally higher
with sertraline and paroxetine, but only significantly so in
comparison with moclobemide on some measures (p < .03). Rates
of sexual dysfunction with venlafaxine tended to fall between
those of SSRIs and the RIMA agent. An unexpected relationship was
found between favorable drug response and a decreased level of
drug-induced sexual dysfunction.
Conclusion: Antidepressant-induced sexual
dysfunction occurs in approximately 30% to 70% of patients who
are treated with sertraline or paroxetine. Lower rates are
reported with moclobemide and venlafaxine. Clinicians should
evaluate the various aspects of sexual dysfunction before and
during antidepressant therapy.