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Major Depressive Disorder, Antidepressants, and Sexual Dysfunction.

Anita H. Clayton, MD, and Angel L. Montejo, MD, PhD

Published: June 15, 2006

Article Abstract
‘ ‹Sexual dysfunction is a common problem with a number of causes, including psychosocial factors,

general medical illness, psychiatric disorders, and psychotropic and nonpsychiatric medications. It is
especially prevalent among patients with poor emotional health and has been strongly associated with
antidepressant medications. Selective serotonin reuptake inhibitors (SSRIs) in particular have demonstrated
a higher incidence of sexual dysfunction than other antidepressants that work through different
mechanisms of action. Further supporting the relationship between sexual dysfunction and antidepressant
mechanism of action, data from a number of studies indicate that bupropion, nefazodone, and
mirtazapine alleviate symptoms of sexual dysfunction and are as effective as SSRIs at controlling depressive
symptoms. Although a number of strategies besides drug substitution have been utilized to
help manage antidepressant-induced sexual dysfunction, many patients remain suboptimally treated;
as many as 42% of patients were found to passively wait for spontaneous remission. The addition of
antidotal therapy has been proven to be among the effective management strategies for sexual dysfunction.
However, due to a lack of systematic data, additional studies are warranted to further investigate
these findings.’ ‹

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