Sexual dysfunction is an underdiscussed adverse effect to selective serotonin reuptake inhibitors SSRIs and may increase the risk for discontinuation and nonadherence to antidepressant pharmacotherapy.
Given the prevalence of depression, health care providers should educate patients about SSRI-associated sexual dysfunction in order to promote patient awareness and medication adherence. This study evaluated primary literature from to to identify SSRI-related sexual side effects, therapeutic alternatives, and treatment "Citalopram sexual difficulties." The results indicate that paroxetine is associated with the greatest rate of sexual dysfunction among the SSRIs.
Potential alternatives to SSRI treatment include bupropion, mirtazapine, vilazodone, vortioxetine, and serotonin-norepinephrine reuptake inhibitors. In the event that a subject responds solely to SSRIs but experiences unwanted sexual side effects, bupropion may be added as an adjunctive medication. Some limited evidence also suggests that saffron may reduce some aspects of sexual dysfunction, excluding ability to reach orgasm.
The prevalence of depression in the United States
Citalopram sexual difficulties approximately 7. In a survey, approximately However, in the studied population, subjects were less likely to experience orgasmic or ejaculation difficulties, the most common sexual side effects associated with SSRI therapy.
Focus should be placed on the most common types of sexual side effects, the risks associated with different SSRIs, and alternative solutions should an SSRI become intolerable. This study seeks to address these concerns in order to facilitate better patient education and treatment.
This article is a narrative literature review of SSRIs and their potential to cause sexual dysfunction. SSRIs alleviate symptoms of depression primarily by selectively inhibiting the reuptake of serotonin in the central nervous system. Specifically, an increase in serotonin may affect other hormones and neurotransmitters, such as testosterone and dopamine.
Many different categories of sexual side effects are
Citalopram sexual difficulties with SSRIs, the most common of which is delayed ejaculation. The frequency of subjects experiencing side effects increased with higher SSRI doses, indicating that subjects should be on the lowest effective dose to decrease the risk of side effects. These conclusions are in accordance with Citalopram sexual difficulties findings of a similar study, which found that paroxetine caused more sexual dysfunction than fluvoxamine, sertraline, and fluoxetine.
Arlas et al 16 found that the incidence of sexual dysfunction was Arlas et al 16 and Waldinger et al 17 reported similar results, with citalopram resulting less delay in orgasm and ejaculation compared with paroxetine. From these studies, paroxetine appears to have the greatest risk of causing sexual dysfunction compared with other SSRIs. The sexual side effects of SSRIs are attributed to their mechanism of action, which includes increasing the availability of serotonin.
Specifically, bupropion, mirtazapine, and serotonin-norepinephrine reuptake inhibitors SNRIs are antidepressants generally viewed as having less risk for sexual side effects.
Bupropion's mechanism of action involves blocking the reuptake of norepinephrine and dopamine; the SNRI mechanism of action involves blocking the reuptake of serotonin and norepinephrine. However, bupropion XL may have an advantage "Citalopram sexual difficulties" venlafaxine XR when it comes to the incidence of sexual dysfunction.
A placebo-controlled, double-blinded experiment utilized sustained-release bupropion mg twice a day versus placebo as an adjunct to SSRI treatment in 55 subjects experiencing SSRI-induced sexual dysfunction.
Orgasm and global sexual functioning also improved in both groups, but it was nonsignificant. Another study used adjunct bupropion on an as needed basis, with starting doses Citalopram sexual difficulties immediate-release bupropion 75 mg taken 1 to 2 hours before sex.
These results imply that bupropion may have a role as an adjunct to SSRI therapy in subjects experiencing a decrease in sexual activity. However, it is significant to note that the improvement in sexual dysfunction may be a by-product of further relief of depressive symptoms, which affect sexual dysfunction.
Mirtazapine, an alpha-2 adrenoceptor and serotonin receptor antagonist, may increase serotonin availability. However, because mirtazapine is Citalopram sexual difficulties selective, this medication may cause sleep disturbance, nausea, and weight gain.
Mirtazapine was titrated from 7. There was no significant change in HAM-D scores, indicating that depression remained in remission while on mirtazapine. This result was consistent with the findings of another study, which concluded that the incidence of sexual dysfunction with subjects taking mirtazapine was Novel antidepressants, vilazodone and vortioxetine, are also being considered as alternative treatments to traditional SSRIs.
In placebo-controlled trials, vilazodone has been reported to have minimal sexual side effects, but few studies directly compared vilazodone to an SSRI. One double-blinded, randomized, control trial compared vilazodone with placebo and utilized citalopram 40 mg as an active control.
The most commonly reported adverse effects were loss of and anorgasmia, similar to previous findings Citalopram sexual difficulties SSRIs. Since this study did not indicate whether or not the results were statistically significant, more studies may necessary to determine whether vilazodone is less likely to cause sexual side effects compared with SSRIs.
The mechanism of action of vortioxetine is not fully understood, but it is proposed to function as Citalopram sexual difficulties serotonin reuptake inhibitor with antagonizing action at several other 5-HT3 receptors. However, sexual dysfunction was more common with increasing doses of vortioxetine, and the study was not powered to detect statistical significance of sexual dysfunction in vortioxetine versus placebo.
Additionally, similar to trials assessing sexual side effects of vilazodone, there are few direct comparisons between vortioxetine and SSRIs. Therefore, while vortioxetine may be considered as an alternative pharmacotherapy to SSRIs, additional studies may further elucidate the risks of sexual dysfunction in vortioxetine. A systematic review of randomized control trials found that phosphodiesterase 5 PDE5 inhibitors, such as sildenafil and tadalafil, improved erectile dysfunction better than placebo in male subjects with sexual dysfunction as a result of antidepressant treatment.
Reviews of the effects of PDE5 inhibitors on sexual dysfunction in women were limited to small studies
Citalopram sexual difficulties case studies and require additional research. The PDE5 inhibitors may play a role in treating men with "Citalopram sexual difficulties" dysfunction as a result of SSRI therapy, but it does not provide a solution to the most common SSRI-related sexual side effect, difficulty with achieving orgasm. Saffron, a spice derived from the flower Crocus sativushas implications of producing aphrodisiac effects in animals and humans.
Modabbernia Citalopram sexual difficulties al 31 assessed the efficacy of saffron in fluoxetine-induced sexual dysfunction. The research was a randomized, double-blind, placebo-controlled study of 36 male subjects with stabilized depression.
Each subject was enrolled in the study based on complaints of sexual impairment and was assigned to either adjunctive saffron 15 mg twice daily or placebo for 4 weeks. The primary outcome was the measurement of the International Index of Erectile Function scale IIEFwhich has a minimum score of 5 and a maximum score of Lower IIEF scores correlate to greater sexual dysfunction.
Satisfaction with intercourse also improved in the saffron group mean difference of 2. However, improvements in sexual desire and ability to orgasm remained nonsignificant. A similar randomized, double blinded, placebo-controlled study looked at saffron's efficacy in women with fluoxetine-induced sexual dysfunction. However, similar to the study by Modabbernia et al, 31 improvements in the ability to achieve orgasm remained nonsignificant.
In terms of adverse drug reactions, saffron was comparable to placebo and Citalopram sexual difficulties serve to reverse some of the sexual side effects created by the SSRI. Saffron's efficacy in reducing sexual side effects of SSRIs may indicate an alternative or additional mechanism of action, since higher doses of serotonin reuptake inhibitors correspond to greater prevalence of sexual side effects.
Alternatively, the conjunction of an additional inhibitor of serotonin reuptake may have improved symptoms of depression, which can subsequently lead to better sexual function. This may explain why improvements Citalopram sexual difficulties the ability to achieve orgasm, the main sexual side effect of SSRI, were nonsignificant between saffron and placebo.
If an unwanted sexual side effect of an SSRI is attributed to arousal, lubrication, erectile function, or satisfaction, it may still be warranted to use saffron as an adjunctive therapy.
Citalopram sexual difficulties However, well understood pharmacotherapy approaches should be considered as alternatives before saffron is used. Patient education on the sexual side-effect profiles of SSRIs is critical to medication adherence, resolution of depressive symptoms, and improving quality of life.
Delaying this discussion may result in confusion and distrust of pharmacotherapies and health care providers, making it more difficult to adjust and recommend medications later on. This literature review serves as an aid to better facilitate patient education and treatment. However, as with all narrative studies, flaws of this study include potential for selection bias as one reviewer was responsible for article selection. Additionally, given the wide breadth of articles analyzed, there may be some concerns with external validity because subject groups were heterogeneous.
Lastly, antidepressants include a wide range of pharmacotherapy and nonpharmacotherapy options and not every facet explored, potentially contributing to external bias. Given the prevalence of sexual dysfunction in subjects with depression, it is for health care providers to give a full assessment and explanation of potential side effects of antidepressant pharmacotherapy.
For sexually active subjects requiring an SSRI, it is recommended to first try fluoxetine or sertraline, as they have less incidence of causing sexual dysfunction. Paroxetine should be the last SSRI of choice as it has the greatest incidence of causing sexual dysfunction. If an SSRI is chosen, subjects should be maintained on the lowest effective dose to decrease the risk of adverse effects.
If sexual side effects occur in subjects stabilized on an SSRI, solutions include switching to an alternative antidepressant or adding an adjunctive antidepressant eg, bupropion.
Novel agents, such as vortioxetine, appear to have limited sexual side effects, but the higher cost may be burdensome.
Other nontraditional methods for alleviating sexual side effects, such as the supplementation of saffron 15 mg twice a day, may improve arousal and erectile function in subjects experiencing SSRI-related sexual dysfunction.
However, given the limited research on saffron, other therapies should be tried first. There are many more pharmacologic and nonpharmacologic alternatives not mentioned in this As such, health care providers should choose a treatment based on patient need, cost, and clinical evidence. The authors have nothing to disclose. National Center for Biotechnology InformationU.
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This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 3. Abstract Sexual dysfunction is an underdiscussed adverse effect to selective serotonin reuptake inhibitors SSRIs and may increase the risk for discontinuation and nonadherence to antidepressant pharmacotherapy.