The SSRIs as a class produce a variety of sexual side effects, including impotence, anorgasmia, decreased libido. SSRIs-induced sexual dysfunction is common but remains highly unrecognized and underreported. Only 14% of depressed patients taking SSRIs for depression spontaneously report sexual dysfunction; however, if queried directly, nearly 60% of patients report sexual dysfunction. The incidence of sexual dysfunction in men is higher than in women, but women's sexual dysfunction is more intense than men's.
Suggested causes include increased serotonin, particularly affecting 5HT2 and 5HT3 receptors; decreased dopamine; blockade of cholinergic and alpha-1 adrenergic receptors; inhibition of nitric oxide synthetase; and elevation of prolactin levels.
Some evidence exists to support the claim that paroxetine (Paxil) causes the highest rates of sexual side effects. According to the study paroxetine (Paxil) is associated with more delay of orgasm or ejaculation and more impotence than fluoxetine (Prozac) and sertraline (Zoloft).
The conventional view has been that once the drug is stopped, sexual functioning comes back to normal. There are indicators however that this may not be true for everyone and antidepressant-induced SD may turn into Post SSRI Sexual Dysfunction (PSSD). If sexual functioning remains abnormal, this should be brought to the attention of your physician.
There are several methods for the management of SSRIs-induced sexual dysfunction. One method is to reduce the current antidepressant dose while maintaining the medication at a therapeutic level. Drug holidays can be useful in some patients who are compliant and don’t have significant problems with discontinuation. In general, adjunctive pharmacotherapy with stimulants can be extremely helpful. Switching to treatment with an antidepressant medication that is associated with a low incidence of sexual side effects should also be considered.
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