Sexual difficulties associated with antidepressant use

Sexual difficulties are a common but under-reported adverse effect of antidepressants and a leading cause of nonadherence. Antidepressant-induced sexual difficulties can affect both males and females, and include effects on desire (libido), arousal and orgasm. Despite limited evidence of the comparative risk of sexual difficulties with antidepressants, the greatest risk has been observed with selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenaline reuptake inhibitors (SNRIs) and clomipramine (see c_ptg8-c68-s1.html#ptg8-c68-s1__tptg8-c68-tbl2).

Consider screening for sexual difficulties before starting an antidepressant then regularly throughout treatment. If the patient has sexual difficulties, consider other causes or contributors—see Low libido in females, Low libido in males, Orgasm difficulties in females, Erectile dysfunction or Premature ejaculation. In some cases, sexual difficulties can persist for some time after stopping an antidepressant, particularly an SSRI or SNRI.

There is limited evidence to guide the most appropriate strategy for managing antidepressant-induced sexual difficulties. Although sexual difficulties can resolve spontaneously, this is uncommon. Psychotherapy and physical exercise may improve symptoms.

For general strategies to manage antidepressant adverse effects, see here.