Physicians use these guidelines to help patients manage the sexual side effects of antidepressants.

Causes

1. Medication Induced Sexual Dysfunction
2. Tricyclic Antidepressants
3. MAO inhibitors
4. Selective Serotonin Reuptake Inhibitor (SSRI)
   1. Fluoxetine (Prozac) (54% Incidence sexual dysfunction)
   2. Sertraline (Zoloft) (56% Incidence sexual dysfunction)
   3. Paroxetine (Paxil) (65% Incidence sexual dysfunction)

Management Approach

1. Observe for 4 to 6 weeks for adverse effects to subside
2. Adjust current Antidepressant dosing
   1. Decrease Antidepressant dosage
   2. Alter timing of daily dose
   3. Consider 2 day drug holiday
      1. Sertraline (Zoloft)
      2. Paroxetine (Paxil)
      3. Not effective for Fluoxetine (Prozac)
3. Consider adjunctive therapy (see below)
4. Substitute another Antidepressant
   1. Minimal to no sexual dysfunction
      1. Bupropion (Wellbutrin)
      2. Mirtazapine (Remeron)
   2. Low risk of sexual dysfunction (10-15%)
      1. Fluvoxamine (Luvox)
      2. Citalopram (Celexa)
      3. Venlafaxine (Effexor)

Management: Adjunctive therapy to improve sexual function

1. Approach to specific sexual dysfunction problems
   1. Orgasm: all of the agents below
   2. Libido: Amantadine, Buspar, Periactin, Yohimbine
   3. Erection: Amantadine, Buspar, Periactin, Yohimbine
2. As Needed dosing
   1. Sildenafil (Viagra) 25-50 mg PO 0.5 to 4 hours before
      1. Numberg (2003) JAMA 289:56-64
   2. Amantadine 100 to 400 mg PO prn 2 days before coitus
   3. Bupropion 75-150 mg PO prn 1 to 2 hours before coitus
   4. Buspar 15-60 mg PO prn 1 to 2 hours before coitus
   5. Periactin 4-12 mg PO prn 1 to 2 hours before coitus
   6. Dexedrine 5-20 mg PO prn 1 to 2 hours before coitus
   7. Yohimbine 5.4-10.8 mg prn 1 to 2 hours before coitus
3. Daily Dosing
   1. Amantadine 75-100 mg PO bid to tid
   2. Bupropion 75 mg PO bid to tid
   3. Buspar 5-15 mg PO bid
   4. Dexedrine 2.5 to 5 mg bid to tid
   5. Pemoline 18.75 mg PO qd
   6. Yohimbine 5.4 mg PO tid

References

1. Montejo-Gonzalez (1997) J Sex Marital Ther 23:176
2. Moore (Jan 1999) Hospital Practice, p. 89-96
3. Labbate (1998) J Sex Marital Ther 24:3

Source: Family Practice Notebook. The author of the Family Practice Notebook, is Scott Moses, MD, a board-certified Family Physician practicing in Lino Lakes, Minnesota.

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