Three cases of female anorgasmia associated with MAOIs

Phenelzine-induced sexual dysfunction treated with sildenafil

This article describes the presence, in a 56-year-old male, of sexual dysfunction that was associated with phenelzine (Nardil) and was treated successfully with sildenafil (Viagra). The sexual dysfunction was assessed using the Arizona Sexual Experiences Scale for males (ASEX-Male).

Physiological mechanisms of sexual dysfunction side effects associated with antidepressant medication

Sexual dysfunction side effects have been associated with antidepressant medication, especially with serotonin reuptake inhibitors. Neurotransmitters appear to be involved, especially dopamine and serotonin, but the processes by which they influence sexual dysfunction are not clear.

Sexual side effects of antidepressants: a review

Antidepressant-induced adverse sexual effects are becoming more frequently reported by patients who require pharmacotherapy. A MED-LINE search was conducted to generate articles reporting such events. We report here on the sexual side effects associated with tricyclics, monoamine oxidase inhibitors including moclobemide, selective serotonin reuptake inhibitors, bupropion, and on the newer antidepressants venlafaxine and nefazadone. We conclude that adverse sexual effects are an increasingly important side effect of antidepressant medications, and patients must be routinely asked about their occurrence.

Fluvoxamine-associated sexual dysfunction

OBJECTIVE

To report two cases of sexual dysfunction induced by fluvoxamine, a selective serotonin reuptake inhibitor (SSRI).

SETTING

University teaching hospital.

PATIENTS

Two depressed patients who developed ejaculation and orgasmic difficulties after initiation of fluvoxamine therapy.

DISCUSSION

The literature concerning sexual dysfunction with serotonergic antidepressants is reviewed, and speculated mechanisms for this untoward effect are discussed.

CONCLUSIONS

Sexual dysfunction associated with antidepressant drugs, including SSRIs, may be underreported. This troublesome adverse effect may significantly affect patient comfort and compliance. Careful evaluation of sexual function is warranted, prior to and during drug treatment, especially as more serotonergic antidepressant agents become available.

Genitourinary and sexual adverse effects of psychotropic medication

OBJECTIVE

We review the adverse effects on genitourinary and sexual function associated with antidepressants, neuroleptics, lithium, and benzodiazepines, and suggest treatment strategies that may be used for their management.

METHOD

This article is based on systematic review of the existing literature, including more than 130 relevant articles on genitourinary and sexual effects of psychotropic medications.

RESULTS

We find that genitourinary function, including effects on continence and flow, and sexual function, including libido, erection, ejaculation and orgasm, may be altered by psychotropic administration. Many of these effects may be consequent to the impact of these medications on neurophysiologic systems.

CONCLUSIONS

Genitourinary and sexual adverse effects associated with psychotropic therapy are important areas of study and clinical concern that may affect patient comfort and compliance with treatment.

Psychoactive drugs and human sexual behavior: the role of serotonergic activity

A wide range of both prescription and nonprescription drugs has been reported to affect human sexual functioning. While the sexual side effects resulting from drug use have often been attributed to adrenergic, anticholinergic or dopaminergic activity, the present review considers the potential role of serotonin. Based on animal studies, serotonin has been shown to either facilitate or inhibit sexual activity depending on which serotonin receptor subtype is activated. However, few studies have been done in the human that assess the effects of drugs that bind selectively to serotonin receptors. Consequently, little is known about the role of serotonin in human sexual functioning. In this review, a wide range of drugs that affect both brain serotonergic systems and human sexual behavior is examined in an effort to determine the possible role of serotonin in human sexual behavior. A review of the literature is consistent with the hypothesis that the 5-HT1A and the 5-HT2 receptor subtypes play a facilitatory role in human sexual behavior. The evidence suggests that drugs that act as agonists on these receptor sites enhance sexual functioning in the human, while those that act as antagonists inhibit sexual functioning.

Sexual side-effects of psychiatric drugs

Clinical case reports, clinical series, and a small number of controlled studies provide evidence that many commonly prescribed psychiatric drugs may have untoward effects on sexual function. Both heterocyclic antidepressants and monoamine oxidase inhibitors appear to be associated with ejaculatory impairment. Erectile dysfunction and retarded ejaculation have been associated with neuroleptics. Several benzodiazepines have been reported to interfere with ejaculation. This information has clear significance for the prescribing physician.

Anorgasmia from clomipramine in obsessive-compulsive disorder. A controlled trial

Forty-six patients with obsessive-compulsive disorder undergoing a double-blind controlled study of clomipramine and placebo were interviewed to assess changes in sexual function. Of 33 patients with previously normal organism, nearly all of the 24 on clomipramine developed total or partial anorgasmia; none of the 9 on placebo did so. Anorgasmia persisted with minimal tolerance over the five months that clomipramine was taken. Men and women were equally affected. Sexual side-effects are easily missed without a structured interview, and can detract from the value of drug treatment.