4.4. Sexual dysfunction
Very common and common adverse effects
SSRIs can reduce libido and cause difficulty achieving orgasm in men and women. Men may not be able to sustain erection and ejaculation may be delayed or abnormal. In women, there may also be alteration to menstrual bleeding, changes in breast size, and breast tenderness. It is likely that problems with sexual dysfunction are underreported. Further, the picture might be complicated by the effect of depression1 itself.
Factors which increase risk
Factors that affect sexual function, such as physical illness (eg diabetes and hypertension), concomitant medicines (eg for cardiovascular disease), and substance abuse can increase the risk of sexual dysfunction in those treated with SSRIs.
Risk-reduction measures
Sexual dysfunction is a common reason for the patient to discontinue SSRI treatment. Sensitive and frank questioning and discussion of sexual side effects during medication review can help promote adherence to treatment.
Lifestyle changes (exercise, weight reduction, smoking cessation, abstinence from substance abuse) can be conducive to improved sexual function.
Treatment
Sexual counseling may be called for and specific treatment for erectile dysfunction can be considered. If symptoms persist, consider reduction in dose or alternative treatment.
- A psychiatric disorder characterised by lowered mood, reduced energy and decreased activity. The severity of a depressive episode is divided clinically into mild, moderate and severe subtypes (the latter may or may not have psychotic features). Repeated episodes of depression, without a history of mania, are classified as recurrent depressive disorder.↩