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Biologic basis of serotonin reuptake inhibitor antidepressant-associated female sexual dysfunction: A novel signaling perspective

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Abstract

Depression, which affects women twice as often as it does men, is rapidly becoming the second major cause of disability worldwide. This is true despite evidence that 80% to 90% of major depressive disorder patients respond to the first or second agent prescribed, and they can prevent relapse with continuing medication. Although “improved” serotonin reuptake inhibitor antidepressant agents advance treatment, most patients do not continue their prescribed medication for extended periods, resulting in premature treatment withdrawal rates approaching 68% in the first 3 months of treatment. This makes rates of relapse and recurrence three to four times higher. The principal reasons for premature withdrawal are side effects—mainly sexual dysfunction, which is under-recognized, occurs early in treatment, is dose related, is reversible, and rarely remits spontaneously. Assessment requires comprehensive evaluation of sexual function, pre-existing depression, depression associated with antidepressant treatment, and other related factors (eg, concurrent medical conditions, treatments, lifestyle risk factors, and response to treatments). Research on treatments for sexual dysfunction caused by serotonin reuptake inhibitor antidepressants relied on open label reports and clinical wisdom but lacked supporting double-blind placebo-controlled studies. This resulted in random pharmacology being given to patients. Advances in novel signal transduction and the use of phosphodiesterase type 5 (PDE5) inhibitors offer new opportunities for the development of evidence-based treatments for sexual dysfunction and for improving depression management outcomes. However, although evidence for PDE5 inhibitor effectiveness is extensive, it has predominantly focused on erectile dysfunction in men. Considerations for using PDE5 inhibitors to treat sexual dysfunction in women have begun to emerge and suggest potential treatment options for female sexual arousal disorder associated with the use of selective serotonin reuptake inhibitors.

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  1. Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker NE, 87131, Albuquerque, NM, USA

    H. George Nurnberg MD

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  1. H. George Nurnberg MD
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Nurnberg, H.G. Biologic basis of serotonin reuptake inhibitor antidepressant-associated female sexual dysfunction: A novel signaling perspective. Current Sexual Health Reports 2, 85–92 (2005). https://doi.org/10.1007/s11930-005-0009-8

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  • DOI: https://doi.org/10.1007/s11930-005-0009-8

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