Strategies for managing sexual dysfunction induced by antidepressant medication.
Rudkin L., Taylor MJ., Hawton K.
BACKGROUND: Sexual dysfunction (including altered desire, orgasmic dysfunction, erectile and ejaculatory problems) is a relatively common side effect of antidepressant medication. These sexual side effects may compromise a person's lifestyle and result in a lack of compliance with the prescribed antidepressant to the detriment of the person's mental health. OBJECTIVES: The objective of this review was to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication. SEARCH STRATEGY: We searched the CCDANCTR (March 2003), the Cochrane Central Register of Controlled Trials (Cochrane Library issue 2, 2004), MEDLINE (1966 - June 2004), EMBASE (1980 - March 2004), CINAHL (1982 - March 2004), PsycINFO (1984 - March 2004) and the reference lists of articles. We also contacted pharmaceutical companies and experts in the field of sexology. SELECTION CRITERIA: Randomised controlled trials comparing the management strategies for antidepressant induced sexual dysfunction were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. Study authors were contacted for additional information. Adverse effect information was collected from the trials. MAIN RESULTS: Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 - 0.6) and was not associated with any worsening of depression. Fourteen trials involving 829 people assessed the addition of other medication while continuing the same antidepressant. Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF; WMD 19.36, 95% CI 15.00 to 23.72). There was no significant difference in dropout rates between sildenafil and placebo. One trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 - 1.55). One trial found that the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo. REVIEWERS' CONCLUSIONS: The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.