Management of Sexual Dysfunction

Management of sexual dysfunction in patients being treated with antidepressant drugs should follow a detailed assessment, including systematic inquiry into each area of sexual function, to determine its exact nature and potential cause. In particular it is important to establish whether the sexual dysfunction is a treatment-emergent side-effect of medication, or whether there may have been pre-existing sexual dysfunction related to other causes. Men may be more willing than women to describe sexual problems to a psychiatrist, and direct questioning about specific symptoms is the preferred method of inquiry.80,111 More of a problem may be the reluctance of doctors themselves to initiate the necessary line of questioning.

General principles of psychological management include explanation and reassurance, reduction of performance anxiety, reduction of feelings of failure and resentment, and establishment of better communication between partners when addressing relationship difficulties.112,113 This is likely to be helpful even for those patients whose sexual dysfunction is primarily drug-related. Common-sense suggests waiting for spontaneous improvement, especially in patients in the early stages of drug treatment, still recovering from depression.

Specific pharmacological approaches include reduction in dose of the offending drug, especially if this is unusually high, withdrawal (with or without substitution) of medication and drug holidays (from short-acting drugs). A problem may be the return of depressive or other symptoms. Accordingly, adjunctive drug treatments such as cyproheptadine, yohimbine, bethanecol, amantadine and pemoline are potentially useful if a variety of clinical anecdotes are correct. However, none of these adjunctive drug treatments have been investigated in randomized, double-blind controlled studies of a specific drug-induced disorder of sexual function.

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