Treatment-Emergent Sexual Dysfunction Related to Antidepressants: A Meta-Analysis
Abstract
BACKGROUND: Sexual dysfunction (SD) is an important underestimated adverse effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. The aim of the present meta-analysis was to quantify SD caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires. METHODS: A literature search was conducted using MEDLINE, ISI Web of Knowledge, and references of selected articles. Selected studies performed on patients without previous SD were entered in the Cochrane Collaboration Review Manager (RevMan version 4.2). Our primary outcome measure was the rate of total treatment-emergent SD. Our secondary outcome measures were the rates of treatment-emergent desire, arousal, and orgasm dysfunction. RESULTS: Our analyses indicated a significantly higher rate of total and specific treatment-emergent SD and specific phases of dysfunction compared with placebo for the following drugs in decreasing order of impact: sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram, and fluvoxamine, with SD ranging from 25.8% to 80.3% of patients. No significant difference with placebo was found for the following antidepressants: agomelatine, amineptine, bupropion, moclobemide, mirtazapine, and nefazodone. DISCUSSION: Treatment-emergent SD caused by antidepressants is a considerable issue with a large variation across compounds. Some assumptions, such as the inclusion of open-label studies or differences in scales used to assess SD, could reduce the significance of our findings. However, treatment-emergent SD is a frequent adverse effect that should be considered in clinical activity for the choice of the prescribed drug.
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Standard antidepressants leave residual symptoms such as cognitive and sleep disturbances.
“the persistence of some residual symptoms (e.g., cognitive and sleep disturbances)”
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Atypical antidepressants such as bupropion, mirtazapine, and nefazodone are less likely to cause TESD.
“Atypical antidepressants such as bupropion, mirtazapine, and nefazodone are less likely to cause TESD”
From A randomized, double-blind, duloxetine-referenced study comparing efficacy and tolerability of 2 fixed doses of vortioxetine in the acute treatment of adults with MDD (2015) · cites this paper as Serretti and Chiesa 2009
A study showed that antidepressants with high serotonin selectivity such as citalopram, fluoxetine, paroxetine, sertraline, and venlafaxine showed the highest rates of total sexual dysfunction.
“In contrast, a study showed that the antidepressants with high serotonin selectivity such as citalopram, fluoxetine, paroxetine, sertraline, and venlafaxine showed the highest rates of total sexual dysfunction.”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [65]
Although imipramine showed significantly higher sexual dysfunction than placebo, the rate was lower than the previous 5 antidepressants.
“Although imipramine showed significantly higher sexual dysfunction than placebo, the rate was lower than the previous 5 antidepressants.65”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [65]
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Szmulewicz, A., Samamé, C., Caravotta, P., Martino, D. J., Igoa, A., Hidalgo-Mazzei, D., Colom, F., & Strejilevich, S. A. (2016) · International Journal of Bipolar Disorders · doi:10.1186/s40345-016-0047-3 · Cited by 28 · see citing works
Safer, D. J. (2016) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000564 · Cited by 19 · see citing works
Jacobsen, P. L., Thorley, E. M., & Curran, C. (2020) · Neurology, Psychiatry and Brain Research · doi:10.1016/j.npbr.2020.03.002 · Cited by 19 · see citing works
Scala, M., Fabbri, C., Fusar-Poli, P., Di Lorenzo, G., Ferrara, M., Amerio, A., Fusar-Poli, L., Pichiecchio, A., Asteggiano, C., Menchetti, M., et al. (2024) · CNS Spectrums · doi:10.1017/s1092852924002268 · Cited by 9 · see citing works
“These include high nonresponse rates, the persistence of some residual symptoms (e.g., cognitive and sleep disturbances), undesirable metabolic and sexual side effects, 4-7 as well as the delayed onset of therapeutic effects.”
Self-citation
- Authors
- Serretti, A., & Chiesa, A.
- Affiliations
- University of Bologna (IT)
- Venue
- Journal of Clinical Psychopharmacology
- Published
- 2009-06
- Volume
- 29
- Issue
- 3
- Pages
- 259-266
- ISSN
- 0271-0749 (ISSN-L)
- OpenAlex
- W1976410377
- Cited by
- 583
- References
- 67
- Citations by year
- 2026: 35 · 2025: 26 · 2024: 43 · 2023: 39 · 2022: 30 · 2021: 38 · 2020: 21 · 2019: 34 · 2018: 28 · 2017: 38 · 2016: 36 · 2015: 31 · 2014: 46 · 2013: 36 · 2012: 34
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- sexual dysfunction, antidepressants, treatment-emergent adverse events, sexual desire, sexual arousal, sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram, fluvoxamine, agomelatine, mirtazapine, nefazodone, bupropion, moclobemide, amineptine, drug selection
- MeSH terms
- Antidepressive Agents, Arousal, Female, Humans, Male, Orgasm, Sex Factors, Sexual Dysfunctions, Psychological
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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