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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
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Minerva Psichiatrica 1999 September;40(3):171-200

language: Italian

Sexual effects of selective serotonin reuptake inhibitor drugs

Facchi A., Puzella A., Bersani G.


SSRI antidepressants have sexual side effects in both men and women, much like what occurs with tricyclic antidepressants; such effects do not depend on the nature of the disease and involve the motivation, excitement, orgasmic and sexual pleasure phases. The mechanisms involved in these effects appear to be serotonergic, dopaminergic and noradrenergic; however, other neurochemical mechanisms cannot be excluded. It has been hypothesised that at the basis of retarded ejaculation and anorgasmia, as well as impotence, there could be the main pharmacological property of SSRI drugs, i.e., serotonin transporter inhibition. The incidence of sexual side effects during SSRI treatment has been determined using all available scientific literature. Symptoms are described in detail and their relationship with drug intake is underlined. At times, sexual side effects of SSRIs include paradoxical sexual hyperstimulation (for example, clitoral engorgement, excitation and orgasmic activity with fluoxetine). Finally, treatments intended to correct SSRI intake-induced sexual dysfunction. Besides dosage reduction, some 5-HT2A/2C receptor antagonists, alfa2-blockers and dopaminergic stimulants proved to be effective. For some 5-HT2A receptor antagonists, return of the depression has been reported, which sets off all the advantages of treatment. Such depression relapse or recurrence on the other hand has not been described for 5-HT2A antagonists which also bear antidepressant properties, such as mianserin or nefazodone.

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