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SSRI antidepressants: persistant sexual dysfunction

Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) expose patients to sexual adverse effects that may persist long after discontinuation of the drug.

In mid-2019, the European Medicines Agency (EMA) recommended that the patient information leaflets of some antidepressants should warn of the risk of persistent sexual dysfunction. Cases of long-lasting sexual dysfunction despite discontinuation of the antidepressant have been reported with so-called selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and citalopram, as well as with serotonin and norepinephrine reuptake inhibitors such as venlafaxine and duloxetine.

This is based on the European Pharmacovigilance Database, which received reports of 574 cases associated with duloxetine, as well as reports from scientific journals of 219 observations in 170 men and 49 women. The most frequently reported adverse reactions were erectile dysfunction, loss of libido, genital anaesthesia, delayed orgasm and anorgasmia, emotional numbing.

Various sexual disorders are known adverse effects of these antidepressants.

Other adverse reactions suggest an endocrine disrupting effect: reversible effects on sperm quality, galactorrhoea  and hyperprolactinemia, while in children, effects include slowed growth and delayed pubertal development. Studies in juvenile animals have shown a decrease in fertility and delays in sexual maturation.

Antidepressants expose patients to numerous side effects, sexual in particular. The persistence of sexual dysfunction after stopping the antidepressant comes as news.

©Prescrire 1 February 2020

"SSRI antidepressants: persistent sexual dysfunction" Prescrire Int 2020; 29 (212): 45. (Pdf, subscribers only).

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