Effects of depression and antidepressants on sexual functioning.

With serotonergic antidepressants dominating the treatment of depressive disorders, antidepressant-induced sexual side effects have emerged as a major clinical issue. Surprisingly, the effects of depression on sexuality are less well established and more variable than previously thought. It is likely that antidepressants with strong serotonergic effects--selective serotonin reuptake inhibitors, clomipramine, and monoamine oxidase inhibitors--are associated with higher rates of sexual side effects, compared to other antidepressant classes. Orgasmic and ejaculation difficulties are prominent with these medications, although alterations in libido, arousal, and erectile function are also common. Treatment of these side effects includes both general strategies and specific antidotes, such as cyproheptadine, yohimbine, dopamine agonists, and buspirone.