Antidepressant-Induced Sexual Dysfunction During Treatment With Moclobemide, Paroxetine, Sertraline, and Venlafaxine

Sidney H. Kennedy, M.D., F.R.C.P.C.; Beata S. Eisfeld, Hons.B.Sc.; Susan E. Dickens, M.A.; Jason R. Bacchiochi, B.A.; and R. Michael Bagby, Ph.D., C.Psych.

Background: Recent reports suggest that adverse effects on sexual function occur in up to 50% of patients who are treated with selective serotonin reuptake inhibitor (SSRI) antidepressants. Previously cited low rates were more likely a function of underreporting than underoccurrence. There is less evidence about rates of dysfunction with serotonin-norepinephrine reuptake inhibitor (SNRI) and reversible inhibitor of monoamine oxidase A (RIMA) antidepressants. The purpose of this report is to evaluate disturbances in sexual drive/desire and arousal/orgasm in 107 patients who met criteria for major depressive disorder and received treatment with either moclobemide, paroxetine, sertraline, or venlafaxine.

Method: All consenting eligible patients who met DSM-IV criteria for major depressive disorder completed the Sexual Functioning Questionnaire, version 1 (SFQ) and were assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D) prior to and after 8 or 14 weeks of antidepressant therapy. Analyses were carried out to examine the effect of gender, drug type, pretreatment level of sexual dysfunction, and drug response on reported sexual dysfunction.

Results: Compared with women, men experienced a significantly greater level of drug-related impairment in drive/desire (p < .05), whereas there were no statistically significant differences in levels of arousal/orgasm impairment between men and women. The reported impairment in drive/desire items for men ranged from 38% to 50% and from 26% to 32% for women. No differences were found across the 4 antidepressants in men, whereas in women, rates of dysfunction were generally higher with sertraline and paroxetine, but only significantly so in comparison with moclobemide on some measures (p < .03). Rates of sexual dysfunction with venlafaxine tended to fall between those of SSRIs and the RIMA agent. An unexpected relationship was found between favorable drug response and a decreased level of drug-induced sexual dysfunction.

Conclusion: Antidepressant-induced sexual dysfunction occurs in approximately 30% to 70% of patients who are treated with sertraline or paroxetine. Lower rates are reported with moclobemide and venlafaxine. Clinicians should evaluate the various aspects of sexual dysfunction before and during antidepressant therapy.

(J Clin Psychiatry 2000;61:276-281)

Received March 24, 1999; accepted Oct. 19, 1999. From the Department of Psychiatry, University of Toronto (Drs. Kennedy and Bagby), and the Centre for Addiction and Mental Health (all authors), Toronto, Ontario, Canada.

Supported by the Centre for Addiction and Mental Health Foundation.

A preliminary version of this article was presented at the 152nd annual meeting of the American Psychiatric Association, Washington, D.C., May 19, 1999.

Reprint requests to: Sidney H. Kennedy, M.D., F.R.C.P.C., Mood & Anxiety Disorders Program, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario, Canada M5T 1R8 (e-mail: