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Prevalence of Sexual Dysfunction Among Newer Antidepressants

Anita H. Clayton, M.D.; James F. Pradko, M.D.; Harry A. Croft, M.D.; C. Brendan Montano, M.D.; Robert A. Leadbetter, M.D.; Carolyn Bolden-Watson, Ph.D.; Kristin I. Bass, B.A.; Rafe M. J. Donahue, Ph.D.; Brenda D. Jamerson, Ph.D.; and Alan Metz, M.D.

Background: Sexual dysfunction commonly occurs during antidepressant treatment. However, the reported rates of sexual dysfunction vary across antidepressants and are typically underreported in product literature. The objectives of this study were (1) to estimate the prevalence of sexual dysfunction among patients taking newer antidepressants (bupropion immediate release [IR], bupropion sustained release [SR], citalopram, fluoxetine, mirtazapine, nefazodone, paroxetine, sertraline, venlafaxine, and venlafaxine extended release [XR]) and (2) to compare physician-perceived with patient-reported prevalence rates of antidepressant-associated sexual dysfunction.

Method: This cross-sectional, observational study was conducted in 1101 U.S. primary care clinics. Adult outpatients (4534 women and 1763 men) receiving antidepressant monotherapy were enrolled. The prevalence of sexual dysfunction was measured using the Changes in Sexual Functioning Questionnaire.

Results: In the overall population, bupropion IR (22%) and SR (25%) and nefazodone (28%) were associated with the lowest risk for sexual dysfunction, whereas selective serotonin reuptake inhibitor (SSRI) antidepressants, mirtazapine, and venlafaxine XR were associated with higher rates (36%-43%). In a prospectively defined subpopulation unlikely to have predisposing factors for sexual dysfunction, the prevalence of sexual dysfunction ranged from 7% to 30%, with the odds of having sexual dysfunction 4 to 6 times greater with SSRIs or venlafaxine XR than with bupropion SR. Physicians consistently underestimated the prevalence of antidepressant-associated sexual dysfunction.

Conclusion: Ours is the first study to assess sexual dysfunction across the newer antidepressants using consistent methodology and a validated rating scale. Overall, SSRIs and venlafaxine XR were associated with higher rates of sexual dysfunction than bupropion or nefazodone. Because antidepressant-associated sexual dysfunction is considerably underestimated by physicians, greater recognition and education are imperative when prescribing antidepressant treatment.

(J Clin Psychiatry 2002;63:357-366)

Received June 13, 2001; accepted Jan. 3, 2002. From the Department of Psychiatric Medicine, University of Virginia, Charlottesville (Dr. Clayton); Private Practice, St. Clair Shores, Mich. (Dr. Pradko); The Croft Group, San Antonio, Tex. (Dr. Croft); Department of Family Practice, University of Connecticut, Farmington (Dr. Montano); and GlaxoSmithKline (formerly Glaxo Wellcome Inc.), Research Triangle Park, N.C. (Drs. Leadbetter, Bolden-Watson, Donahue, Jamerson, and Metz and Ms. Bass).

The research described in this manuscript was sponsored by Glaxo Wellcome Inc. Protocol number AK140020.

The authors acknowledge Tracie D. Giargiari, M.A., and Trisha L. Houser, B.A., for assistance with writing the manuscript for this article.

Dr. Clayton has been a consultant for Eli Lilly, GlaxoSmithKline, and Pharmacia; has received grant/research support from Eli Lilly, Forest Laboratories, GlaxoSmithKline, Organon, Pfizer, and Pharmacia; and has been a speakers/advisory board member for Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, and Organon. Dr. Pradko has been a consultant for GlaxoSmithKline and a speakers/advisory board member for GlaxoSmithKline, Pfizer, Organon, Wyeth, and Solvay. Dr. Croft has been a consultant for Pfizer and GlaxoSmithKline and has received grant/research support from GlaxoSmithKline, Pfizer, TAPP, and Novartis. Dr. Montano has received grant/research support from GlaxoSmithKline and Takeda and has received honoraria from and been a speakers/advisory board member for GlaxoSmithKline, Eli Lilly, Abbott, Forest Pharmaceuticals, Wyeth Ayerst, Hoffman LaRoche, and Searle.

Corresponding author and reprints: Anita H. Clayton, M.D., 2955 Ivy Rd., Northridge Bldg., Suite 210, Charlottesville, VA 22903 (e-mail: