The assessment of traumatic brain injury

Antidepressants and psychosexual dysfunction: Part 2 – treatment

When antidepressant-induced sexual dysfunction has been established and recognised as an important aspect of a
patient’s well-being, failure to treat may lead to non-compliance and loss of faith in the psychiatrist.
Nonetheless, psychiatrists may simply find themselves out of their depth or be reluctant to change proven
treatment regimes for the sake of a side effect. They may also be under time constraints or doubtful about straining
further already stretched budgets. However, a systematic, well thought-through approach to treatment may be
surprisingly resource-efficient.
Treatment of antidepressant-induced sexual dysfunction

For patients who value their sexual function highly, an antidepressant associated with a low prevalence of sexual dysfunction should be prescribed as first-line treatment. Using an alternative antidepressant with less impact on sexual function should be considered for those patients who are already on antidepressants and suffer from sexual dysfunction. Reversing sexual dysfunction pharmacologically by targeting specific receptors is a further treatment option.
Other treatments for sexual dysfunction

Hormonal treatments are used for the treatment of HSDD, but the role of hormone supplementation in the treatment of antidepressant-induced sexual dysfunction remains unclear. All hormone replacement therapies may promote the growth of hormone-sensitive cancer cells. HRT is also associated with an increased cardiovascular risk so that risks and benefits must be carefully considered before treatment is initiated. Men with an elevated PSA must not be prescribed testosterone. Testosterone is associated with an increased risk of depression and DHEA with an increased risk of mania. Complementary therapies should be carefully evaluated with regard to potential risks and treatment recommendation must be based on individual circumstances. Many complementary treatments may have psychotropic properties and/or interact with antidepressants.
Formal aspects of prescribing for sexual dysfunction

Doctors who prescribe substances which are either not licensed at all or not licensed for the treatment of sexual dysfunction must follow the GMC good practice requirements. Agents licensed for the treatment of erectile dysfunction include sublingual apomorphine and phoshodiesterase5 inhibitors such as sildenafil, tadalafil and vardenafil. Treatments for erectile dysfunction can only be prescribed at the expense of the NHS if they meet the prescribing criteria outlined in the BNF. Such prescriptions must be endorsed with 'SLS'.
Further reading

Elton C (2009) Female Sexual Dysfunction: Myth or Malady?
Klein R, Sturm H (2002) Viagra: A Success Story For Rationing? Health Affairs. 21(6): 177–181.
Pfizer (2010) Viagra ® (sildenafil citrate) tablets.
Royal College of Psychiatrists, 04/12/2012 Antidepressants and psychosexual dysfunction: Part 2 – treatment 1


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