The Effect of Sertraline on Sexual Function

Ira D. Sharlip, MD

Disclosures

October 07, 2003

Question

How significant is the effect of sertraline on sexual function? After taking sertraline 100 mg/day for approximately 2 months for panic/anxiety disorder, a patient is experiencing inability to achieve an erection and have an orgasm. This 57-year-old man has some history of inability to maintain an erection but had no previous difficulties with achieving orgasm or initial erection.

Response from Ira D. Sharlip, MD

Association between depression and erectile dysfunction has been described in the medical literature[1,2] and more studies are forthcoming[3] regarding possible associations between panic/anxiety disorder and erectile dysfunction.

Sexual dysfunction is commonly associated with antidepressants.[4,5,6] The most common form of sexual dysfunction due to sertraline and other SSRIs is ejaculatory dysfunction. This can take the form of either delayed ejaculation or complete inability to achieve ejaculation. In fact, the SSRIs can be used to convert premature ejaculation to normal ejaculation. The exact mechanisms by which SSRIs may cause sexual dysfunction are not clear.

This man, with previously compromised erectile dysfunction, is at high risk for further erectile dysfunction from any new psychogenic or physical factor. Approaches to the treatment of his ejaculatory and erectile dysfunctions, which are temporally related to the initiation of sertraline therapy, can be termination of sertraline treatment or a reduction of the dose. If sertraline is terminated but antidepressant therapy is still needed, antidepressants less likely to cause sexual dysfunction can be tried.[4] However, it may be possible to continue sertraline by taking a drug holiday and restarting it at a very low dose. Gradually the dose can be increased to find a level that produces the desired antidepressant effect without causing sexual dysfunction. Concomitant psychotherapy may be very helpful in reducing depression, allowing a further reduction in sertraline dosing.

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