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Am Fam Physician. 2003;67(8):1795

Treatment of major depressive disorder frequently causes adverse effects that lead to discontinuation of medical therapy. Selective serotonin reuptake inhibitors (SSRIs), although generally well tolerated, appear to cause adverse sexual effects, including erectile dysfunction, delay in or inability to achieve orgasm, and decreased libido. Nurnberg and associates conducted a prospective, randomized, placebo-controlled trial in which sildenafil was used to treat antidepressant-associated sexual dysfunction (AASD).

Ninety men 18 to 55 years of age who were experiencing sexual dysfunction while on SSRI therapy and who had major depressive disorder in remission were enrolled in the study. One half of the patients were randomized to placebo, while the rest received sildenafil. Patients were asked to complete four validated sexual health measures at baseline, some at two-week intervals, and all at six weeks. Depression scores were analyzed at frequent intervals.

Seventy-six men completed all aspects of the study. Scores in all measures improved significantly with sildenafil therapy. By the end of the study, patients talking sildenafil had a significantly improved lower score (2.3) on the Clinical Global Impression Scale adapted for Sexual Function than did patients taking placebo (3.9). Improvements were reported as “much/very much improved” in the areas of ejaculation, erectile function, orgasm, and sexual satisfaction.

The authors note that few trials have studied or demonstrated effective treatment of AASD. The positive effects of sildenafil may benefit patients who would otherwise discontinue antidepressant medication because of adverse sexual effects.

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