SSRIs and sexual health

I appreciated the pertinent article by Dr. Burghardt and Ms. Gardner, “Sildenafil for SSRI-induced sexual dysfunction in women” (Current Psychiatry, April 2013, p. 29-32; http://bit.ly/1GCtLZR). Evidence for alternative adjunctive medications for selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction is lacking.

There is some support for bethanechol in reversing dysfunction caused by other antidepressants. Bethanechol reversed anorgasmia in a woman receiving amoxapine and eliminated erectile dysfunction in men receiving monoamine oxidase inhibitors or tricyclic antidepressants.^1-3 The only trial evaluating the efficacy of bethanechol for antidepressant-induced sexual dysfunction found it effective for men receiving clomipramine.⁴ Evidence is limited to patients receiving older antidepressants, and there is only 1 report of efficacy in a female patient.

It would be interesting to see whether bethanechol is effective for SSRI-induced dysfunction in controlled trials, because it may be a practical option for patients with sexual dysfunction and urinary retention.

Jonathan R. Scarff, MD
PGY-4 Resident
University of Louisville
Louisville, KY

References

1. Gross MD. Reversal by bethanechol of sexual
dysfunction caused by anticholinergic anti-depressants. Am J Psychiatry. 1982;139(9):1193-1194.

2. Segraves RT. Reversal by bethanechol of imipramine-induced ejaculatory dysfunction. Am J Psychiatry. 1987;144(9):1243-1244.

3. Yager J. Bethanechol chloride can reverse erectile and ejaculatory dysfunction induced by tricyclic antidepressants and mazindol: case report. J Clin Psychiatry. 1986;47(4):210-211.

4. Bernik M, Vieira AH, Nunes PV. Bethanecol chloride for treatment of clomipramine-induced orgasmic dysfunction in males. Rev Hosp Clin Fac Med Sao Paulo. 2004;59(6):357-360.

I appreciated the pertinent article by Dr. Burghardt and Ms. Gardner, “Sildenafil for SSRI-induced sexual dysfunction in women” (Current Psychiatry, April 2013, p. 29-32; http://bit.ly/1GCtLZR). Evidence for alternative adjunctive medications for selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction is lacking.

There is some support for bethanechol in reversing dysfunction caused by other antidepressants. Bethanechol reversed anorgasmia in a woman receiving amoxapine and eliminated erectile dysfunction in men receiving monoamine oxidase inhibitors or tricyclic antidepressants.^1-3 The only trial evaluating the efficacy of bethanechol for antidepressant-induced sexual dysfunction found it effective for men receiving clomipramine.⁴ Evidence is limited to patients receiving older antidepressants, and there is only 1 report of efficacy in a female patient.

It would be interesting to see whether bethanechol is effective for SSRI-induced dysfunction in controlled trials, because it may be a practical option for patients with sexual dysfunction and urinary retention.

Jonathan R. Scarff, MD
PGY-4 Resident
University of Louisville
Louisville, KY

References

1. Gross MD. Reversal by bethanechol of sexual
dysfunction caused by anticholinergic anti-depressants. Am J Psychiatry. 1982;139(9):1193-1194.

2. Segraves RT. Reversal by bethanechol of imipramine-induced ejaculatory dysfunction. Am J Psychiatry. 1987;144(9):1243-1244.

3. Yager J. Bethanechol chloride can reverse erectile and ejaculatory dysfunction induced by tricyclic antidepressants and mazindol: case report. J Clin Psychiatry. 1986;47(4):210-211.

4. Bernik M, Vieira AH, Nunes PV. Bethanecol chloride for treatment of clomipramine-induced orgasmic dysfunction in males. Rev Hosp Clin Fac Med Sao Paulo. 2004;59(6):357-360.

I appreciated the pertinent article by Dr. Burghardt and Ms. Gardner, “Sildenafil for SSRI-induced sexual dysfunction in women” (Current Psychiatry, April 2013, p. 29-32; http://bit.ly/1GCtLZR). Evidence for alternative adjunctive medications for selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction is lacking.

There is some support for bethanechol in reversing dysfunction caused by other antidepressants. Bethanechol reversed anorgasmia in a woman receiving amoxapine and eliminated erectile dysfunction in men receiving monoamine oxidase inhibitors or tricyclic antidepressants.^1-3 The only trial evaluating the efficacy of bethanechol for antidepressant-induced sexual dysfunction found it effective for men receiving clomipramine.⁴ Evidence is limited to patients receiving older antidepressants, and there is only 1 report of efficacy in a female patient.

It would be interesting to see whether bethanechol is effective for SSRI-induced dysfunction in controlled trials, because it may be a practical option for patients with sexual dysfunction and urinary retention.

Jonathan R. Scarff, MD
PGY-4 Resident
University of Louisville
Louisville, KY

References

1. Gross MD. Reversal by bethanechol of sexual
dysfunction caused by anticholinergic anti-depressants. Am J Psychiatry. 1982;139(9):1193-1194.

2. Segraves RT. Reversal by bethanechol of imipramine-induced ejaculatory dysfunction. Am J Psychiatry. 1987;144(9):1243-1244.

3. Yager J. Bethanechol chloride can reverse erectile and ejaculatory dysfunction induced by tricyclic antidepressants and mazindol: case report. J Clin Psychiatry. 1986;47(4):210-211.

4. Bernik M, Vieira AH, Nunes PV. Bethanecol chloride for treatment of clomipramine-induced orgasmic dysfunction in males. Rev Hosp Clin Fac Med Sao Paulo. 2004;59(6):357-360.