Antidepressants and sexual health – How to improve patients’ quality of life?

Introduction: Depression is one of the most common psychiatric disorders, with its prevalence continuously increasing. Consequently, more individuals are using antidepressants and experiencing various adverse effects. One of the important, yet often overlooked, side effect of depression pharmacotherapy is sexual dysfunction. This article aims to review sexual dysfunction associated with antidepressant therapy, explore available management strategies, and highlight emerging therapeutic options. Materials and methods: A literature review was performed using the PubMed and Scopus databases, covering publications from 2020 to 2024 focused on antidepressant-induced sexual dysfunction. Open-access publications in English-language were included, comprising original research articles, systematic reviews, meta-analyses, and narrative reviews. Results: The most frequently reported antidepressant-related sexual dysfunctions include decreased libido, delayed ejaculation, anorgasmia, and erectile dysfunction. These effects are most often observed in patients treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). A lower, though still relevant, risk is associated with tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). Medications such as vortioxetine, agomelatine, vilazodone, and bupropion offer promising therapeutic alternatives with a reduced risk of sexual side effects. Moreover, growing evidence supports the effectiveness of adjunctive and non-pharmacological interventions. Conclusions: Sexual dysfunctions significantly impair patients’ quality of life and often lead to treatment discontinuation and recurrence of depressive symptoms. Despite their prevalence, many patients do not report these symptoms due to embarrassment, which underscores the need for a conscious, empathetic approach from doctors. Active monitoring and implementing effective strategies to minimise these side effects without compromising antidepressant efficacy are essential.