Introduction: Sexual dysfunction (SD) issues, including erectile dysfunction (ED), low sexual desire (LSD), ejaculatory dysfunction, are common side effects of SSRIs. Some patients may continue to experience sexual side effects even after discontinuation of the antidepressant (Post-SSRI sexual dysfunction). The evidence available regarding these issues’ management is rather limited. We aimed to describe the clinical features of these patients and their response to PDE5 inhibitors (PDE5Is).
Methods: Sociodemographic and clinical data from 1175 consecutive patients presenting with a primary complaint of SD were retrospectively analysed. Descriptive statistics tested clinical differences between patients who were never exposed to SSRIs and those under treatment and/or with an history of depression and previous exposure to SSRIs. The Minimal Clinically Important Differences (MCID) in the Erectile Function (EF) domain of the International Index of Erectile Function (IIEF) were used to define a PDE5I-response. Fisher-Exact Chi2 test investigated the association between SSRI-exposure and PDE5I-response; Mann-Whitney U test was used to evaluate the relation between SSRI-exposure and follow-up IIEF-EF-score. Multivariate analysis tested the relationship between the clinical features and the SSRI-response.
Results: Among the baseline-clinical-features, only concurrent sexual complaints other-than-ED were significantly more frequent among the SSRI-exposed patients (p=0.02; Table 1). SSRI-exposure predicted both worse PDE5I-response (p=0.03) and lower follow-up IIEF-EF scores (Z=-2.59, p=0.01). At multivariate analysis, baseline IIEF-EF (p=0.02), BMI (p=0.03), and SSRI-exposure (p=0.04) were predictive for PDE5I-response; whilst age, CCI-score and smoking habit were non-significantly associated.
Conclusions: SSRI-related sexual side effects may compromise the individual’s wellbeing and result in lack-of-antidepressant-compliance. PDE5Is may be an effective strategy to deal with these issues, although their efficacy may be sub-optimal for some patients, thus outlining the importance of a better tailored management in men with concomitant SSRI-intake.
Source of Funding: No source of funding to be disclosed