Antidepressant-Induced Sexual Dysfunction Treated with Vardenafil
Berigan, Tim, Canadian Journal of Psychiatry
Dear Editor: The selective serotonin reuptake inhibitors (SSRIs) are used to treat a wide array of psychiatric conditions (1). Patients experience fewer side effects, compared with the older antidepressants (2). However, sexual dysfunction may occur in up to 75% of patients taking antidepressants (3). I report a case in which a patient taking sertraline experienced decreased to almost nonexistent erections, with a return to his baseline functioning following treatment with vardenafil. To my knowledge, this is the first reported case of vardenafil used to treat antidepressant-induced sexual dysfunction.
Mr A, aged 32 years, was diagnosed with dysthymic disorder according to DSM-IV criteria. He was in good health and did not use alcohol, tobacco, or illicit substances. He had been married for 6 years and described his marriage as excellent. He was active in psychotherapy and referred for medication. He agreed to a trial of sertraline started at 50 mg dialy and titrated to 150 mg at 3 weeks' time. I obtained a baseline sexual history prior to his starting the sertraline and informed him that the medication could affect his sexual functioning. Mr A stated that he understood and agreed to a trial. Within 2 weeks of initiating sertraline, he began to notice diminished erections but no change in libido. Although he was discouraged about this side effect, he had noted an improvement in his dysthymic symptoms and desired to remain on sertraline. He was interested in adding bupropion sustained release (SR) in an attempt to improve sexual functioning. He began bupropion SR 100 mg daily with no improvement at 1 week, and the dosage was increased to 150 mg daily, with no success after 1 week. The bupropion SR was increased to 200 mg daily; again, there was no success at the end of 1 week, and it was discontinued. A trial of vardenafil 10 mg taken 30 minutes prior to sexual activity was initiated, with noted improvement within 3 days of initiation. Mr A has on occasion taken it 15 minutes prior to sexual activity, with positive results. The patient tolerated the medication without any noted side effects. Mr A has returned to his baseline sexual functioning and is fully satisfied with the quality of his erections.
As noted, a baseline sexual functioning history was taken prior to initiating treatment with sertraline, and the patient was informed about the possibility of sexual dysfunction. These factors facilitated discussion of this commonly occurring problem in patients treated with antidepressants. Taking this history also allows clinicians to distinguish between an antidepressant side effect or a preexisting condition that can occur in up to 31% of men (4). Clinicians frequently are called upon to manage sexual dysfunction as a result of antidepressants. According to a recent survey by Dording and others, 43% of psychiatrists add bupropion to existing medication (5). Bupropion SR has been shown to be beneficial at dosages between 100 and 200 mg taken once daily, with most improvement noted within the first 2 weeks of treatment (6). My patient did not benefit from this strategy and required an alternate agent. …