Current Psychiatry Reports

, Volume 3, Issue 3, pp 202–208 | Cite as

Sexual dysfunction and depression

  • Stuart N. Seidman
  • Steven P. Roose


Sexual functioning is generally impaired during depression. Interest in the relationship between sexual dysfunction and depression has risen substantially, prompted primarily by 1) the 1998 Food and Drug Administration approval of sildenafil citrate as the first oral therapy of erectile dysfunction, and 2) the widespread clinical use of selective serotonin reuptake inhibitors, which prominently impair orgasm, and possibly libido and arousal. In this paper, we first review the phenomenology of sexual dysfunction and important contributing factors, such as age and illness, and then focus on the clinical assessment and therapeutic interventions used for sexual dysfunction in depressed individuals.


Major Depressive Disorder Erectile Dysfunction Sexual Dysfunction Bupropion Premature Ejaculation 
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References and Recommended Reading

  1. 1.
    Basson R, Berman J, Burnett A, et al.: Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 2000, 163:888–893. The report of an international, multidisciplinary consensus development conference that was held in the United States to develop a new classification system to apply to all forms of FSD, regardless of etiology. Major categories of FSD include desire disorders, arousal disorders, orgasm disorders, and sexual pain problems.PubMedCrossRefGoogle Scholar
  2. 2.
    Segraves KB, Segraves RT: Hypoactive sexual desire disorder: prevalence and comorbidity in 906 subjects. J Sex Marital Ther 1991, 17:55–58.PubMedGoogle Scholar
  3. 3.
    Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999, 281:537–544. Summary report and reanalysis of the National Health and Social Life Survey, the most comprehensive national study of sexual behavior in the United States since Kinsey.PubMedCrossRefGoogle Scholar
  4. 4.
    Sherwin BB, Gelfand MM: The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med 1987, 49:397–409.PubMedGoogle Scholar
  5. 5.
    Seidman SN: Hormonal aspects of sexual dysfunction: the therapeutic use of exogenous androgens in men and women. Curr Psychiatry Rep 2000, 2:215–222.PubMedCrossRefGoogle Scholar
  6. 6.
    Schiavi RC, White D, Mandeli J, et al.: Effect of testosterone administration on sexual behavior and mood in men with erectile dysfunction. Arch Sex Behav 1997, 26:231–241.PubMedCrossRefGoogle Scholar
  7. 7.
    Heiman JR: Psychophysiological models of female sexual response. Int J Impot Res 1998 10(Suppl 2):S94–97.PubMedGoogle Scholar
  8. 8.
    Gelenberg AJ, Delgado P, Nurnberg HG: Sexual side effects of antidepressant drugs. Curr Psychiatry Rep 2000, 2:223–227.PubMedCrossRefGoogle Scholar
  9. 9.
    Basson R, McInnes R, Smith MD, et al.: Efficacy and safety of sildenafil in estrogenized women with sexual dysfunction associated with female sexual arousal disorder. Obstet Gynecol 2000, 95:S54. Describes a recent negative study of sildenafil for women with FSD. It is notable for the large N, placebo arm, and strong negative result (see Clinical Trials Report).CrossRefGoogle Scholar
  10. 10.
    Spector IP, Carey MP: Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature. Arch Sex Behav 1990, 19:389–408.PubMedCrossRefGoogle Scholar
  11. 11.
    Heiman JR, Meston CM: Evaluating sexual dysfunction in women. Clin Obstet Gynecol 1997, 40:616–629.PubMedCrossRefGoogle Scholar
  12. 12.
    Heiman JR, Meston CM: Empirically validated treatment for sexual dysfunction. Annu Rev Sex Res 1997, 8:148-94.:148–194.Google Scholar
  13. 13.
    St Lawrence JS, Madakasira S: Evaluation and treatment of premature ejaculation: a critical review. Int J Psychiatry Med 1992, 22:77–97.PubMedCrossRefGoogle Scholar
  14. 14.
    Segraves RT, Saran A, Segraves K, et al.: Clomipramine versus placebo in the treatment of premature ejaculation: a pilot study. J Sex Marital Ther 1993, 19:198–200.PubMedGoogle Scholar
  15. 15.
    Waldinger MD, Hengeveld MW, Zwinderman AH: Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study. Am J Psychiatry 1994, 151:1377–1379.PubMedGoogle Scholar
  16. 16.
    Mendels J, Camera A, Sikes C: Sertraline treatment for premature ejaculation. J Clin Psychopharmacol 1995, 15:341–346.PubMedCrossRefGoogle Scholar
  17. 17.
    Kara H, Aydin S, Yucel M, et al.: The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study [see comments]. J Urol 1996, 156:1631–1632.PubMedCrossRefGoogle Scholar
  18. 18.
    Araujo AB, Durante R, Feldman HA, et al.: The relationship between depressive symptoms and male erectile dysfunction: Cross sectional results from the Massachusetts Male Aging Study. Psychosom Med 1998, 60:458–465. This is an important report that uses a large, representative epidemiologic sample to confirm the strong association between self-reported depressive symptoms and ED. Although it cannot address causality, it is the first study to suggest that depression is a risk factor for ED of equal magnitude to the more commonly acknowledged factors, such as cardiovascular morbidity and diabetes.PubMedGoogle Scholar
  19. 19.
    Morley JE, Korenman SG, Kaiser FE, et al.: Relationship of penile brachial pressure index to myocardial infarction and cerebrovascular accidents in older men. Am J Med 1988, 84:445–448.PubMedCrossRefGoogle Scholar
  20. 20.
    Schiavi RC, Segraves RT: The biology of sexual function. Psychiatr Clin North Am 1995, 18:7–23.PubMedGoogle Scholar
  21. 21.
    Nofzinger EA, Thase ME, Reynolds CF, et al.: Sexual function in depressed men. Assessment by self-report, behavioral, and nocturnal penile tumescence measures before and after treatment with cognitive behavior therapy. Arch Gen Psychiatry 1993, 50:24–30.PubMedGoogle Scholar
  22. 22.
    Casper RC, Redmond DE, Katz MM, et al.: Somatic symptoms in primary affective disorder. Presence and relationship to the classification of depression. Arch Gen Psychiatry 1985, 42:1098–1104.PubMedGoogle Scholar
  23. 23.
    Seidman SN, Roose SP: The relationship between depression and erectile dysfunction. Curr Psychiatry Rep 2000, 2:201–205.PubMedCrossRefGoogle Scholar
  24. 24.
    Roose SP, Glassman AH, Walsh BT, et al.: Reversible loss of nocturnal penile tumescence during depression: a preliminary report. Neuropsychobiology 1982, 8:284–288.PubMedGoogle Scholar
  25. 25.
    Steiger A, Holsboer F, Benkert O: Studies of nocturnal penile tumescence and sleep electroencephalogram in patients with major depression and in normal controls. Acta Psychiatr Scand 1993, 87:358–363.PubMedGoogle Scholar
  26. 26.
    Thase ME, Reynolds CF, Glanz LM, et al.: Nocturnal penile tumescence in depressed men. Am J Psychiatry 1987, 144:89–92.PubMedGoogle Scholar
  27. 27.
    Fagan PJ: Sexual dysfunction in perspectives: an introduction. Psychiatr Med 1992, 10:xi-xvii.PubMedGoogle Scholar
  28. 28.
    Barrett-Connor E, Von Muhlen DG, Kritz-Silverstein D: Bioavailable testosterone and depressed mood in older men: the Rancho Bernardo Study. J Clin Endocrinol Metab 1999, 84:573–577.PubMedCrossRefGoogle Scholar
  29. 29.
    Morales A, Heaton JP, Carson CC: Andropause: a misnomer for a true clinical entity. J Urol 2000, 163:705–712.PubMedCrossRefGoogle Scholar
  30. 30.
    Seidman SN, Araujo AB, Roose SP, et al.: Low testosterone levels in elderly men with dysthymic disorder. Am J Psychiatry 2001, in press.Google Scholar
  31. 31.
    Rosen RC, Lane RM, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 1999, 19:67–85. Provides a comprehensive review and synthesis of available data regarding SSRI-associated sexual dysfunction.PubMedCrossRefGoogle Scholar
  32. 32.
    Balon R: Sexual functioning with selective serotonin reuptake inhibitors [letter; comment]. Am J Psychiatry 1999, 156:807–808.PubMedGoogle Scholar
  33. 33.
    Ashton AK, Rosen RC: Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther 1998, 24:191–192.PubMedCrossRefGoogle Scholar
  34. 34.
    Price J, Grunhaus LJ: Treatment of clomipramine-induced anorgasmia with yohimbine: a case report. J Clin Psychiatry 1990, 51:32–33.PubMedGoogle Scholar
  35. 35.
    Reynolds RD: Sertraline-induced anorgasmia treated with intermittent nefazodone [letter]. J Clin Psychiatry 1997, 58:89.PubMedGoogle Scholar
  36. 36.
    Lauerma H: Successful treatment of citalopram-induced anorgasmia by cyproheptadine. Acta Psychiatr Scand 1996, 93:69–70.PubMedGoogle Scholar
  37. 37.
    Nelson EB, Keck PEJ, McElroy SL: Resolution of fluoxetineinduced sexual dysfunction with the 5-HT3 antagonist granisetron [letter]. J Clin Psychiatry 1997, 58:496–497.PubMedGoogle Scholar
  38. 38.
    Balon R: Intermittent amantadine for fluoxetine-induced anorgasmia. J Sex Marital Ther 1996, 22:290–292.PubMedGoogle Scholar
  39. 39.
    Labbate LA, Grimes JB, Hines A, et al.: Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction. Ann Clin Psychiatry 1997, 9:241–245.PubMedCrossRefGoogle Scholar
  40. 40.
    Roeloffs C, Bartlik B, Kaplan PM, et al.: Methylphenidate and SSRI-Induced sexual side effects [letter; comment]. J Clin Psychiatry 1996, 57:548PubMedGoogle Scholar
  41. 41.
    Balon R: Ginkgo biloba for antidepressant-induced sexual dysfunction? [letter; comment]. J Sex Marital Ther 1999, 25:1–2.PubMedGoogle Scholar
  42. 42.
    Nurnberg HG, Lauriello J, Hensley PL, et al.: Sildenafil for sexual dysfunction in women taking antidepressants [letter]. Am J Psychiatry 1999, 156:1664.PubMedGoogle Scholar
  43. 43.
    Balon R: Sildenafil and sexual dysfunction associated with antidepressants. J Sex Marital Ther 1999, 25:259–264.PubMedCrossRefGoogle Scholar
  44. 44.
    Ashton AK, Rosen RC: Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry 1998, 59:112–115.PubMedGoogle Scholar
  45. 45.
    Michelson D, Bancroft J, Targum S, et al.: Female sexual dysfunction associated with antidepressant administration: a randomized, placebo-controlled study of pharmacologic intervention. Am J Psychiatry 2000, 157:239–243. An important, well-designed, placebo-controlled clinical trial that failed to distinguish between buspirone, amantadine, and placebo in women with fluoxetine-induced sexual dysfunction.PubMedCrossRefGoogle Scholar
  46. 46.
    Shabsigh R, Klein LT, Seidman SN, et al.: Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 1998, 52:848–852.PubMedCrossRefGoogle Scholar
  47. 47.
    Seidman SN, Roose SP, Shabsigh R, et al.: Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001, in press. A study in which men with depression and ED were randomized to receive sildenafil or placebo. Of particular importance was the finding that men who had an improvement in ED, whether they received sildenafil or placebo, had a substantial improvement in depression.Google Scholar

Copyright information

© Current Science Inc. 2001

Authors and Affiliations

  • Stuart N. Seidman
    • 1
  • Steven P. Roose
    • 1
  1. 1.Department of PsychiatryColumbia University College of Physicians and SurgeonsNew YorkUSA

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