A Real-World Study on Antidepressant-Associated Sexual Dysfunction in 2144 Outpatients: The SALSEX I Study
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The objective of this cross-sectional study was to evaluate the frequency, impact, and management of sexual dysfunction associated with commonly prescribed antidepressants available in psychiatry outpatient clinics in Spain. We recruited 2163 adult patients who had undergone treatment with antidepressants for at least 8 weeks and had a history of normal sexual functioning before the prescription of the antidepressant, except for mildly impaired libido. We used the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) for evaluating the frequency and tolerance of sexual dysfunction and whether this side effect was spontaneously reported. Overall, 79% patients showed sexual dysfunction, as indicated by a total score ≥ 3 on the PRSexDQ-SALSEX; 64% showed moderate–severe sexual dysfunction, with no differences between men and women on these outcomes. In the multivariate logistic regression analysis, treatment with a serotonergic antidepressant and having a severe clinical state of psychiatric illness were the factors associated with the highest likelihood of presenting with sexual dysfunction. Sexual dysfunction was spontaneously reported by 838 (41%) of the 2066 evaluable patients for this outcome. Among patients with sexual dysfunction, this condition was poorly tolerated by 22% of the patients, with these frequencies being significantly higher in men than in women. The most frequently used strategies employed by the psychiatrists in our study for dealing with sexual dysfunction were switching to another antidepressant (34%) and waiting for spontaneous resolution (33%). In conclusion, our results indicate that despite being a well-known, long-standing side effect of antidepressants, sexual dysfunction continues to be extremely common in patients receiving antidepressants, especially serotonergic ones, potentially jeopardizing treatment success in a substantial proportion of patients. There are important sex differences in the reporting and tolerance of sexual dysfunction that require further investigation.
KeywordsSexual functioning Sexual dysfunction Antidepressant Psychotropic Sex differences
The SALSEX Working Study Group: José Antonio Aguado Mañas (Valladolid, Spain); José Antonio Agüero (Tudela, Spain); Maite Aldabatreku (Azpeitia, Spain); Ángeles Alonso de La Torre (León, Spain); Paloma Alonso Quintanilla (Valladolid, Spain); Pablo Álvarez Lobato (Valladolid, Spain); María Teresa Amboage Paz (A Coruña, Spain); José Antonio Antón (Logroño, Spain); Jesús Armendia González (San Sebastián, Spain); Jesús Artal Simón (Santander, Spain); Aitxiber Artetxe Chomón (Algorta, Spain); Concepción Babás Rodríguez (Carballo, Spain); Lorena Bartolomé Herrero (Zamora, Spain); Eva Bobadilla Pérez (A Coruña, Spain); Berta Bote Bonaechea (Salamanca, Spain); Julio Brenlla González (Santiago de Compostela, Spain); Javier Caballer García (Oviedo, Spain); Pilar Calvo (Tudela, Navarra, Spain); Marisol Campos (Espartero, Spain); Carlos Castro Dono (Betanzos, Spain); José Manuel Cornés Iglesias (Santiago de Compostela, Spain); Juan Carlos Díaz Del Valle (A Coruña, Spain); Francisco Doce Feliz (A Coruña, Spain); Amaia Echevarria Alfonso (Eibar, Spain); José Ramón Eizmendi Izquierdo (Algorta, Spain); José Antonio Espina Barrio (Valladolid, Spain); Manuel Espiñeira Álvarez (A Coruña, Spain); Carlos Fernández Atienzar (Valladolid, Spain); José Manuel Fernández Cuesta (Santander, Spain); Óscar Fernández Torre (Arriondas, Spain); Eva Fontenla Vivanco (A Coruña, Spain); Isabel Freire (Tudela, Spain); María Teresa Gallego De Dios (Salamanca, Spain); María Carmen García Mahia (A Coruña, Spain); Juan Antonio García Mellado (Zamora, Spain); María García Nicolás (Calahorra, Spain); Fidel García Sánchez (Valladolid, Spain); Llanyra García Ullán (Salamanca, Spain); Esther García Usieto (Torrelavega, Spain); Felisa Gómez Robina (Ávila, Spain); Sonia González Bardanca (A Coruña, Spain); Vanessa González De María (Segovia, Spain); Pilar González Izquierdo (Langreo, Spain); Esperanza González Marín (Salamanca, Spain); Rosa González Martínez (Carballo, Spain); Emilio González Pablos (Palencia, Spain); Ana Isabel González Vázquez (A Coruña, Spain); Luis Gutiérrez-Moyano Zinnmerman (Ourense, Spain); Miguel Ángel Hernández de Las Heras (Soria, Spain); Mario Javier Hernández González (Mieres, Spain); Marcos Huerta González (Gijón, Spain); Fernanda Iglesias Abella (Ourense, Spain); Guillermo Iglesias Lorenzo (Ferrol, Spain); Ignacio Iraizoz (Pamplona, Spain); Juan Larumbe Ochoa (Vitoria, Spain); José María Lomba Borrajo (Ourense, Spain); José López Ilundain (Burlada, Spain); Mario Martínez Pérez (Ponferrada, Spain); Jacqueline Mayoral Van Son (Santander, Spain); María Ángeles Medina (Burgos, Spain); Carmen Medina Merino (León, Spain); Begoña Mendíbil Eguiluz (Algorta, Spain); María Jesús Merino García (Gijón, Spain); Begoña Michel Zugazabeitia (San Sebastián, Spain); Ana Monedero Justel (Eibar, Spain); Blanca Morera (San Sebastián, Spain); Inés Munarriz (Pamplona, Spain); Julio Muñoz García (Santander, Spain); Sergio Ocio León (Mieres, Spain); Magdalena Otaño (Tudela, Spain); Luis Pacheco Yañez (Bilbao, Spain); Mónica Pastor (Logroño, Spain); José María Pelayo Terán (Arriondas, Spain); Mercedes Pérez López (Zamora, Spain); Fernando Pérez Nievas (Burlada, Spain); José Alfredo Pérez Portilla (Lugo, Spain); Nieves Prieto Mestre (Salamanca, Spain); Pablo Quiroga Yañez (Ourense, Spain); Francisco Rodríguez Fernández (León, Spain); Víctor Rodríguez Pérez (Castro De Rei, Spain); Milagros Sánchez García (Ávila, Spain); Santiago Sánchez Iglesias (Salamanca, Spain); Ana de Santiago Iaz (Santander, Spain); José de Santiago Sastre (León, Spain); César Sanz de La Garza (Gijón, Spain); Olga Sanz Granado (Burgos, Spain); José Miguel Segovia López (Ponferrada, Spain); Deidre Sierra Biddle (Santander, Spain); Juan Solana Arribas (Laredo, Spain); Antonio Soto Loza (Valladolid, Spain); Luis Suárez Ablanedo (Avilés, Spain); Antonio Terán Prieto (Palencia, Spain); Pedro Trabajo Vega (Arriondas, Spain); Carlos Vázquez Ventoso (A Coruña, Spain); José Luis Villanueva Boyero (Salamanca, Spain); Yolanda Zapico Merayo (Ponferrada, Spain).
This study was supported by a grant from Fondo de Investigaciones Sanitaria, Instituto de Salud Carlos III, Madrid, Spain (Project Number PS09/02545).
Compliance with Ethical Standards
Conflict of interest
A-LM has been a consultant for, received grant/research support and honoraria from and been on the speakers/advisory board of Eli Lilly, Forum Pharmaceuticals, Rovi, Servier, Shyre, Lundbeck, Otsuka, Janssen, Pfizer and Roche. FR-V has received honoraria for consultancy, providing educational sessions and/or providing medical writing services for Almirall, AstraZeneca, Eli Lilly, Janssen, Lundbeck, Otsuka and Pfizer. The remaining authors declare no conflict of interest related to this manuscript.
The study was approved by the Research Ethics Committee of the University Hospital of Salamanca (Spain) and conducted following the principles of the Helsinki declaration.
Informed consent was obtained from all individual participants included in the study.
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