Depression, Antidepressants, and Sexual Functioning

  • Christina M. DordingEmail author
  • Sean D. Boyden
Part of the Current Clinical Psychiatry book series (CCPSY)


Sexual functioning is complex, and sexual dysfunction may involve any component of the sexual response cycle including libido, arousal, or orgasm. The etiology of most forms of sexual dysfunction is multifactorial and may be physical or psychological. Those suffering from depression may note a change in sexual functioning secondary to their underlying psychiatric condition or quite often, to the antidepressants prescribed to treat their depression. In such situations, patients often become noncompliant with their antidepressant treatment, potentially increasing their risk for serious complications of untreated depression. It is therefore of great importance for clinicians to recognize this side effect and treat it appropriately.

In this chapter we discuss the etiology and prevalence of antidepressant-induced sexual dysfunction from a research perspective and discuss the management of this condition, as well as exploring the available data on possible treatments.


Sexual functioning Depression Antidepressants Libido Natural remedies 


  1. 1.
    Hunot VM, Horne R, Leese MN, Churchill RC. A cohort study of adherence to antidepressants in primary care: the influence of antidepressant concerns and treatment preferences. Prim Care Companion J Clin Psychiatry. 2007;9(2):91–9.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Zimmerman M, Posternak M, Friedman M, Attiullah N, Baymiller S, Boland R, et al. Which factors influence psychiatrists’ selection of antidepressants? Am J Psychiatry. 2004;161(7):1285–9.CrossRefGoogle Scholar
  3. 3.
    Hu XH, Bull SA, Hunkeler EM, Ming E, Lee JY, Fireman B, Markson LE. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. J Clin Psychiatry. 2004;65(7):959–65.CrossRefGoogle Scholar
  4. 4.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC; 2013.Google Scholar
  5. 5.
    Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women – prevalence and correlates. Obstet Gynecol. 2008;112(5):970–8.CrossRefGoogle Scholar
  6. 6.
    Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319–26.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, European Association of Urology, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804–14.CrossRefGoogle Scholar
  8. 8.
    Seagraves RT, Balone R. Antidepressant-induced sexual dysfunction in men. Pharmacol Biochem Behav. 2014;121:132–7.CrossRefGoogle Scholar
  9. 9.
    Araujo AB, Durante R, Feldman HA, Goldstein I, McKinley J. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med. 1998;60:458–65.CrossRefGoogle Scholar
  10. 10.
    Kivelä SL, Pahkala K. Symptoms of depression in old people in Finland. Z Gerontol. 1988;21(5):257–63.Google Scholar
  11. 11.
    Bonierbale M1, Lançon C, Tignol J. The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France. Curr Med Res Opin. 2003;19(2):114–24.CrossRefGoogle Scholar
  12. 12.
    McCool ME, Zuelke A, Theurich MA, Knuettel H, Ricci C, Apfelbacher C. Prevalence of female sexual dysfunction among premenopausal women: a systematic review and meta-analysis of observational studies. Sex Med Rev. 2016;4(3):197–212.CrossRefGoogle Scholar
  13. 13.
    Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A, Parish SJ, et al. Hypoactive sexual desire disorder: International Society for the Study of Women’s Sexual Health (ISSWSH) expert consensus panel review. Mayo Clin Proc. 2017;92(1):114–28.CrossRefGoogle Scholar
  14. 14.
    Frohlich PF, Meston CM. Evidence that serotonin affects female sexual functioning via peripheral mechanisms. Physiol Behav. 2000;71(3–4):383–93.CrossRefGoogle Scholar
  15. 15.
    Giuliani D, Ottani A, Ferrari F. Influence of sildenafil on copulatory behaviour in sluggish or normal ejaculator male rats: a central dopamine mediated effect? Neuropharmacology. 2002;42(4):562–7.CrossRefGoogle Scholar
  16. 16.
    Graf H, Walter M, Metzger CD, Abler B. Antidepressant-related sexual dysfunction – perspectives from neuroimaging. Pharmacol Biochem Behav. 2014;121:138–45.CrossRefGoogle Scholar
  17. 17.
    Abler B, Seeringer A, Hartmann A, Grön G, Metzger C, Walter M, Stingl J. Neural correlates of antidepressant-related sexual dysfunction: a placebo-controlled fMRI study on healthy males under subchronic paroxetine and bupropion. Neuropsychopharmacology. 2011;36(9):1837–47.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Eaton H. Clomipramine (Anafranil) in the treatment of premature ejaculation. J Int Med Res. 1973;1:432.CrossRefGoogle Scholar
  19. 19.
    Rowland DL, De Gouveia Brazao CA, Koos Slob A. Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective. BJU Int. 2001;87(4):357–60.CrossRefGoogle Scholar
  20. 20.
    La Torre A, Giupponi G, Duffy D, Conca A. Sexual dysfunction related to psychotropic drugs: a critical review – part I: antidepressants. Pharmacopsychiatry. 2013;46(5):191–9.CrossRefGoogle Scholar
  21. 21.
    Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63(4):357–66.CrossRefGoogle Scholar
  22. 22.
    Zajecka J, Mitchell S, Fawcett J. Treatment-emergent changes in sexual function with selective serotonin reuptake inhibitors as measured with the Rush Sexual Inventory. Psychopharmacol Bull. 1997;33(4):755–60.Google Scholar
  23. 23.
    Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry. 2001;62(Suppl 3):10–21.Google Scholar
  24. 24.
    Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36(10):1577–89.CrossRefGoogle Scholar
  25. 25.
    Reichenpfader U, Gartlehner G, Morgan LC, Greenblatt A, Nussbaumer B, Hansen RA, et al. Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug Saf. 2014;37(1):19–31.CrossRefGoogle Scholar
  26. 26.
    Ashton AK, Mahmood A, Iqbal F. Improvements in SSRI/SNRI-induced sexual dysfunction by switching to escitalopram. J Sex Marital Ther. 2005;31(3):257–62.CrossRefGoogle Scholar
  27. 27.
    Thase ME, Danchencko N, Brignone M, Florea I, Diamand F, Jacobsen PL, Vieta E. Comparative evaluation of vortioxetine as a switch therapy in patients with major depressive disorder. Eur Neuropsychopharmacol. 2017;27:773–81.CrossRefGoogle Scholar
  28. 28.
    Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29(3):259–66.CrossRefGoogle Scholar
  29. 29.
    McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, Manber R. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther. 2000;26(1):25–40.CrossRefGoogle Scholar
  30. 30.
    Meston CM. Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. J Sex Marital Ther. 2003;29(1):39–46.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.CrossRefGoogle Scholar
  32. 32.
    Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731–45.PubMedCentralPubMedGoogle Scholar
  33. 33.
    Rosen R, Riley A, Wagner G, Osterloh I, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.CrossRefGoogle Scholar
  34. 34.
    Dording CM, Mischoulon D, Petersen TJ, Kornbluh R, Gordon J, Nierenberg AA, et al. The pharmacologic management of SSRI-induced side effects: a survey of psychiatrists. Ann Clin Psychiatry. 2002;14(3):143–7.CrossRefGoogle Scholar
  35. 35.
    Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry. 1995;152(10):1514–6.CrossRefGoogle Scholar
  36. 36.
    Montejo AL, Montejo L, Navarro-Cremades F. Sexual side-effects of antidepressant and antipsychotic drugs. Curr Opin Psychiatry. 2015;28(6):418–23.CrossRefGoogle Scholar
  37. 37.
    Schweitzer I, Maguire K, Ng C. Sexual side-effects of contemporary antidepressants: review. Aust N Z J Psychiatry. 2009;43(9):795–808.CrossRefGoogle Scholar
  38. 38.
    Citrome L. Vortioxetine for major depressive disorder: an indirect comparison with duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, using number needed to treat, number needed to harm, and likelihood to be helped or harmed. J Affect Disord. 2016;196:225–33.CrossRefGoogle Scholar
  39. 39.
    Jacobsen PL, Mahableshwarkar AR, Chen Y, Chrones L, Clayton AH. Effect of vortioxetine vs. escitalopram on sexual functioning in adults with well-treated major depressive disorder experiencing SSRI-induced sexual dysfunction. J Sex Med. 2015;12(10):2036–48.CrossRefGoogle Scholar
  40. 40.
    Jacobsen PL, Mahableshwarkar AR, Palo WA, Chen Y, Dragheim M, Clayton AH. Treatment-emergent sexual dysfunction in randomized trials of vortioxetine for major depressive disorder or generalized anxiety disorder: a pooled analysis. CNS Spectr. 2016;21(5):367–78.CrossRefGoogle Scholar
  41. 41.
    Clayton AH, Durgam S, Tang X, Chen C, Ruth A, Gommoll C. Characterizing sexual function in patients with generalized anxiety disorder: a pooled analysis of three vilazodone studies. Neuropsychiatr Dis Treat. 2016;12:1467–76.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Nurnberg HG, Hensley PL, Gelenberg AJ, Fava M, Lauriello J, Paine S. Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA. 2003;289:56–64.CrossRefGoogle Scholar
  43. 43.
    Seagraves RT, Lee J, Stevenson R, Walker DJ, Wang WC, Dickson RA. Tadalafil for treatment of erectile dysfunction in men on antidepressants. J Clin Psychopharmacol. 2007;27(1):62–6.CrossRefGoogle Scholar
  44. 44.
    Huang SA, Lie JD. Phosphodiesterase-5 (PDE5) inhibitors in the management of erectile dysfunction. P T. 2013;38(7):407, 414–419.PubMedCentralPubMedGoogle Scholar
  45. 45.
    Gorkin L, Hvidsten, Sobel RE, Siegel R. Sildenafil citrate use and the incidence of nonarteritic anterior ischemic optic neuropathy. Int J Clin Pract. 2006;60(4):500–3.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Gao L, Yang L, Qian S, Li T, Han P, Yuan J. Systematic review and meta-analysis of phosphodiesterase type 5 inhibitors for the treatment of female sexual dysfunction. Int J Gynaecol Obstet. 2016;133(2):139–45.CrossRefGoogle Scholar
  47. 47.
    McMahon CG. Management of ejaculatory dysfunction. Intern Med J. 2014;44(2):124–31.CrossRefGoogle Scholar
  48. 48.
    Stahl SM, Sommer B, Allers KA. Multifunctional pharmacology of flibanserin: possible mechanism of therapeutic action in hypoactive sexual desire disorder. J Sex Med. 2011;8(1):15–27.CrossRefGoogle Scholar
  49. 49.
    Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ET. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(4):453–62.CrossRefGoogle Scholar
  50. 50.
    Joffe HV, Chang C, Sewell C, Easley O, Nguyen C, Dunn S, et al. FDA approval of flibanserin – treating hypoactive sexual desire disorder. N Engl J Med. 2016;374(2):101–4.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Reed BG, Bou Nemer L, Carr BR. Has testosterone passed the test in premenopausal women with low libido? A systematic review. Int J Womens Health. 2016;8:599–607. eCollection 2016.PubMedCentralCrossRefPubMedGoogle Scholar
  52. 52.
    Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril. 2002;77(Suppl 4):S42–8.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Achilli C, Pundir J, Ramanathan P1, Sabatini L, Hamoda H, Panay N. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis. Fertil Steril. 2017;107(2):475–482.e15.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Kingsberg SA, Woodard T. Female sexual dysfunction: focus on low desire. Obstet Gynecol. 2015;125(2):477–86.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Safarinejad MR, Hosseini SY, Asgari MA, Dadkhah F, Taghva A. A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women. BJU Int. 2010;106(6):832–9.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Clayton AH, Warnock JK, Kornstein SG, Pinkerton R, Sheldon-Keller A, Mcgarvey EL. A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry. 2004;65(1):62–7.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Zahiroddin A, Faridhosseini F, Zamani A, Shahini N. Comparing the efficacy of bupropion and amantadine on sexual dysfunction induced by a selective serotonin reuptake inhibitor. Iran Red Crescent Med J. 2015;17(12):e24998.PubMedCentralCrossRefPubMedGoogle Scholar
  58. 58.
    Clayton AH, Althof SE, Kingsberg S, DeRogatis LR, Kroll R, Goldstein I, et al. Bremelanotide for female sexual dysfunctions in premenopausal women: a randomized, placebo-controlled dose-finding trial. Womens Health (Lond). 2016;12(3):325–37.CrossRefGoogle Scholar
  59. 59.
    Landén M, Eriksson E, Agren H, Fahlén T. Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. J Clin Psychopharmacol. 1999;19(3):268–71.CrossRefGoogle Scholar
  60. 60.
    Michelson D, Bancroft J, Targum S, Kim Y, Tepner R. Female sexual dysfunction associated with antidepressant administration: a randomized, placebo-controlled study of pharmacologic intervention. Am J Psychiatry. 2000;157(2):239–43.CrossRefGoogle Scholar
  61. 61.
    Berner M, Gunzler C. Efficacy of psychosocial interventions in men and women with sexual dysfunctions – a systematic review of controlled clinical trials. J Sex Med. 2012;9:3089–107.CrossRefGoogle Scholar
  62. 62.
    Khamba B, Aucoin M, Lytle M, Vermani M, Maldonado A, Iorio C, et al. Efficacy of acupuncture treatment of sexual dysfunction secondary to antidepressants. J Altern Complement Med. 2013;19(11):862–9.CrossRefGoogle Scholar
  63. 63.
    Oakley SH, Walther-Liu J, Crisp CC, Pauls RN. Acupuncture in premenopausal women with hypoactive sexual desire disorder: a prospective cohort pilot study. Sex Med. 2016;4(3):e176–81.PubMedCentralCrossRefPubMedGoogle Scholar
  64. 64.
    Lee MS, Shin BC, Ernst E. Acupuncture for treating erectile dysfunction: a systematic review. BJU Int. 2009;104(3):366–70.CrossRefGoogle Scholar
  65. 65.
    Tsai MY, Liu CT, Chang CC, Chen SY, Huang ST. Overview of the relevant literature on the possible role of acupuncture in treating male sexual dysfunction. Acupunct Med. 2014;32(5):406–10.CrossRefGoogle Scholar
  66. 66.
    Dhikav V, Karmarkar G, Gupta M, Anand KS. Yoga in premature ejaculation: a comparative trial with fluoxetine. J Sex Med. 2007;4(6):1726–32.CrossRefGoogle Scholar
  67. 67.
    Ben-Josef AM, Wileyto EP, Chen J, Vapiwala N. Yoga intervention for patients with prostate cancer undergoing external beam radiation therapy: a pilot feasibility study. Integr Cancer Ther. 2016;15(3):272–8.CrossRefGoogle Scholar
  68. 68.
    Lorenz TA, Meston CM. Exercise improves sexual function in women taking antidepressants: results from a randomized crossover trial. Depress Anxiety. 2014;31(3):188–95.PubMedCentralCrossRefPubMedGoogle Scholar
  69. 69.
    Ito TY, Trant AS, Plan ML. A double-blind placebo -controlled study of ArginMax, a nutritional supplement for enhancement of female sexual function. J Sex Marital Ther. 2001;7:541–9.CrossRefGoogle Scholar
  70. 70.
    Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI):a multidimensional self-report instrument for the assessment o female sexual function. J Sex Marital Ther. 2000;26:191–208.CrossRefGoogle Scholar
  71. 71.
    Ito TY, Polan ML, Whipple B, Trant AS. The enhancement of female sexual function with Argin Max, a nutritional supplement, among women differing in menopausal status. J Sex Marital Ther. 2006;32:369–78.CrossRefGoogle Scholar
  72. 72.
    Meston CM, Worcel M. The effects of yohimbine plus L-arginine glutamate of sexual arousal in postmenopausal women with sexual arousal disorder. Arch Sex Behav. 2002;31:323–32.CrossRefGoogle Scholar
  73. 73.
    Bottari A, Belcaro G, Ledda A, Cesarone MR, Vinciguerra G, Di Renzo A, et al. Lady Prelox improves sexual function in post-menopausal women. Panminerva Med. 2012;54(Suppl):3–9.Google Scholar
  74. 74.
    Bottari A, Belcaro G, Ledda A, Luzzi R, Cesarone MR, Dugall M. Lady Prelox improves sexual function in generally healthy women of reproductive age. Minerva Ginecol. 2013;65:435–44.Google Scholar
  75. 75.
    Klotz T, Mathers MJ, Braun M, Bloch W, Engelmann U. Effectiveness of oral L-arginine in first-line treatment of erectile dysfunction in a controlled crossover study. Urol Int. 1999;63(4):220–3.CrossRefGoogle Scholar
  76. 76.
    Chen J, Wollman Y, Chernichovsky T, Iaina A, Sofer M, Matzkin H. Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized, placebo-controlled study. BJU Int. 1999;83(3):269–73.CrossRefGoogle Scholar
  77. 77.
    Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther. 2003;29(3):207–13.CrossRefGoogle Scholar
  78. 78.
    Aoki H, Nagao J, Ueda T, Strong JM, Schonlau F, Yu-Jing S, Lu Y, Horie S. Clinical assessment of a supplement of Pycnogenol® and L-arginine in Japanese patients with mild to moderate erectile dysfunction. Phytother Res. 2012;26(2):204–7.CrossRefGoogle Scholar
  79. 79.
    Gianfrilli D, Lauretta R, Di Dato C, Graziadio C, Pozza C, De Larichaudy J, et al. Propionyl-L-carnitine, L-arginine and niacin in sexual medicine: a nutraceutical approach to erectile dysfunction. Andrologia. 2012;44(Suppl 1):600–4.CrossRefGoogle Scholar
  80. 80.
    Cohen AJ, Bartlik B. Gingko biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther. 1998;24:149–3.CrossRefGoogle Scholar
  81. 81.
    Ashton AK, Ahrens K, Gupta S, Masand PS. Antidepressant-induced sexual dysfunction and Ginkgo Biloba. Am J Psychiatry. 2000;157(5):836–7.CrossRefGoogle Scholar
  82. 82.
    Kang BJ, Lee SJ, Kim MD, Cho MJ. A placebo-controlled, double-blind trial of Ginkgo biloba for antidepressant-induced sexual dysfunction. Hum Psychopharmacol. 2002;17:279–84.CrossRefGoogle Scholar
  83. 83.
    Meston CM, Rellini AH, Telch MJ. Short- and long-term effects of Ginkgo biloba extract on sexual dysfunction in women. Arch Sex Behav. 2008;37:530–47.PubMedCentralCrossRefPubMedGoogle Scholar
  84. 84.
    Wheatley D. Triple-blind, placebo-controlled trial of Ginkgo biloba in sexual dysfunction due to antidepressant drugs. Hum Psychopharmacol. 2004;19:545–8.CrossRefGoogle Scholar
  85. 85.
    Corazza O, Martinotti G, Santacroce R, Chillemi E, Di Giannantonio M, Schifano F, Cellek S. Sexual enhancement products for sale online: raising awareness of the psychoactive effects of yohimbine, maca, horny goat weed, and Ginkgo biloba. Biomed Res Int. 2014;2014:841798.PubMedCentralCrossRefPubMedGoogle Scholar
  86. 86.
    Lee HW, Choi J, Lee Y, Kil KJ, Lee MS. Ginseng for managing menopausal women’s health: a systematic review of double-blind, randomized, placebo-controlled trials. Medicine (Baltimore). 2016;95:e4914.CrossRefGoogle Scholar
  87. 87.
    Oh KJ, Chae MJ, Lee HS, Hong HD, Park K. Effects of Korean red ginseng on sexual arousal in menopausal women: placebo-controlled, double-blind crossover clinical study. J Sex Med. 2010;7:1469–77.CrossRefGoogle Scholar
  88. 88.
    Chung HS, Hwang I, Oh KJ, Lee MN, Park K. The effect of Korean red ginseng on sexual function in premenopausal women: placebo-controlled, double-blind crossover clinical trial. Evid Based Complement Intern Med. 2015;2015:913158.Google Scholar
  89. 89.
    Jang DJ, Lee MS, Shin BC, Lee YC, Ernst E. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. 2008;66(4):444–50.PubMedCentralCrossRefPubMedGoogle Scholar
  90. 90.
    Choi YD, Park CW, Jang J, Kim SH, Jeon HY, Kim WG, et al. Effects of Korean ginseng berry extract on sexual function in men with erectile dysfunction: a multicenter, placebo-controlled, double-blind clinical study. Int J Impot Res. 2013;25(2):45–50.CrossRefGoogle Scholar
  91. 91.
    Chacon RC. Estudio fitquimico de Lepidium meyenii (Phytochemical study of Lepidium meyenii). Disertation, Peru: University Nacionale Mayo de San Marcos; 1961.Google Scholar
  92. 92.
    Advisory Committee on Technical Innovation, Board on Science and Technology for International Development, National Research Council. Lost crops of the Incas: little know plants of the Andes with promise for worldwide. Washington, DC: Nation Research Council; 1989.Google Scholar
  93. 93.
    Dini A, Migliuolo G, Rastrelli L, Saturnino P, Schettino O. Chemical composition of Lepidum meyenii. Food Chem. 1994;49:347–9.CrossRefGoogle Scholar
  94. 94.
    Dording CM, Schettler PJ, Dalton ED, Parkin SR, Walker RS, Fehling KB, et al. A double-blind placebo-controlled trial of maca root as treatment for antidepressant-induced sexual dysfunction in women. Evid Based Complement Alternat Med. 2015;2015:949036.PubMedCentralCrossRefPubMedGoogle Scholar
  95. 95.
    Zenico T, Cicero AF, Valmorri L, Mercuriali M, Bercovich E. Subjective effects of Lepidium meyenii (Maca) extract on well-being and sexual performances in patients with mild erectile dysfunction: a randomised, double-blind clinical trial. Andrologia. 2009;41(2):95–9.CrossRefGoogle Scholar
  96. 96.
    Shin BC, Lee MS, Yang EJ, Lim HS, Ernst E. Maca (L. meyenii) for improving sexual function: a systematic review. BMC Complement Altern Med. 2010;10:44.PubMedCentralCrossRefPubMedGoogle Scholar
  97. 97.
    Peixoto C, Carrilho CG, Barros JA, Ribeiro TT, Silva LM, Nardi AE, et al. The effects of dehydroepiandrosterone on sexual function: a systematic review. Climacteric. 2017;20:129–37.CrossRefGoogle Scholar
  98. 98.
    Jameel JK, Kneeshaw PR, Rao VS, Drew PJ. Gynaecomastia and the plant product “Tribulis terrestris”. Breast. 2004;13(5):428–30.CrossRefGoogle Scholar
  99. 99.
    Santos CA Jr, Reis LO, Destro-Saade R, Luiza-Reis A, Fregonesi A. Tribulus terrestris versus placebo in the treatment of erectile dysfunction: a prospective, randomized, double blind study. Actas Urol Esp. 2014;38(4):244–8.CrossRefGoogle Scholar
  100. 100.
    Kamenov Z, Fileva S, Kalinov K, Jannini EA. Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction-a prospective, randomized, double-blind, placebo-controlled clinical trial. Maturitas. 2017;99:20–6.CrossRefGoogle Scholar
  101. 101.
    Adimoelja A. Phytochemicals and the breakthrough of traditional herbs in the management of sexual dysfunctions. Int J Androl. 2000;23(Suppl 2):82–4.CrossRefGoogle Scholar
  102. 102.
    Wuttkek W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemose) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogen-controlled study. Menopause. 2016;13:185–96.CrossRefGoogle Scholar
  103. 103.
    Low Dog T, Powell L, Weisman SM. Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief. Menopause. 2003;10:299–313.CrossRefGoogle Scholar
  104. 104.
    Duker EM, Kopanski L, Jarry H, Wuttke W. Effects of extracts from Cimicifuga racemosa on gonadotropin release in menopausal women and ovariectomized rats. Planta Med. 1991;57(5):420–4.CrossRefGoogle Scholar
  105. 105.
    Molla MD, Hidalgo-Mora JJ, Soteras MG. Phytotherapy as alternative to hormone replacement therapy. Front Biosci (Schol Ed). 2011;3:191–204.CrossRefGoogle Scholar
  106. 106.
    Mazaro-Costa R, Andersen ML, Hachul H, Tufik S. Medicinal plants as alternative treatment for female sexual dysfunction: utopian vision or possible treatment in climacteric women. J Sex Med. 2010;7:3695–714.CrossRefGoogle Scholar
  107. 107.
    Kashani L, Raisi F, Saroukhani S, Sohrabi H, Modabbernia A, Nasehi AA, et al. Saffron for treatment of fluoxetine-induced sexual dysfunction in women: randomized double-blind placebo-controlled study. Hum Psychopharmacol Clin Exp. 2012;28(1):54–60.CrossRefGoogle Scholar
  108. 108.
    Modabbernia A, Sohrabi H, Nasehi AA, Raisi F, Saaroukhani S, Jamshidi A, et al. Effect of saffron on fluoxetine-induced sexual impraiment in men: randomized double-blind placebo-controlled trial. Psychopharmacology. 2012;223(4):381–8.CrossRefGoogle Scholar
  109. 109.
    Morales A. Yohimbine in erectile dysfunction: the facts. Int J Impot Res. 2000;12(Suppl 1):S70–4.CrossRefGoogle Scholar
  110. 110.
    Farnia V, Shirzadifar M, Shakeri J, Rezaei M, Bajoghli H, Holsboer-Trachsler E, Brand S. Rosa damascena oil improves SSRI-induced sexual dysfunction in male patients suffering from major depressive disorders: results from a double-blind, randomized, and placebo-controlled clinical trial. Neuropsychiatr Dis Treat. 2015;11:625–35.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Depression Clinical and Research Program, Department of PsychiatryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations