How to manage sexual dysfunction in patients taking Lexapro (escitalopram)?

From the Guidelines

Managing sexual dysfunction in patients taking Lexapro (escitalopram) involves several strategies that can be implemented while maintaining effective depression or anxiety treatment. First, consider waiting 4-8 weeks as sexual side effects sometimes resolve spontaneously with continued treatment. If problems persist, dose reduction may help if the patient's mental health condition is stable enough to tolerate it. Scheduling sexual activity before daily Lexapro dosing can be effective since blood levels are lowest at this time. Taking drug holidays (skipping doses for 1-2 days before planned sexual activity) may help some patients, though this approach carries risk of discontinuation symptoms and should be discussed with a healthcare provider. For persistent dysfunction, adding bupropion (Wellbutrin) at 150-300 mg daily can counteract sexual side effects while potentially enhancing antidepressant efficacy, as bupropion had a significantly lower rate of sexual adverse events than fluoxetine or sertraline 1. Phosphodiesterase-5 inhibitors like sildenafil (Viagra) or tadalafil (Cialis) may help with erectile dysfunction in men, as recommended by the American College of Physicians for men who seek treatment for erectile dysfunction and who do not have a contraindication to PDE-5 inhibitor use 1. For some patients, switching to antidepressants with lower rates of sexual side effects (such as bupropion, mirtazapine, or vortioxetine) might be appropriate. These interventions work because SSRIs like Lexapro can increase serotonin, which inhibits dopamine and norepinephrine pathways involved in sexual desire and function, while the suggested medications help restore balance to these neurotransmitter systems. It is also beneficial to review medications to consider any impact on sexual function and encourage the patient to report any side effects of medications related to sexual activity, as suggested by the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP) 1. Key considerations include:

• Waiting for spontaneous resolution of sexual side effects
• Dose reduction if mental health condition allows
• Scheduling sexual activity when Lexapro blood levels are lowest
• Considering drug holidays with caution
• Adding bupropion for counteracting sexual side effects
• Using phosphodiesterase-5 inhibitors for erectile dysfunction
• Switching to antidepressants with lower sexual side effect rates
• Reviewing and adjusting medications for sexual function impact.

From the FDA Drug Label

1. 11 Sexual Dysfunction Use of SSRIs, including Escitalopram tablets, may cause symptoms of sexual dysfunction [see Adverse Reactions(6. 1)]. In male patients, SSRI use may result in ejaculatory delay or failure, decreased libido, and erectile dysfunction. In female patients, SSRI use may result in decreased libido and delayed or absent orgasm It is important for prescribers to inquire about sexual function prior to initiation of Escitalopram tablets and to inquire specifically about changes in sexual function during treatment, because sexual function may not be spontaneously reported When evaluating changes in sexual function, obtaining a detailed history (including timing of symptom onset) is important because sexual symptoms may have other causes, including the underlying psychiatric disorder. Discuss potential management strategies to support patients in making informed decisions about treatment.

To manage sexual dysfunction in patients taking Lexapro (escitalopram), prescribers should:

• Inquire about sexual function prior to initiation of Escitalopram tablets
• Inquire specifically about changes in sexual function during treatment
• Obtain a detailed history, including timing of symptom onset, to evaluate changes in sexual function
• Discuss potential management strategies to support patients in making informed decisions about treatment 2 Key considerations include:
• Evaluating the underlying cause of sexual symptoms, which may include the underlying psychiatric disorder
• Monitoring sexual function during treatment with Escitalopram tablets.

From the Research

Managing Sexual Dysfunction while on Lexapro (Escitalopram)

To manage sexual dysfunction in patients taking Lexapro (escitalopram), several strategies can be considered:

• Dose reduction: Reducing the dose of escitalopram may help alleviate sexual dysfunction, as the effects of SSRIs on sexual functioning seem strongly dose-related 3.
• Switching to a different antidepressant: Switching to an antidepressant with a lower risk of sexual dysfunction, such as vortioxetine, may be beneficial for patients experiencing sexual dysfunction during treatment with SSRIs 4.
• Adding medication to treat sexual dysfunction: Adding medications like sildenafil, tadalafil, or bupropion to the treatment regimen may help improve sexual function in patients with antidepressant-induced sexual dysfunction 5.
• Assessing and addressing other causes of sexual dysfunction: It is essential to assess and address other potential causes of sexual dysfunction, such as underlying medical conditions, relationship issues, or other medications, to develop an effective management plan 6.

Strategies for Managing Sexual Dysfunction

Some specific strategies for managing sexual dysfunction induced by antidepressant medication include:

• Waiting for tolerance to develop: Allowing time for the body to adjust to the medication and potentially develop tolerance to its sexual side effects 3.
• Drug holidays: Temporarily discontinuing the antidepressant medication to assess the impact on sexual function 3.
• Augmentation strategies: Adding other medications, such as 5-HT2, 5-HT3, or alpha2 adrenergic receptor antagonists, to the treatment regimen to help alleviate sexual dysfunction 3.
• Switching to a different SSRI: Switching to a different SSRI, such as fluvoxamine, which may have a lower risk of sexual dysfunction, may be considered 7.

Importance of Active Assessment and Individualized Approach

Active assessment of sexual function at baseline, during treatment, and after treatment cessation is crucial in managing sexual dysfunction induced by antidepressant medication 6. An individualized approach, considering the patient's specific needs and circumstances, is necessary to develop an effective management plan for sexual dysfunction while on Lexapro (escitalopram) 6, 3, 5, 4.