What are the chances of sexual dysfunction with Lexapro (escitalopram) compared to other Selective Serotonin Reuptake Inhibitors (SSRIs)?

Sexual Dysfunction with Lexapro (Escitalopram) Compared to Other SSRIs

Lexapro (escitalopram) has significant rates of sexual dysfunction similar to other SSRIs, with approximately 7% of patients experiencing decreased libido and 12-14% of males experiencing ejaculatory disorders, though these rates are likely underreported. 1

Comparative Rates of Sexual Dysfunction Among Antidepressants

• Sexual dysfunction is a common side effect of SSRIs, with significant differences in incidence among medications 2
• According to FDA labeling for escitalopram, sexual side effects include:
  • In males: ejaculation disorder (primarily ejaculatory delay) 12-14%, decreased libido 6%, impotence 2% 1
  • In females: decreased libido 3%, anorgasmia 3% 1
• These rates are likely underreported as patients and physicians may be reluctant to discuss sexual side effects 1, 2
• Paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, and sertraline 2
• Fluoxetine is associated with particularly high rates of sexual dysfunction, with reported rates between 57.7% and 62.9% 3
• Among SSRIs as a class, sexual dysfunction rates range from 36-43%, significantly higher than non-SSRI alternatives 4

Non-SSRI Alternatives with Lower Sexual Side Effect Profiles

• Bupropion has significantly lower rates of sexual adverse events (22-25%) compared to SSRIs and should be considered as a first-line alternative when sexual side effects are a concern 2, 4
• In a prospectively defined population without predisposing factors for sexual dysfunction, the odds of experiencing sexual dysfunction were 4-6 times greater with SSRIs compared to bupropion SR 4
• Mirtazapine and nefazodone (28%) are associated with lower rates of sexual dysfunction than SSRIs 4, 5
• Vortioxetine has shown significantly greater improvements in sexual functioning compared to escitalopram in patients with SSRI-induced sexual dysfunction 6

Types of Sexual Dysfunction with Escitalopram

• The most common sexual side effects with escitalopram include:
  • Ejaculation disorder (primarily ejaculatory delay) in males (12-14%) 1
  • Decreased libido in both males (6%) and females (3%) 1
  • Anorgasmia in females (3%) 1
  • Impotence in males (2%) 1

Management Options for SSRI-Induced Sexual Dysfunction

• For patients requiring antidepressant therapy where sexual dysfunction is a significant concern, bupropion should be considered as a first-line agent 2
• Switching from an SSRI to escitalopram may help in some cases, though evidence is limited 7
• Switching to vortioxetine has shown benefits for patients experiencing sexual dysfunction during SSRI therapy 6
• Buspirone has been studied as a potential off-label treatment option for sexual dysfunction, particularly for low desire or libido 2

Important Clinical Considerations

• Sexual dysfunction is a leading cause of medication non-adherence in antidepressant therapy 5
• Post-SSRI sexual dysfunction has been identified as a potential, although rare, adverse effect that may persist after discontinuation of the drug 5
• Physicians consistently underestimate the prevalence of antidepressant-associated sexual dysfunction, making active assessment essential 4
• Sexual function should be actively assessed at baseline, at regular intervals during treatment, and after treatment cessation 5

Monitoring Recommendations

• Assess sexual function before starting treatment to establish a baseline 5
• Regularly inquire about possible sexual side effects during treatment, as patients may be reluctant to report them spontaneously 1, 4
• Monitor for persistent sexual dysfunction even after discontinuation of SSRIs 5