From the Guidelines
A common side effect of SSRIs that may limit their use in treating anxiety disorders is sexual dysfunction, which can occur in approximately 30-50% of patients taking SSRIs. This includes decreased libido, delayed orgasm, anorgasmia (inability to achieve orgasm), and erectile dysfunction in men 1. The sexual dysfunction typically begins within the first few weeks of treatment and often persists throughout therapy. This side effect can significantly impact quality of life and relationship satisfaction, leading to medication non-adherence or discontinuation in many patients.
Key Points to Consider
- The mechanism behind SSRI-induced sexual dysfunction involves increased serotonin levels, which can inhibit dopamine and norepinephrine pathways that regulate sexual function 1.
- Some SSRIs affect nitric oxide production, which is important for sexual arousal.
- Patients experiencing these side effects should discuss them with their healthcare provider rather than stopping medication abruptly, as dose adjustments, switching to alternative medications like bupropion, or adding medications to counteract these effects may help manage this common but troublesome side effect.
Management of Sexual Dysfunction
- Dose adjustments: Reducing the dose of the SSRI may help alleviate sexual dysfunction in some patients 1.
- Switching to alternative medications: Medications like bupropion, which has a lower risk of sexual dysfunction, may be considered as an alternative to SSRIs 1.
- Adding medications to counteract sexual dysfunction: Medications like sildenafil or tadalafil may be added to help manage erectile dysfunction caused by SSRIs 1. It is essential to weigh the benefits and risks of SSRIs in treating anxiety disorders, considering the potential impact of sexual dysfunction on quality of life and relationship satisfaction. Healthcare providers should closely monitor patients for signs of sexual dysfunction and work with them to develop strategies to manage this side effect.
From the FDA Drug Label
Serotonin Syndrome — The development of a potentially life–threatening serotonin syndrome may occur with SNRIs and SSRIs, including Prozac treatment, particularly with concomitant use of serotonergic drugs (including triptans) and with drugs which impair metabolism of serotonin (including MAOIs). Anaphylactoid events, including bronchospasm, angioedema, laryngospasm, and urticaria alone and in combination, have been reported.
A common side effect of SSRIs that may limit their use in treating anxiety disorders is the risk of developing Serotonin Syndrome, a potentially life-threatening condition. Additionally, anaphylactoid events such as bronchospasm, angioedema, and urticaria have been reported 2.
From the Research
Common Side Effects of SSRIs
- The most common side effects of Selective Serotonin Reuptake Inhibitors (SSRIs) include nausea, diarrhea, fatigue, somnolence, and sexual side effects 3
- Other common side effects reported by patients taking SSRIs are flatulence, memory impairment, decreased concentration, yawning, fatigue, dry mouth, weight gain, light headedness, and sweating 4
- Patients treated with escitalopram had a significantly higher incidence of headache, pruritus, memory impairment, decreased concentration, and dizziness 4
- Patients treated with sertraline had a significantly decreased appetite 4
Limitations of SSRIs in Treating Anxiety Disorders
- SSRIs are associated with a delay of several weeks in onset of therapeutic effect and have the potential to exacerbate anxiety and panic early in the treatment course 5
- Despite their usefulness in anxiety disorders, the side-effect profiles of SSRIs may limit their use in some patients 6, 7
- The potential for dose-dependent blood pressure elevation is a disadvantage of some antidepressants, such as venlafaxine, relative to SSRIs 3