From the Guidelines
Seroquel (quetiapine) generally causes fewer sexual side effects than citalopram. While both medications can potentially impact sexual function, citalopram, as a selective serotonin reuptake inhibitor (SSRI), is more commonly associated with sexual dysfunction including decreased libido, delayed orgasm, and erectile dysfunction, affecting approximately 30-50% of patients 1, 2, 3. Seroquel, an atypical antipsychotic, has a different mechanism of action primarily affecting dopamine and serotonin receptors, and typically produces sexual side effects in only about 5-10% of users. However, individual responses vary significantly based on dosage, duration of treatment, and personal factors. If experiencing sexual side effects with either medication, don't stop taking it abruptly; instead, consult your healthcare provider who might adjust your dosage, recommend taking the medication at a different time of day, or consider alternative medications. The difference in sexual side effect profiles relates to their distinct neurochemical actions - citalopram's strong serotonergic effects directly impact sexual function pathways, while Seroquel's more diverse receptor profile generally has less impact on these specific pathways. Some studies have shown that bupropion had a significantly lower rate of sexual adverse events than fluoxetine or sertraline 4, 5, 6, and paroxetine had higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 7, 8. It's essential to consider these factors and discuss them with your healthcare provider to determine the best course of treatment for your specific needs. Key points to consider include:
- The mechanism of action of each medication and its potential impact on sexual function
- The individual's medical history, current health status, and personal factors that may influence the risk of sexual side effects
- The importance of regular monitoring and open communication with your healthcare provider to address any concerns or issues that arise during treatment.
From the Research
Comparison of Sexual Side Effects
- Seroquel (quetiapine) is an atypical antipsychotic, whereas citalopram is a selective serotonin reuptake inhibitor (SSRI) 9.
- SSRIs, such as citalopram, have been associated with a high frequency of sexual side effects, including sexual dysfunction, with more than 70% of patients experiencing these effects 10.
- The mechanism of sexual side effects with SSRIs is thought to be through serotoninergic inhibition of the sexual response 10.
- In contrast, atypical antipsychotics like quetiapine have been reported to have a lower incidence of sexual side effects compared to SSRIs, although the exact frequency is not well-established 9, 11.
- Quetiapine has been approved for the treatment of bipolar depression and has been shown to have similar efficacy to other treatments, but with different tolerability profiles 11.
Sexual Side Effects of Citalopram
- Citalopram has been associated with a high risk of sexual side effects, including sexual dysfunction, with more than 70% of patients experiencing these effects 10.
- The risk of sexual side effects with citalopram is thought to be due to its mechanism of action as an SSRI, which can inhibit the sexual response 10.
- Management strategies for sexual side effects associated with citalopram include dose reduction, change of medication, and add-on treatment 10.
Sexual Side Effects of Quetiapine
- Quetiapine has been reported to have a lower incidence of sexual side effects compared to SSRIs, although the exact frequency is not well-established 9, 11.
- Quetiapine has been approved for the treatment of bipolar depression and has been shown to have similar efficacy to other treatments, but with different tolerability profiles 11.
- The risk of sexual side effects with quetiapine is not as well-studied as with SSRIs, but it is thought to be lower due to its different mechanism of action as an atypical antipsychotic 9.