Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Ejaculatory dysfunction and depression: pharmacological and psychobiological interactions

Abstract

In recent years, increased attention has been focused on antidepressant-associated sexual dysfunction, largely because of the widespread use of serotonin-specific reuptake inhibitors (SSRIs) and the recognition that such side effects can have a negative impact on treatment compliance. Data suggest that serotonergic antidepressants are associated with delayed ejaculation and anorgasmia, although these sexual problems are also linked to depression and to age. In this review, we discuss central mediators of normal orgasmic functioning and dysfunction, the relationship between depression and sexual dysfunction, possible mechanisms for SSRI-associated sexual dysfunction, and evolving treatment strategies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Fava M, Rankin M . Sexual functioning and SSRIs. J Clin Psychiatry 2002; 63(Suppl 5): 13–16.

    PubMed  Google Scholar 

  2. Jannini EA, Simonelli C, Lenzi A . Sexological approach to ejaculatory dysfunction. Int J Androl 2002; 25: 317–323.

    Article  CAS  PubMed  Google Scholar 

  3. Parelman MA . Regarding ejaculation, delayed and otherwise. J Androl 2003; 24: 496.

    Article  PubMed  Google Scholar 

  4. Jannini EA, Simonelli C, Lenzi A . Disorders of ejaculation. J Endocrinol Invest 2002; 25: 1006–1019.

    Article  CAS  PubMed  Google Scholar 

  5. Schiavi RC, Segraves RT . The biology of sexual function. Psychiatr Clin N Am 1995; 18: 7–23.

    Article  CAS  Google Scholar 

  6. Hull EM, Lorrain DS, Du J, Matuszewich L, Lumley LA, Putnam SK et al. Hormone-neurotransmitter interactions in the control of sexual behavior. Behav Brain Res 1999; 105: 105–116.

    Article  CAS  PubMed  Google Scholar 

  7. Putnam SK, Du J, Sato S, Hull EM . Testosterone restoration of copulatory behavior correlates with medial preoptic dopamine release in castrated male rats. Horm Behav 2000; 39: 216–224.

    Article  Google Scholar 

  8. Pfaus JG . Neurobiology of sexual behavior. Curr Opin Neurobiol 1999; 9: 751–758.

    Article  CAS  PubMed  Google Scholar 

  9. Rosen RC, Seidman SN, Menza MA, Shabsigh R, Roose SP, Tseng LJ et al. Quality of life, mood, and sexual function: a path analytic model of treatment effects in men with erectile dysfunction and depressive symptoms. Int J Impot Res 2004; 16: 334–340.

    Article  CAS  PubMed  Google Scholar 

  10. Coleman CC, King BR, Bolden-Watson C, Book MJ, Segraves RT, Richard N et al. A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine. Clin Ther 2001; 23: 1040–1058.

    Article  CAS  PubMed  Google Scholar 

  11. Rosen RC, Lane RM, Menza M . Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol 1999; 19: 67–85.

    Article  CAS  PubMed  Google Scholar 

  12. Laumann EO, Paik A, Rosen RC . Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281: 537–544.

    Article  CAS  PubMed  Google Scholar 

  13. 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: 357–366.

    Article  PubMed  Google Scholar 

  14. 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.

    CAS  PubMed  Google Scholar 

  15. Nofzinger EA, Thase ME, Reynolds CF, Frank E, Jennings JR, Garamoni GL et al. Sexual function in depressed men. Assessment by self-report, behavioral, and nocturnal penile tumescence measures before and after treatment with cognitive behavior therapy. Arch Gen Psychiatry 1993; 50: 24–30.

    Article  CAS  PubMed  Google Scholar 

  16. Casper RC, Redmond DE, Katz MM, Schaffer CB, Davis JM, Koslow SH . Somatic symptoms in primary affective disorder Presence and relationship to the classification of depression. Arch Gen Psychiatry 1985; 42: 1098–1104.

    Article  CAS  PubMed  Google Scholar 

  17. Roose SP, Glassman AH, Walsh BT, Cullen K . Reversible loss of nocturnal penile tumescence during depression: a preliminary report. Neuropsychobiology 1982; 8: 284–288.

    Article  CAS  PubMed  Google Scholar 

  18. Steiger A, von Bardeleben U, Guldner J, Lauer C, Rothe B, Holsboer F . The sleep EEG and nocturnal hormonal secretion studies on changes during the course of depression and on effects of CNS-active drugs. Biol Psychiatry 1993; 17: 125–137.

    CAS  Google Scholar 

  19. Nofzinger EA, Schwartz RM, Reynolds CF, Thase ME, Jennings JR, Frank E et al. Correlation of nocturnal penile tumescence and daytime affect intensity in depressed men. Psychiatry Res 1993; 49: 139–150.

    Article  CAS  PubMed  Google Scholar 

  20. Ernst C, Foldenyi M, Angst J . The Zurich Study: XXI. Sexual dysfunctions and disturbances in young adults. Data of a longitudinal epidemiological study. Eur Arch Psychiatry Clin Neurosci 1993; 243: 179–188.

    Article  CAS  PubMed  Google Scholar 

  21. Angst J . Sexual problems in healthy and depressed persons. Int Clin Psychopharmacol 1998; 13(Suppl 6): S1–S4.

    Article  PubMed  Google Scholar 

  22. Kennedy SH, Dickens SE, Eisfeld BS, Bagby RM . Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord 1999; 56: 201–208.

    Article  CAS  PubMed  Google Scholar 

  23. Bonierbale M, Lancon C, Tignol J . The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France. Curr Med Res Opin 2003; 19: 114–124.

    Article  PubMed  Google Scholar 

  24. Fagan PJ, Schmidt CW, Wise TN, Derogatis LR . Sexual dysfunction and dual psychiatric diagnoses. Compr Psychiatry 1988; 29: 278–284.

    Article  CAS  PubMed  Google Scholar 

  25. Seidman SN, Roose SP, Menza MA, Shabsigh R, Rosen RC . Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001; 158: 1623–1630.

    Article  CAS  PubMed  Google Scholar 

  26. Ashton AK, Rosen RC . Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther 1998; 24: 191–192.

    Article  CAS  PubMed  Google Scholar 

  27. Montejo-Gonzalez AL, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther 1997; 23: 176–194.

    Article  CAS  PubMed  Google Scholar 

  28. Landen M, Hogberg P, Thase ME . Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine. J Clin Psychiatry 2005; 66: 100–106.

    Article  CAS  PubMed  Google Scholar 

  29. Gelenberg AJ, Laukes C, McGahuey C, Okayli G, Moreno F, Zentner L et al. Mirtazapine substitution in SSRI-induced sexual dysfunction. J Clin Psychiatry 2000; 61: 356–360.

    Article  CAS  PubMed  Google Scholar 

  30. Clayton AH . Female sexual dysfunction related to depression and antidepressant medications. Curr Womens Health Rep 2002; 2: 182–187.

    PubMed  Google Scholar 

  31. Atmaca M, Kuloglu M, Tezcan E, Buyukbayram A . Switching to tianeptine in patients with antidepressant-induced sexual dysfunction. Hum Psychopharmacol 2003; 18: 277–280.

    Article  PubMed  Google Scholar 

  32. Clayton AH, Zajecka J, Ferguson JM, Filipiak-Reisner JK, Brown MT, Schwartz GE . Lack of sexual dysfunction with the selective noradrenaline reuptake inhibitor reboxetine during treatment for major depressive disorder. Int Clin Psychopharmacol 2003; 18: 151–156.

    PubMed  Google Scholar 

  33. Price J, Grunhaus LJ . Treatment of clomipramine-induced anorgasmia with yohimbine: a case report. J Clin Psychiatry 1990; 51: 32–33.

    CAS  PubMed  Google Scholar 

  34. Reynolds RD . Sertraline-induced anorgasmia treated with intermittent nefazodone [letter]. J Clin Psychiatry 1997; 58: 89.

    Article  CAS  PubMed  Google Scholar 

  35. Lauerma H . Successful treatment of citalopram-induced anorgasmia by cyproheptadine. Acta Psychiatr Scand 1996; 93: 69–70.

    Article  CAS  PubMed  Google Scholar 

  36. Nelson EB, Keck PEJ, McElroy SL . Resolution of fluoxetine-induced sexual dysfunction with the 5-HT3 antagonist granisetron [letter]. J Clin Psychiatry 1997; 58: 496–497.

    Article  CAS  PubMed  Google Scholar 

  37. Balon R . Intermittent amantadine for fluoxetine-induced anorgasmia. J Sex Marital Ther 1996; 22: 290–292.

    Article  CAS  PubMed  Google Scholar 

  38. Labbate LA, Grimes JB, Hines A, Pollack MH . Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction. Ann Clin Psychiatry 1997; 9: 241–245.

    Article  CAS  PubMed  Google Scholar 

  39. 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: 62–67.

    Article  CAS  PubMed  Google Scholar 

  40. Landen M, Eriksson E, Agren H, Fahlen T . Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. J Clin Psychopharmacol 1999; 19: 268–271.

    Article  CAS  PubMed  Google Scholar 

  41. Roeloffs C, Bartlik B, Kaplan PM, Kocsis JH . Methylphenidate and SSRI-induced sexual side effects [letter; comment]. J Clin Psychiatry 1996; 57: 548.

    Article  CAS  PubMed  Google Scholar 

  42. Balon R . Ginkgo bilobafor antidepressant-induced sexual dysfunction? [letter; comment]. J Sex Marital Ther 1999; 25: 1–2.

    CAS  PubMed  Google Scholar 

  43. Seftel A . Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. J Urol 2003; 170: 682–683.

    Article  PubMed  Google Scholar 

  44. Seidman SN, Pesce VC, Roose SP . High-dose sildenafil citrate for selective serotonin reuptake inhibitor-associated ejaculatory delay: open clinical trial. J Clin Psychiatry 2003; 64: 721–725.

    Article  CAS  PubMed  Google Scholar 

  45. Nurnberg HG, Seidman SN, Gelenberg AJ, Fava M, Rosen R, Shabsigh R . Depression, antidepressant therapies, and erectile dysfunction: clinical trials of sildenafil citrate (Viagra(R)) in treated and untreated patients with depression. Urology 2002; 60: 58–66.

    Article  PubMed  Google Scholar 

  46. Wheatley D . Triple-blind, placebo-controlled trial of Ginkgo biloba in sexual dysfunction due to antidepressant drugs. Hum Psychopharmacol 2004; 19: 545–548.

    Article  PubMed  Google Scholar 

  47. Masand PS, Ashton AK, Gupta S, Frank B . Sustained-release bupropion for selective serotonin reuptake inhibitor-induced sexual dysfunction: a randomized, double-blind, placebo-controlled, parallel-group study. Am J Psychiatry 2001; 158: 805–807.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Seidman.

Additional information

Prepared for International Journal of Impotence Research supplement on Ejaculatory Disorders.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seidman, S. Ejaculatory dysfunction and depression: pharmacological and psychobiological interactions. Int J Impot Res 18 (Suppl 1), S33–S38 (2006). https://doi.org/10.1038/sj.ijir.3901509

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijir.3901509

Keywords

This article is cited by

Search

Quick links