Monday, July 14, 2008

Which antidepressants have no sexual side effects?

1) Bupropion - minimal sexual side effects
2) Mirtazapine - probably no sexual side effects; but this drug is quite sedating and often leads to a lot of weight gain
3) Trazodone - does not diminish sexual function, but can cause rare instances of priapism in men (abnormally sustained erections, which could be a medical emergency). Trazodone on its own is probably not a potent enough antidepressant though, or at least for it to be effective the dose would have to be raised so high that there would be a lot of sedation. It may be a useful adjunctive medication, perhaps to add on to something else to help with sleep.
4) Moclobemide -- often forgotten! No sexual side effects. There is a good body of literature from Scandinavia demonstrating its effectiveness in controlled trials. This drug is available in Canada, perhaps not in the U.S. This drug is an example of an antidepressant that has "fallen out of fashion"--it isn't prescribed very often. Yet the evidence base is similar to that of the other antidepressants. Such phenomena are self-perpetuating: because moclobemide is prescribed less often, and people are less familiar with it, it will be more often prescribed as a second or third-line treatment option. Any treatment used after something else has NOT worked will automatically tend to have a smaller chance of working. So we see moclobemide work less often, and falsely assume that it is an inferior antidepressant. If it were prescribed with equal frequency as a first-line agent, people would probably see that it works as well as the other antidepressants.

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