-The antidepressant treatment:
Although it is effective in improving the manifestations of depression, it may also be able to induce or exacerbate some symptoms of sexual dysfunction, these symptoms negatively affect the quality of life of the subject who suffers and their self-esteem and may lead to non-compliance with the treatment and, consequently, to relapse of depressive symptomatology.
The frequency of sexual dysfunction associated with the treatment of adverse effects on sexuality associated with different antidepressants is important, since some are more associated with this problem and others are relatively innocuous in this regard,
Studies conducted to analyze the effects on sexual function of antidepressants are difficult to compare for the different measures of variable used and because they are usually clinical trials in which two antidepressants are compared with each other.
Bupropion, is one of the antidepressants that has shown a lower affectation of the sexual function in the realized studies, even increasing the sexual desire for its action as dopaminergic agonist.
Nefazodone and amitriptyline have been shown to cause fewer sexual dysfunctions than selective serotonin reuptake inhibitors (SSRIs).
Among the different SSRIs fluvoxamine may cause less sexual dysfunction than sertraline, it can also be assumed that the use of duloxetine has a lesser adverse effect on sexual function compared to other isrs.
Trazodone is associated with very low rates of incidence of sexual dysfunction, can act by increasing desire, erections and prolong the latency time to orgasm.
Sometimes if you have started with an IRSS, which has a negative effect on the sexual area, this can be corrected by associating it with another one, that does not produce sexual dysfunction.
In patients under treatment with IRSR, it is known that nefazodone, bupropion and mirtazapine are the antidepressants with a lower incidence of sexual dysfunction at the same height would be agomelatine which is a relatively recent antidepressant, melatoninergic agonist and tryptophan antagonist. and to a lesser degree vortioxetine, which inhibits the transporter and modulates the serotonin receptor, with an increase in the levels of serotonin, dopamine, acetylcholine, noradrenaline and histamine, although its mechanism is not completely clear.
It has been reported that in randomized trials, nefazodone and bupropion were associated with less sexual dysfunction than sertraline and that reboxetine was associated with higher sexual satisfaction than fluoxetine.
Among the criteria to assess the indication of an antidepressant and guide on what type of antidepressant would be the most suitable for a particular patient, there are no specific recommendations on which antidepressant to choose initially if you want to avoid the possible side effect of impotence or sexual dysfunction.
Among those with less possibility of sexual dysfunction, mirtazapine (although there is a greater gain in weight), reboxetine, bupropion, which can also improve libibido, mianserin, trazodone, and the more recent agomelatine and vortioxetine. Nefazodone was withdrawn of commercialization in some countries in 2003 due to the risk of hepatotoxicity.