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Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale

Published online by Cambridge University Press:  12 April 2021

Marissa J. Luft ,
Eric T. Dobson ,
Amir Levine ,
Paul E. Croarkin Open the ORCID record for Paul E. Croarkin [Opens in a new window]  and
Jeffrey R. Strawn Open the ORCID record for Jeffrey R. Strawn [Opens in a new window]
Marissa J. Luft
Affiliation:
Anxiety Disorders Research Program, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
Eric T. Dobson
Affiliation:
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
Amir Levine
Affiliation:
Department of Psychiatry, Columbia University and New York State Psychiatric Institute (NYSPI), New York, New York, USA
Paul E. Croarkin
Affiliation:
Mayo Clinic, Department of Psychiatry and Psychology, Rochester, Minnesota, USA
Jeffrey R. Strawn*
Affiliation:
Anxiety Disorders Research Program, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
*
*Author for correspondence: Jeffrey R. Strawn, MD Email: strawnjr@uc.edu
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Abstract

Background

Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking.

Methods

To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

Results

We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: −1.8, 95% credible interval [CrI]: [−3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: −1.2, 95% CrI [−2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance.

Conclusions

While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions.

Keywords

Selective serotonin reuptake inhibitor (SSRI)erectile dysfunctionanorgasmiasexual dysfunctionsildenafil
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 4 , August 2022 , pp. 496 - 505
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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