One of the most common, and many times hidden, secondary effects of antidepressants drugs use is sexual dysfunction (SD). It has been noted that as many as 20% of patients will discontinue treatment with an SSRI, with one-third of these patients doing so due to adverse reactions.

A review was conducted aiming to clarify the pathogenesis of sexual dysfunction in depressed patients or taking antidepressants and how to prevent and manage it. The literature search was conducted in PubMed data reviewing articles dating between 2015 and 2016.

(1) the sexual response cycle is negatively affected in individuals suffering from major depressive disorder, even before initiation of any psychotropic medication. The serotonergic system plays a largely inhibitory role on sexual desire, orgasm, and ejaculation with involvement of the hippocampus and amygdala. Tricyclic antidepressants increase the level of prolactin and indirectly suppress the level of testosterone. (2) Bupropion and vortioxetine are the only antidepressants that have level 1 evidence supporting that they either have a more favorable SD profile. (3) SD with vortioxetine was not statistically higher when compared with placebo, and was statistically lower compared with other SSRIs or SNRIs. (4) There is evidence that antidepressants that are also 5–HT1A receptor agonists (e.g. vortioxetine and vilazodone) may facilitate sexual performance.

In case of SD pharmacologic and non-pharmacologic options are available. Vortioxetine seems to be a good pharmacologic option, with better NNH than SNRI and less SD.