Citalopram and Sexual Side Effects of Selective Serotonin Reuptake Inhibitors

Ms. A, a medically healthy 65-year-old woman with a history of depression, presented with severe depression, anhedonia, guilt, lack of concentration and appetite, and obsessive thoughts. Despite successful treatment of two earlier depressive episodes with clomipramine, Ms. A refused a regimen of clomipramine because of the sexual dysfunction she had experienced. We prescribed a regimen of fluoxetine, at 40 mg/day, and after 45 days, her depression was resolved. Two months later, Ms. A discontinued her fluoxetine because of side effects including absent libido, anorgasmia, and pain during coitus. Citalopram was initiated and titrated to a dose of 40 mg/day. At 2 months, Ms. A reported no depressive symptoms or obsessive thoughts and no sexual impairment or side effects.

Mr. B, a 58-year-old man with no significant organic disease, received benzodiazepines for 10 years for panic disorder with agoraphobia. In 1992, presenting with moderate depression, Mr. B was prescribed a regimen of fluoxetine, 20 mg/day. After 3 weeks, and despite good response, Mr. B discontinued fluoxetine, complaining of delayed ejaculation and dry mouth. In 1997, presenting with depression, sleep disturbance, anhedonia, decreased libido, and asthenia, Mr. B was treated with a regimen of paroxetine, at 20 mg/day, and temazepam, at 20 mg/day. After 45 days, Mr. B said that he intended to stop treatment, reporting decreased libido, absence of ejaculation, nocturnal priapism with emission of seminal fluid, and emission of seminal fluid on defecation. Treatment was changed to a regimen of citalopram, at 20 mg/day, and temazepam, at 20 mg/day. During the 4 months of citalopram treatment, Mr. B has had no sexual side effects, and his mood and anxiety symptoms have been in remission.