Sexual Functioning With Selective Serotonin Reuptake Inhibitors

To the Editor: Lisa A. Piazza, M.D., and colleagues (1) presented interesting findings on sexual functioning in chronically depressed patients treated with selective serotonin uptake inhibitors (SSRIs). However, their findings raise several questions.

Results of presumably 25 sexually active patients are analyzed; however, only 19 patients were involved in a sexual relationship. Does this mean that the remaining six patients were using masturbation as their predominant sexual activity?

Results are presented in the form of means of items on the Arizona Sexual Experience Scale (2). However, the data on frequency of sexual dysfunction are missing. Antidepressants do not usually induce sexual dysfunction in all patients. For instance, in another longitudinal study (3), only 35% of patients on paroxetine showed sexual dysfunction after 6 weeks of treatment. In view of this fact, and of the sometimes high standard deviations of Arizona Sexual Experience Scale items (1), it would be helpful to report the data only in patients who reported SSRI-induced sexual dysfunction. Most of the differences between baseline means and end-of-treatment means are small (from 0.54 to 1.18 in men and from 0.09 to 1.07 in women). Thus, severe worsening or improvement of sexual functioning in a very few individuals could account for the group difference.

The findings on gender differences in treatment-associated sexual dysfunction should also be interpreted with caution. South Carolina researchers, in their longitudinal treatment studies with SSRIs, found that, for women, an orgasm delay gradually improved over 3 months but for men, persisted almost unchanged (4). However, in another of their reports, women tended to be anorgasmic more than men at months 1 and 2 (5). In both reports, the patient population was larger (N=62 and N=75) but not diagnostically homogeneous.

It is obvious that we need double-blind, placebo-controlled studies of sexual dysfunction in larger population samples with use of standardized measures to clarify issues raised by smaller studies.