An evidence-based review updating the various treatment and management approaches to serotonin reuptake inhibitor-associated sexual dysfunction.

Although most patients (80-90%) will respond to the first or second antidepressant prescribed, major depression disease management outcomes data are poor. Serotonin reuptake inhibitor (SRI) antidepressant-associated sexual dysfunction, which is reported to occur in 40-70% of patients on these agents, is a major factor for treatment noncompliance, treatment failure and costly disease management outcomes. Up to 90% of patients with treatment-emergent sexual dysfunction will discontinue their prescribed medication prematurely. Despite several thousand published reports on treatment modalities based on heuristic post hoc hypotheses of central serotonin inhibition and those involving agonist, antagonist, partial agonist, switching, augmentation and waiting management approaches, no evidence-based data are available to support those treatment modalities, leaving patients exposed to random pharmacology. The emergence of new approaches based on novel signaling to treat sexual dysfunction, which demonstrate efficacy for selective type 5 phosphodiesterase inhibitor treatment of SRI antidepressant-associated sexual dysfunction, offers an opportunity for an evidence-based re-evaluation of the comparative effectiveness of various management approaches to SRI antidepressant-associated sexual dysfunction.