Switching to moclobemide to reverse fluoxetine-induced sexual dysfunction in patients with depression.

OBJECTIVE

To determine the efficacy of substituting moclobemide, a reversible monoamine oxidase-A inhibitor, for fluoxetine to reverse fluoxetine-induced sexual dysfunction in patients with depression.

DESIGN

Prospective open trial.

SETTING

Outpatient treatment.

PARTICIPANTS

Five patients with depressive disorder who experienced sexual side effects during treatment with standard doses of fluoxetine (20 to 40 mg per day).

INTERVENTION

Discontinuation of fluoxetine and replacement with moclobemide (300 to 600 mg per day) after a 2-week washout period.

OUTCOME MEASURES

Libido, orgasmic function (in women) or erectile and ejaculatory function (in men), and overall improvement in sexual function during a follow-up period of 2 months to 3 years.

RESULTS

Among patients receiving fluoxetine questioned about sexual side effects, 4 (1 man and 3 women) had treatment-related diminished libido with poor orgasmic response or partial erectile failure, and 1 female patient had enhanced sexual desire with intense clitoral stimulation. In all patients, sexual disturbances resolved completely after a 2-week washout period and a switch to treatment with moclobemide. Moclobemide was well tolerated. The antidepressant effect of moclobemide was comparable to that of fluoxetine.

CONCLUSIONS

Moclobemide may be preferred as a treatment for depression in patients with fluoxetine-induced sexual dysfunction.