Escitalopram and sexual side effects

Hello,

SSRI-type antidepressants are frequently associated with sexual side effects such as decreased libido, difficulty reaching orgasm, decreased lubrication in women and erectile dysfunction in men. These effects are reported in approximately 15 to 80% of cases, depending on the studies and the drug studied. They would also be dose-dependent, meaning that the higher the dose, the greater the risk of suffering these effects.

However, these effects are reversible when the drug is stopped in the vast majority of patients. The prevalence of persistent sexual side effects after discontinuation is unknown and most of the available data comes from case reports, incidental findings and internet anecdotes. There have been no randomized double-blind controlled trials investigating this phenomenon in humans to date. Animal data suggest that SSRIs may cause permanent sexual dysfunction when rats were exposed to the drugs at a young age, but not when they were exposed as adults. In addition, decreased libido and sexual desire are well-known symptoms of depression. It is therefore difficult to distinguish in the studies whether these effects are really due to the medication or rather to the disease. Further studies are therefore needed before it can be concluded that there is a true cause and effect relationship between SSRIs and these persistent sexual dysfunctions after stopping in humans.

I can understand your concern. In making a decision, it is important to weigh the risks and benefits of the treatment, because as with any medication, there is a risk of adverse effects. Do the benefits of the drug outweigh the risks? Is there a greater risk of not treating the depression/anxiety or taking the medication? These are all questions that should be discussed with your doctor and pharmacist.

To answer your question, in my practice I often encounter patients with sexual side effects, but this is far from the majority. I have never encountered patients with persistent effects after treatment. Although sexual side effects are possible with escitalopram (Cipralex), they are mostly tolerable and rarely severe and are well controlled either by lowering the dose or by substituting it for an antidepressant of another class that is better tolerated sexually, such as bupropion (Wellbutrin), mirtazapine (Remeron) or vortioxetine (Trintellix), or by combining it with one of these alternatives.

I hope my answer sheds some light on the subject,

Raphaël Parent, Pharmacist