What is your next step in management for patients who develop sexual side effects on an SSRI (anorgasmia, low libido, etc.) but are responding well to therapy?

Managing side effects from SSRI medications is a key component of treating patients in the outpatient setting who are suffering from depression and/or anxiety. This is doubly true given the fact that primary care is often the most accessible, and often most trusted, source for patients to make their...

There are several theoretical possibilities that have been suggested over the past few decades in the literature. Periactin 4 mg 30 minutes prior to sex is noted as a possible intervention. When I've tried this intervention, my patients have reported no benefit from it. Another possibility is to add...

Have a conversation with the patient about preference and weigh risks vs benefits.

Appreciate the thoughtful discussion. My biggest issue is more for men - retrograde ejaculation, or for men and women, inability to orgasm and decreased libido. The last two are not insignificant. I start with a hearty informed consent when we begin the meds. Some luck with sildenafil for men; testo...

It's a common problem. Whenever possible, I add a small amount of bupropion SR.

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