Sexual dysfunction associated with antidepressants and antipsychotics: a structured narrative review of mechanisms, assessment, and personalized management
Abstract
Sexual dysfunction is a common and clinically significant problem in patients treated with antidepressants and antipsychotics, yet it remains under-recognized in routine psychiatric practice. Its relevance extends beyond tolerability, as it may adversely affect quality of life, intimate relationships, self-esteem, and long-term adherence. A major clinical and methodological challenge is that sexual dysfunction frequently precedes pharmacotherapy, particularly in depressive and psychotic disorders, making it essential to distinguish illness-related impairment from treatment-emergent dysfunction. This narrative review provides an integrated overview of sexual dysfunction associated with antidepressants and antipsychotics, with emphasis on mechanisms, clinical assessment, and management. We summarize current evidence on the comparative risk across major drug classes and selected individual agents, highlighting the generally higher burden associated with strongly serotonergic antidepressants and prolactin-elevating antipsychotics, as well as the relatively more favorable profiles of selected newer or prolactin-sparing compounds. We further examine the principal serotonergic, dopaminergic, endocrine, autonomic, and vascular mechanisms involved, and discuss their relevance to the different domains of sexual functioning. Finally, we review practical strategies for routine care, including baseline evaluation, direct questioning, validated rating instruments, prevention through drug…
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