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Treatment of Antidepressant-Associated Sexual Dysfunction With Sildenafil
A Randomized Controlled Trial
H. George Nurnberg, MD;
Paula L. Hensley, MD;
Alan J. Gelenberg, MD;
Maurizio Fava, MD;
John Lauriello, MD;
Susan Paine, MPH
JAMA. 2003;289:56-64.
Context Sexual dysfunction is a common adverse effect of antidepressants that frequently results in treatment noncompliance.
Objective To assess the efficacy of sildenafil citrate in men with sexual dysfunction associated with the use of selective and nonselective serotonin reuptake inhibitor (SRI) antidepressants.
Design, Setting, and Patients Prospective, parallel-group, randomized, double-blind, placebo-controlled trial conducted between November 1, 2000, and January 1, 2001, at 3 US university medical centers among 90 male outpatients (mean [SD] age, 45 [8] years) with major depression in remission and sexual dysfunction associated with SRI antidepressant treatment.
Intervention Patients were randomly assigned to take sildenafil (n = 45) or placebo (n = 45) at a flexible dose starting at 50 mg and adjustable to 100 mg before sexual activity for 6 weeks.
Main Outcome Measures The primary outcome measure was score on the Clinical Global Impression-Sexual Function (CGI-SF); secondary measures were scores on the International Index of Erectile Function, Arizona Sexual Experience Scale, Massachusetts General Hospital-Sexual Functioning Questionnaire, and Hamilton Rating Scale for Depression (HAM-D).
Results Among the 90 randomized patients, 93% (83/89) of patients treated per protocol took at least 1 dose of study drug and 85% (76/89) completed week 6 end-point assessments with last observation carried forward analyses. At a CGI-SF score of 2 or lower, 54.5% (24/44) of sildenafil compared with 4.4% (2/45) of placebo patients were much or very much improved (P<.001). Erectile function, arousal, ejaculation, orgasm, and overall satisfaction domain measures improved significantly in sildenafil compared with placebo patients. Mean depression scores remained consistent with remission (HAM-D score  10) in both groups for the study duration.
Conclusion In our study, sildenafil effectively improved erectile function and other aspects of sexual function in men with sexual dysfunction associated with the use of SRI antidepressants. These improvements may allow patients to maintain adherence with effective antidepressant treatment.
Author Affiliations: Department of Psychiatry, Health Sciences Center, University of New Mexico School of Medicine, Albuquerque (Drs Nurnberg, Hensley, and Lauriello, and Ms Paine); Department of Psychiatry, Arizona Health Sciences Center, Tucson (Dr Gelenberg); Massachusetts General Hospital, Boston (Dr Fava).
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