Sildenafil Treatment of Paroxetine-Induced Anorgasmia in a Woman
1999; American Psychiatric Association; Volume: 156; Issue: 5 Linguagem: Inglês
10.1176/ajp.156.5.800
ISSN1535-7228
Autores Tópico(s)Sexuality, Behavior, and Technology
ResumoBack to table of contents Previous article Next article Letter to the EditorFull AccessSildenafil Treatment of Paroxetine-Induced Anorgasmia in a WomanADAM KELLER ASHTON, M.D., ADAM KELLER ASHTON, M.D., Williamsville, N.Y.Published Online:1 May 1999https://doi.org/10.1176/ajp.156.5.800AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Selective serotonin reuptake inhibiting antidepressants (SSRIs) commonly produce iatrogenic sexual dysfunction (1, 2). Spontaneous remission of SSRI-induced sexual dysfunction is uncommon even after continuing the SSRI for years (2, 3). A variety of augmentation strategies intended to reverse SSRI-induced sexual dysfunction have been proposed (4). Sildenafil, a phosphodiesterase type 5 inhibitor, is indicated in the treatment of male erectile disorder. There are two case reports of men having SSRI-induced sexual dysfunction reversed by sildenafil (unpublished 1998 study by Ashton and Bennett). I report here a case of SSRI-induced anorgasmia in a woman that was reversed by sildenafil.Ms. A was a 41-year-old Caucasian woman with a psychiatric history significant for generalized anxiety disorder with obsessive compulsive traits refractory to trials of counseling with three psychotherapists as well as three psychiatrists. In addition, medication trials of doxepin, buspirone, clomipramine, fluoxetine, fluvoxamine, trazodone, and clonazepam had failed . Ultimately, she responded to a regimen of paroxetine, at 60 mg/day. However, she developed anorgasmia of over 1 year's duration associated with paroxetine treatment while taking no other medication. She denied difficulties with sexual drive or arousal. Trials of yohimbine, ginkgo biloba, and sustained-release bupropion did not relieve her anorgasmia. Ms. A then successfully responded to sildenafil, at 50 mg, 1 hour prior to anticipated sexual activity. She consistently responded to sildenafil treatment over many months, except for one episode when she waited 3 hours before engaging in sexual activity. She denied side effects other than mild facial flushing within 45 minutes of taking sildenafil, which she used as a physiologic marker of her sexual readiness.This letter describes a woman with SSRI-induced anorgasmia without other sexual complaints who had this side effect reversed by taking sildenafil. Since this trial was not controlled, it is possible that the response noted was a placebo effect, although Ms. A had failed prior antidote trials and continued to have a beneficial response. At this point, sildenafil only has Food and Drug Administration approval for use in men with erectile dysfunction. This description of the successful and safe use of sildenafil in a woman may reveal other potential opportunities for using this agent. Further research in this area would be helpful in defining other populations and medical conditions that may be responsive to sildenafil treatment.References1. Ashton AK, Hamer R, Rosen RC: Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients. J Sex Marital Ther 1997; 23:165–175Crossref, Medline, Google Scholar2. Montejo-Gonzalez AM, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Calcedo A, Carrasco JL, Ciudad J, Daniel E, de la Gandara J, Derecho J, Franco M, Gomez MJ, Macias JA, Martin T, Perez V, Sanchez JM, Sanchez S, Vicens E: SSRI-induced sexual dysfunction—fluoxetine, paroxetine, sertraline and fluvoxamine in a prospective multicenter and descriptive clinical study of 344 patients. J Sex Marital Ther 1997; 23:176–194Crossref, Medline, Google Scholar3. Ashton AK, Rosen RC: Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther 1998; 24:191–192Crossref, Medline, Google Scholar4. Ellison JM: Antidepressant induced sexual dysfunction: review, classification and treatment suggestions. Harv Rev Psychiatry (in press)Google Scholar FiguresReferencesCited byDetailsCited ByCarbamazepine and Rebound ManiaGILLIAN E. JESS, M.B., Ch.B., M.R.C.Psych., DANIEL J. SMITH, M.B., Ch.B., M.R.C.Psych., CATHERINE MacKENZIE, M.R.Pharm.S., and COLIN CRAWFORD, M.B., Ch.B., M.R.C.Psych., 1 November 2004 | American Journal of Psychiatry, Vol. 161, No. 11Vardenafil Reversal of Female AnorgasmiaADAM KELLER ASHTON, M.D., 1 November 2004 | American Journal of Psychiatry, Vol. 161, No. 11Catatonia in Juvenile CorrectionsJULIE A. NIEDERMIER, M.D., 1 November 2004 | American Journal of Psychiatry, Vol. 161, No. 11Focal Segmental Glomerulosclerosis and Lithium TreatmentANDREAS SCHREINER, M.D., RÜDIGER WALDHERR, M.D., PETER ROHMEISS, M.D., and WALTER HEWER, M.D., 1 May 2000 | American Journal of Psychiatry, Vol. 157, No. 5Amphetamine Misuse and Social PhobiaKELWYN WILLIAMS, M.R.C.PSYCH., SPILIOS ARGYROPOULOS, M.SC., M.R.C.PSYCH., and DAVID J. NUTT, D.M., M.R.C.P., F.R.C.PSYCH., 1 May 2000 | American Journal of Psychiatry, Vol. 157, No. 5 Volume 156Issue 5 May 1999Pages 800-800 Metrics History Published online 1 May 1999 Published in print 1 May 1999
Referência(s)