Antidepressants, Antipsychotics & Sexual Dysfunction

Sexual dysfunction is a frequent and often underrecognized adverse effect associated with both antipsychotic and antidepressant medications, significantly impacting patients’ quality of life, relationships, and adherence to treatment. Antidepressants, particularly those with serotonergic activity such as selective serotonin reuptake inhibitors (SSRIs), are linked to high rates of sexual dysfunction, including decreased libido, arousal difficulties, and delayed or absent orgasm, with prevalence estimates ranging from 30% to over 60% depending on the agent and assessment method. While noradrenergic, dopaminergic, or melatonergic antidepressants tend to have a lower risk, the clinical context often dictates their use. Antipsychotics, especially first-generation agents and those that strongly block dopamine receptors or elevate prolactin levels (e.g., risperidone, haloperidol), are also associated with substantial rates of sexual dysfunction such as erectile, ejaculatory, and orgasmic difficulties. Second-generation antipsychotics like aripiprazole and quetiapine generally have a lower risk, but sexual side effects remain a concern for many patients. These adverse effects are a major cause of treatment nonadherence, particularly among younger patients and those with previously satisfactory sexual function. Effective management requires proactive discussion, individualized risk assessment, and consideration of strategies such as switching to agents with lower sexual side-effect profiles, dose adjustments, or adjunctive therapies. Greater awareness and routine monitoring of sexual function are essential to optimize treatment outcomes and support patient well-being.