Major depressive disorder (MDD) is a common mental health condition that affected an estimated 163 million people worldwide in 2017. People with MDD may experience chronic low mood, low self-esteem, and a loss of interest in things that they once found pleasurable or enjoyable.

A depressed mood can have a negative effect on a person’s relationships and reduce their sex drive. Therefore, it may not be surprising that MDD is associated with sexual dysfunction.

Interestingly, however, the first-line drug treatment for MDD, selective serotonin reuptake inhibitors (SSRIs), have also been found to impair one’s sexual functioning. As such, a team of researchers sought to discover how MDD and SSRIs affect a person’s sexual function over time.

To do so, they designed a study that assessed the depressive symptoms and sexual functioning of 92 patients with MDD at four timepoints: baseline and 4, 8, and 12 weeks after starting treatment with escitalopram (a type of SSRI antidepressant).

The investigators used the 6- and 17-item versions of the Hamilton Depression Rating Scale (HDRS₆ and HDRS₁₇) to measure the participants’ depressive symptoms and the Changes in Sexual Functioning Questionnaire (CSFQ) to measure their sexual function. Baseline sexual function was compared to the sexual function of 73 healthy control participants.

In the end, the researchers found that, as they hypothesized, the patients with MDD had worse sexual functioning than the healthy controls at baseline. Not only did they score significantly lower on the CSFQ than the healthy individuals, but they also had a much greater proportion of individuals who scored below the questionnaire’s cutoff for sexual dysfunction.

Promisingly, the proportion of MDD patients with sexual dysfunction decreased significantly from baseline to 12 weeks after initiating medication, dropping from 60.8% to 38.7%. This change coincided with a decrease in depressive symptoms.

These findings suggest that treatment with SSRI antidepressants had an overall positive effect on the sexual functioning of people with MDD, despite the drug’s potential sexual side effects. The authors of the study speculated that while the SSRIs can have negative sexual side effects, these side effects may be outweighed by the improvement in depressive symptoms they provide.

Nevertheless, this study had some limitations. First, there was no placebo arm in the study, which means that the researchers cannot confidently attribute the improvement in sexual functioning to the use of antidepressants. Additionally, most of the participants in this study were young, which may have had a protective effect against sexual side effects.

Still, the results are encouraging, and further studies could help to strengthen these findings over time.

References:

• Weber, S., Frokjaer, V.G., Armand, S., Nielsen, J.H., Knudsen, G.M., Joergensen, M.B., Stenbaek, D.S., & Giraldi, A. (2023). Sexual function improves as depressive symptoms decrease during treatment with escitalopram: results of a naturalistic study of patients with major depressive disorder. The Journal of Sexual Medicine, qdac016, https://doi.org/10.1093/jsxmed/qdac016.