TABLE 1.

Common psychotropic classes causing sexual dysfunction

TRICYCLIC ANTIDEPRESSANTS
Adapted from Crenshaw TL, Goldberg JP. Sexual Pharmacology: Drugs That Affect Sexual Functioning. New York, NY: W. W. Norton & Company, 1996.
Mechanism of action (general)
Inhibits the re-uptake of norepinephrine and serotonin (5-HT) Modulates norephinephrine and 5-HT activity at the neural synapse
Mechanism of action (sexual)
Positive Increased adrenergic α1 activity Decreased cortisol
Negative Decreased β–adrenergic activity Decreased cholinergic activity Decreased histamine Decreased oxytocin Increased prolactin Increased serotonin
Direct sexual side effects*
Desire disorders Dyspareunia Erection difficulties
Orgasm disorders Orgasmic inhibition Anorgasmia Spontaneous orgasm
Ejaculation disorders Retarded ejaculation Ejaculation without orgasm Anesthetic ejaculation
MONOAMINE OXIDASE INHIBITORS
Mechanism of action (general)
Decreases the neural monoamine oxidase enzymatic metabolic breakdown of norepinephrine and serotonin I Increases norepinephrine and serotonin activity at the neural synapse
Mechanism of action (sexual)
Positive Increased adrenergic α1 activity Decreased monoamine oxidase
Negative Decreased β-adrenergic activity Decreased cholinergic activity Increased prolactin Increased serotonin Decreased testosterone
Direct sexual side effects*
Desire disorders Erection difficulties
Orgasm disorders Orgasmic inhibition Decreased number
Ejaculation disorders Retarded, inhibited premature ejaculation diminished
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
Mechanism of action (general)
Work through selective serotonin-uptake inhibition
Mechanism of action (sexual)
Negative Increased cortisol Increased opioids Increased prolactin Increased serotonin (5-HT)
Direct sexual side effects
Desire disorders Hyposexuality Hypersexuality
Orgasm disorders Orgasmic inhibition Anorgasmia Spontaneous orgasm
Ejaculation disorders Retarded ejaculation Ejaculatory inhibition
Erection disorders Inability/difficulty obtaining erection Decreased quality of erection Decreased or absent nocturnal/morning erections
ANTIPSYCHOTICS
Mechanism of action (general)
Block dopamine activity Block sigma receptors and/or 5-HT2 serotonin receptors
Mechanism of action (sexual)
Negative Decreased adrenergic ·1 activity Decreased cholinergic activity Decreased dopamine Increased prolactin Decreased testosterone Decreased LHRH pulsatile activity
Direct sexual side effects
Desire disorders Hyposexuality Hypersexuality (rare)
Orgasm disorders Orgasmic inhibition Anorgasmia Diminished number of orgasms
Ejaculation disorders Retarded ejaculation Ejaculatory inhibition Decreased ejaculatory volume Anesthetic ejaculation Orgasm without ejaculation Dyspareunia
Erection disorders Inability/difficulty obtaining erection Decreased quality of erection Priapism

* Despiramine appears to have the least amount of sexual side effects of the TCAs