To the Editor: We present the case of a 42-year-old man with major depression who experienced remission with sertraline but suffered anorgasmia and erectile dysfunction reversed with sildenafil citrate.
Mr. A’s first episode of major depression was at age 40, a time of personal stress and bereavement. He and his wife reported that he became anhedonic; slowed mentally; felt sad, hopeless, and fatigued; and experienced a decrease in appetite. He met DSM-IV criteria for major depression, and his score on the Inventory to Diagnose Depression (1) was 38 (a score of 0–10 is normal). A family member had responded to sertraline, so Mr. A was treated similarly, and after 5–6 weeks had a full remission on a dose of 150 mg/day. His scores on repeated administrations of the Inventory to Diagnose Depression ranged from 6 to 11.
Mr. A complained about anorgasmia, which began while he was taking 100 mg/day of sertraline, and erectile dysfunction, which began while he was taking 125–150 mg. Although he reported being "annoyed" at this side effect, he felt it was "tolerable." He then obtained sildenafil from his family doctor.
The patient reported that on four occasions, 50 mg of sildenafil allowed him to have his normal erection and ejaculation with no side effects to date. Without the sildenafil, while taking 150 mg/day of sertraline, he experienced a return of his sexual side effects.
Sildenafil is now best known as a novel, oral treatment for male erectile dysfunction that acts on a subclass of the phosphodiesterases, specifically, PDE5 (2). Anorgasmia is a common complaint of both men and women treated with selective serotonin reuptake inhibitors (SSRIs), and any new medication that might enhance compliance should be considered. Sildenafil should be tested systematically for treatment of SSRI-induced anorgasmia and erectile dysfunction.