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Letter to the Editor   |    
Sildenafil Treatment of Paroxetine-Induced Anorgasmia in a Woman
ADAM KELLER ASHTON, M.D.
Am J Psychiatry 1999;156:800-800.

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 There are two case reports of men having SSRI-induced sexual dysfunction reversed by sildenafil (unpublished 1998 study by Ashton and Bennett).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.

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; 23:165–175
[PubMed]
[CrossRef]
 
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; 23:176–194
[PubMed]
[CrossRef]
 
Ashton AK, Rosen RC: Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther  1998; 24:191–192
[PubMed]
[CrossRef]
 
Ellison JM: Antidepressant induced sexual dysfunction: review, classification and treatment suggestions. Harv Rev Psychiatry (in press)
 
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References

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; 23:165–175
[PubMed]
[CrossRef]
 
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; 23:176–194
[PubMed]
[CrossRef]
 
Ashton AK, Rosen RC: Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther  1998; 24:191–192
[PubMed]
[CrossRef]
 
Ellison JM: Antidepressant induced sexual dysfunction: review, classification and treatment suggestions. Harv Rev Psychiatry (in press)
 
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