Kortvarig Sertralin- eller Voxrabehandling och långvarig impotens

Fråga: Finns det beskrivet fall där kortvarig Sertralin- eller Voxrabehandling gett långvarig impotens?

Svar: Erectile dysfunction has been reported as a common side effect of treatment with sertraline (1), and the product information for sertraline, as for other SSRIs as well as SNRIs, mentions that there have been reports of long-lasting sexual dysfunction even after withdrawal of the drug.

SSRIs

SSRIs can interfere with different aspects of sexual functioning, including desire, arousal, and orgasm (2, 3). The frequency of sexual side effects may vary among the different SSRIs (2, 3). However, it is estimated that it occurs in roughly 50 percent of patients treated with SSRIs (2). The symptoms appear to be dose dependent (4) and genetic polymorphisms may be involved (2).

There have been reports of long-lasting, for months or years, sexual dysfunction where the symptoms have continued despite discontinuation of SSRIs (1, 2, 5, 6). However, according to the Uptodate topic "Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management” (2) these reports are rare, anecdotal reports and, there is no compelling evidence that SSRI-induced sexual side effects persist after discontinuation. Based upon their clinical experience (2), sexual side effects induced by SSRIs resolve soon after the medication is stopped.

The cases reported in the medical literature concerning sertraline are very few. In 2006, the first case report from Bolton et al (7) describes a 26-year-old male with persistent sexual side effects following treatment with sertraline. Sexual dysfunction had emerged early in treatment, which was continued for around four or five months. Some of the symptoms had persisted for six years after withdrawal of the drug.

One of three case reports from Csoka and Shipko (8) was about a 30-year-old male who experienced moderate erectile dysfunction, and other sexual side effects, within four to five days of starting sertraline. The drug was discontinued after five weeks, but the problems remained unchanged several years later.

In 2012, the Netherlands Pharmacovigilance Center (Lareb) published a report with details of 19 suspected cases of post-SSRI sexual dysfunction (PSSD) from their database (9). There were 13 male subjects and six female, aged from 20 to 59 years. The drugs involved included sertraline (n=4). Duration of treatment ranged from 9 days to 10 years, and the time since stopping the drug and still experiencing sexual side effects ranged from two months to two years. There was no specific information about the 4 Sertraline cases.

In 2015, Ben-Sheetrit et al published a study of 183 possible cases of PSSD including 23 high-probability cases from an online survey (10). The high-probability cases involved sertraline (n = 2) among other SSRIs. There were 19 male subjects. The shortest duration of treatment was 4 days of sertraline. The longest time since stopping an SSRI and still experiencing sexual side effects was 16 years.

Voxra (bupropion)

Several randomized trials have demonstrated that bupropion does not impair sexual functioning and that sexual dysfunction occurs less often with bupropion than SSRIs (2, 3, 11).

In a double-blind, randomized, comparative trial of bupropion vs sertraline (n=248) evaluating adverse sexual effects (12), bupropion was found to be significantly less associated with sexual dysfunction compared with sertraline (15% vs 63% among men).

We have found no published case report of persistent impotence following treatment with bupropion.

Proposed strategies to limit sexual dysfunction associated with SSRI treatment includes add-on therapy with bupropion or switching to bupropion (2, 3).

1. Produktresumén för Sertralin. www.FASS.se
2. Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management. Literature review current through: Oct 2021. | This topic last updated: Jul 08, 2021. UpToDate.
3. Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L. Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med. 2019;8(10):1640. Published 2019 Oct 7. doi:10.3390/jcm8101640
4. Baldwin DS, Foong T. Antidepressant drugs and sexual dysfunction. Br J Psychiatry. 2013 Jun;202:396-7.
5. Bahrick, AS. Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence The Open Psychology Journal, 2008, 1, 42-50
6. Healy D. Citizen petition: Sexual side effects of SSRIs and SNRIs. Int J Risk Saf Med. 2018;29(3-4):135-147. doi:10.3233/JRS-180745
7. Bolton JM, Sareen J, Reiss JP. Genital anaesthesia persisting six years after sertraline discontinuation. J Sex Marital Ther. 2006;32(4):327–30.
8. Csoka AB, Shipko S. Persistent sexual side effects after SSRI discontinuation. Psychother Psychosom. 2006;75(3):187–8.
9. Lareb, Netherlands Pharmacovigilance Center. SSRIs and persistent sexual dysfunction [Internet]. 2012. Available from: http://databankws.lareb.nl/Downloads/KWB_2012_3_SSRI.pdf. Accessed 2017 June 1.
10. Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H. Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. J Clin Psychopharmacol. 2015;35(3):273–8.
11. Gartlehner G, Hansen RA, Morgan LC, Thaler K, Lux L, Van Noord M, Mager U, Thieda P, Gaynes BN, Wilkins T, Strobelberger M, Lloyd S, Reichenpfader U, Lohr KN . Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med. 2011 Dec;155(11):772-85.
12. Segraves RT, Kavoussi R, Hughes AR, Batey SR, Johnston JA, Donahue R, Ascher JA. Evaluation of sexual functioning in depressed outpatients: a double-blind comparison of sustained-release bupropion and sertraline treatment. J Clin Psychopharmacol. 2000 Apr;20(2):122-8.