Editing Antidepressant (section)

===Sexual dysfunction===
Sexual side effects are also common with SSRIs, such as loss of [[sexual drive]], [[anorgasmia|failure to reach orgasm]], and [[erectile dysfunction]].<ref>{{cite book|veditors=Grant JE, Potenza MN|title=The Oxford handbook of impulse control disorders|year=2012|publisher=Oxford University Press|location=Oxford|isbn=978-0-19-538971-5}}</ref> Although usually reversible, these sexual side-effects can, in rare cases, continue after the drug has been completely withdrawn.<ref name="pmid18173768">{{cite journal|vauthors=Csoka AB, Csoka A, Bahrick A, Mehtonen OP|title=Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors|journal=The Journal of Sexual Medicine|volume=5|issue=1|pages=227–233|date=January 2008|pmid=18173768|doi=10.1111/j.1743-6109.2007.00630.x|s2cid=15471717}}</ref><ref>{{cite journal|vauthors=Healy D, Le Noury J, Mangin D|title=Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases|journal=The International Journal of Risk & Safety in Medicine|volume=29|issue=3–4|pages=125–134|date=4 June 2018|pmid=29733030|pmc=6004900|doi=10.3233/JRS-180744}}</ref>

In a study of 1,022 outpatients, overall sexual dysfunction with all antidepressants averaged 59.1%<ref name="pmid11229449">{{cite journal|vauthors=Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F|title=Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction|journal=The Journal of Clinical Psychiatry|volume=62|issue=Suppl 3|pages=10–21|year=2001|pmid=11229449}}</ref> with SSRI values between 57% and 73%, mirtazapine 24%, nefazodone 8%, amineptine 7%, and [[moclobemide]] 4%. Moclobemide, a selective reversible MAO-A inhibitor, does not cause sexual dysfunction<ref name="pmid19440080">{{cite journal|vauthors=Serretti A, Chiesa A|title=Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis|journal=Journal of Clinical Psychopharmacology|volume=29|issue=3|pages=259–266|date=June 2009|pmid=19440080|doi=10.1097/JCP.0b013e3181a5233f|s2cid=1663570}}</ref> and can lead to an improvement in all aspects of sexual function.<ref name="pmid9696909">{{cite journal|vauthors=Chebili S, Abaoub A, Mezouane B, Le Goff JF|title=[Antidepressants and sexual stimulation: the correlation]|language=fr|journal=L'Encephale|volume=24|issue=3|pages=180–184|year=1998|pmid=9696909}}</ref>

Biochemical mechanisms suggested as causative include increased serotonin, particularly affecting [[5-HT2 receptor|5-HT<sub>2</sub>]] and [[5HT3 receptor|5-HT<sub>3</sub> receptors]]; decreased [[dopamine]]; decreased [[norepinephrine]]; blockade of [[cholinergic receptor|cholinergic]] and [[alpha-1 adrenergic receptor|α<sub>1</sub>adrenergic receptors]]; inhibition of [[nitric oxide synthase|nitric oxide synthetase]]; and elevation of [[prolactin]] levels.<ref>{{cite journal|vauthors=Keltner NL, McAfee KM, Taylor CL|title=Biological Perspectives|journal=Perspectives in Psychiatric Care|volume=38|issue=3|pages=111–6|year=2009|pmid=12385082|doi=10.1111/j.1744-6163.2002.tb00665.x|doi-access=free}}</ref> [[Mirtazapine]] is reported to have fewer sexual side effects, most likely because it antagonizes 5-HT<sub>2</sub> and 5-HT<sub>3</sub> receptors and may, in some cases, reverse sexual dysfunction induced by SSRIs by the same mechanism.<ref name="pmid18278806">{{cite journal|vauthors=Ozmenler NK, Karlidere T, Bozkurt A, Yetkin S, Doruk A, Sutcigil L, Cansever A, Uzun O, Ozgen F, Ozsahin A|s2cid=39616771|title=Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors|journal=Hum Psychopharmacol|volume=23|issue=4|pages=321–6|year=2008|pmid=18278806|doi=10.1002/hup.929}}</ref>

[[Bupropion]], a weak NDRI and nicotinic antagonist, may be useful in treating reduced libido as a result of [[SSRI]] treatment.<ref name="Schwasinger-Schmidt2018">{{cite book|vauthors=Schwasinger-Schmidt TE, Macaluso M|title=Antidepressants|chapter=Other Antidepressants|series=Handbook of Experimental Pharmacology|volume=250|pages=325–355|date=8 September 2018|pmid=30194544|doi=10.1007/164_2018_167|isbn=978-3-030-10948-6}}</ref>