Amitriptyline-induced anorgasmia reversed by nefazodone

Abstract

Amitriptyline-induced anorgasmia reversed by nefazodoneSir -Delayed or absent ejaculation and/or orgasm is the commonest sexual side-effect of antidepressant drugs, matched only by decreased libido. Attempts to treat antidepressant-induced anorgasmia with cyproheptadine, amantadine, methylphenidate, yohimbine, dosage reduction, drug holidays and drug substitution had mixed results. 1 We report a case of amitriptyline-induced anorgasmia reversed by switching over to nefazodone.A 31 year old married man was referred with a first episode of major depression of six months duration. Prior to the onset of depression he was sexually active. He had decreased libido and decreased frequency of sexual intercourse since the onset of the depression. His depression as well as his libido improved on treatment with amitriptyline 200mg for four weeks. However, he was unable to attain ejaculation/orgasm even after trying for 30 minutes and caused his wife genital soreness. This increased the strain on their marriage which was already affected by his depression. Therefore we stopped the amitriptyline and commenced him on nefazodone. Six weeks after being on nefazodone 400mg/day, he reported complete return of normal sexual functioning while his depression remained in remission. This is the first report of successful reversal of antidepressant-induced anorgasmia by substitution with nefazodone. Nefazodone inhibits serotonin reuptake and blocks 5-HT 2 receptors, resulting in the facilitation of 5-HT| A neurotransmission. Both 5-HT 2 blockers 1 and 5-HT 1A agonists 2 facilitate male rat sexual behaviour. This may explain the reports of nefazodone causing spontaneous ejaculations' and correcting sertraline-induced anorgasmia when used as an adjunct.'All antidepressant drugs have the potential to cause sexual side-effects which can cause distress, impair quality of life and reduce compliance with treatment. An adverse effect in one patient may be used beneficially in another.

Amitriptyline and Sexual Function: A Systematic Review Updated for Sexual Health Practice

“…In the one observational study ( Couper-Smartt & Rodham, 1973 ), SD was described in three out of five amitriptyline-treated patients (LOE: 4). In another case series report and four case reports ( Lucca et al, 2016 ; Mitchell & Popkin, 1983 ; Nininger, 1978 ; Rao et al, 1998 ; Simpson et al, 1965 ), there were a total of 16 amitriptyline-treated patients (LOE: 4).…”

“…There were a total of 15 publications that explicitly recorded the frequency or types of sexual function change under amitriptyline use. They included one observational study ( Couper-Smartt & Rodham, 1973 ), one review study ( Montgomery, 1995 ), eight randomized case-control or case-placebo clinical trials ( Bremner, 1995 ; Hekimian, Friedhoff, & Deever, 1978 ; Mathur, Sharma, Choudhary, & Jain, 2005 ; Reimherr et al, 1990 ; Sohn et al, 2012 ; Stahl, Zivkov, Reimitz, Panagides, & Hoff, 1997 ; van Ophoven, Pokupic, Heinecke, & Hertle, 2004 ; Zivkov & de Jongh, 1995 ), and five clinical case reports ( Lucca, Ramesh, Ram, Kurian, & Mathew, 2016 ; Mitchell & Popkin, 1983 ; Nininger, 1978 ; Rao, Morriss, & Michael, 1998 ; Simpson et al, 1965 ). The review study, which included pooled clinical and preclinical trials of mirtazapine (Org 3770) in Europe and the United States before 1995, was discarded from this study as the demographic information was not fully described and part of the data has been published in another study ( Montgomery, 1995 ).…”