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Does Sildenafil Help Antidepressant-Induced Erectile Dysfunction? Does It Also Raise Mood?

Erectile dysfunction, which is common in patients with depression, can result from treatment with antidepressant medications and may itself promote depression. Two manufacturer-supported studies examined the effects of sildenafil on antidepressant-induced erectile dysfunction and depressive symptoms.

In a 12-week, double-blind, placebo-controlled, randomized study, researchers examined the effectiveness of sildenafil in 152 drug-free, nonsubstance-abusing men with erectile dysfunction and DSM-IV diagnoses of mild-to-moderate depression not otherwise specified (60 percent scored between 12 and 17 on the Hamilton Rating Scale for Depression). Compared with placebo recipients, sildenafil recipients reported significantly better sexual performance and satisfaction. Improved erectile function, regardless of treatment, was associated significantly with reduced depressive symptoms and increased life satisfaction across many domains. Adverse effects of sildenafil included headache (20 percent), dyspepsia (15 percent), flushing (15 percent), and visual abnormalities (8 percent).

Other researchers retrospectively analyzed data from 10 placebo-controlled, randomized studies of sildenafil efficacy in 3414 men, focusing on sexual performance in the 93 men taking serotonergic antidepressants. In this subgroup, both placebo and sildenafil groups showed significant improvement from baseline; however, compared with placebo, sildenafil was associated with significantly greater improvement on 4 measures of erectile and sexual performance, but not with a greater increase in sexual desire.

Comment: These findings must be interpreted with caution. The patients in the first study did not have DSM-IV major depression, and the effects of sildenafil on depressive symptoms seem to be secondary to improved sexual functioning. It is unclear how effective sildenafil alone would be for treating erectile dysfunction and depressive symptoms in more seriously ill patients. Longer-term studies are needed to ascertain the sustainability of these mood improvements.

The second study suggests that sildenafil improves antidepressant-induced sexual side effects. Still, larger prospective studies of patients without prior sexual disturbance are needed to demonstrate that sildenafil specifically reverses medication-induced side effects and that its use increases medication adherence among patients who might discontinue antidepressants due to these side effects.

— J Yager

Published in Journal Watch Psychiatry November 15, 2001

Citation(s):

Seidman SN et al. Treatment of erectile dysfunction in men with depressive symptoms: Results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry 2001 Oct 158 1623-1630.

• Medline abstract (Free)

Nurnberg HG et al. Efficacy of sildenafil citrate for the treatment of erectile dysfunction in men taking serotonin reuptake inhibitors. Am J Psychiatry 2001 Nov 158 1926-1928.

• Medline abstract (Free)

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