Adverse effects including sexual problems associated with the use of selective serotonin reuptake inhibitors in a tertiary care center of Eastern Nepal

Bhawesh Koirala, Gajendra P. Rauniar, Dhana R. Shakya


Background: Selective serotonin reuptake inhibitors (SSRIs) use has been associated with various adverse drug events, including sexual problems in recent literature.

Methods: After written informed consent, remitted psychiatric patients were enrolled if they were taking an SSRI. The remitted state was ascertained by clinical assessment of a psychiatrist and reassessed with the use of self-response screening questionnaires (Beck Anxiety Inventory for anxiety, Beck Depression Inventory for depression). The self-response questionnaire “adverse drug effect (ADE) tool” was used to assess ADEs and the Arizona Sexual Experience Scale to assess sexual problems.

Results: The total of 200 subjects was enrolled with 63% females. Commonly used SSRIs were escitalopram, fluoxetine, and sertraline for the common diagnosis of depression, recurrent depressive disorder, and panic disorder in this institute. The average duration of remission during the enrollment was 11.99 months (standard deviation: 12.269). The overall prevalence of adverse effects was 91.5%. The incidence of adverse effect and sexual problem were: weight gain (57%), dryness of mouth (32.5%), headache (30%), dizziness (28.5%), paresthesia (24.5%), confusion (23.5%), tremors (21.5%), irritation (20.5%) sexual dysfunction (SD) (17.2%), increase in anxiety (17%), akathisia (16%), nausea (14.5%), itchiness (14.5%), excessive sweating, (14.5%), difficulty in sleeping (10%), weight loss (6%), rash (6%), diarrhea (4%), vomiting (3%), and others (3%).

Conclusion: Adverse effect (irrespective of severity) was commonly seen with SSRI use. Common adverse effects seen among remitted subjects were weight gain, dryness of mouth, headache, dizziness, paresthesia, etc. SD was other important side effect.


Selective serotonin reuptake inhibitors, Adverse effects, Remitted psychiatric patients

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Shakya DR, Dhali TK, Bhattarai S, Pandey AK, Sapkota N. Psychosexual problems in remitted psychiatric patients. Paper Presented in ‘Research Forum’ of BPKIHS, 2012.

O’Donnell JM, Shelton RC. Drug therapy of depression and anxiety disorder. In: Brunton LL, Jolla L, editors. Goodman and Gillman’s The Pharmacological Basis of Therapeutics. 12th Edition. California: McGraw-Hill; 2011: 397-415.

Stahl SM. Classical antidepressants, selective serotonin reuptake inhibitors, noradrenergic reuptake inhibitors. In: Essential Psychopharmacology: neuro- Scientific Basis and Practical Applications. 2nd Edition. United Kingdom: Cambridge University Press; 2000: 199-243.

Triphati KD. Drugs used in mental illness: antidepressant and antianxiety drugs. In: Essentials of Medical Pharmacology. 6th Edition. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2008: 439-52.

Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability. Prim Care Companion J Clin Psychiatry. 2001;3(1):22-7.

Spigset O. Adverse reactions of selective serotonin reuptake inhibitors: reports from a spontaneous reporting system. Drug Saf. 1999;20(3):277-87.

Shakya DR, Lama S, Thapa LJ, Shyangwa PM. Psychiatric disorders in adult people living with HIV/AIDS attending a tertiary care hospital. Paper Presented in ‘Scientific Programme’, BPKIHS, 2011.

Nikelly AG. Drug advertisements and the medicalization of unipolar depression in women. Health Care Women Int. 1995;16(3):229-42.

Meijer WE, Heerdink ER, Pepplinkhuizen LP, van Eijk JT, Leufkens HG. Prescribing patterns in patients using new antidepressants. Br J Clin Pharmacol. 2001;51:181-3.

Kauffman JM. Selective serotonin reuptake inhibitor (SSRI) drugs: more risks than benefits? J PANDS. 2009;14(1):7-12.

Cohn CK, Shrivastava R, Mendels J, Cohn JB, Fabre LF, Claghorn JL, et al. Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. J Clin Psychiatry. 1990;51 Suppl B:28-33.

Patterson WM. Fluoxetine-induced sexual dysfunction. J Clin Psychiatry. 1993;54(2):71.

Monteiro WO, Noshirvani HF, Marks IM, Lelliott PT. Anorgasmia from clomipramine in obsessive-compulsive disorder. A controlled trial. Br J Psychiatry. 1987;151:107-12.

Montejo-González AL, Llorca G, Izquierdo JA, Ledesma A, Bousoño M, Calcedo A, et al. 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(3):176-94.

Hsu JH, Shen WW. Male sexual side effects associated with antidepressants: a descriptive clinical study of 32 patients. Int J Psychiatry Med. 1995;25(2):191-201.

Keller Ashton A, 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(3):165-75.

Jacobsen FM. Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry. 1992;53(4):119-22.

Rosen RC, Lane RM, Menza M. Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999;19(1):67-85.