Would another SSRI or a newer antidepressant be less likely than fluoxetine to cause problems?
Of the SSRIs, there are limited data to suggest that paroxetine may be associated with an increased rate of sexual difficulties compared with fluoxetine, fluvoxamine and sertraline. It has been suggested that nefazodone and mirtazapine are associated with a low incidence of sexual side effects but this requires confirmation. If problems do develop might they remit during continued treatment? There have been reports of tolerance to sexual side effects developing, sometimes after months of treatment. If the antidepressant is effective it may be worth continuing it for a period of time to see whether the problem resolves, if this is acceptable to the patient and their partner. Some patients may find that the effect diminishes but does not disappear entirely. How else could this problem be managed? Would sildenafil be of benefit? The preferred approach is to find a medication that is effective without causing sexual adverse effects. These problems are generally dose related so it is import
