Those psychiatrists and psychologists who do get their patients to talk about sex, often do so at the suggestion, albeit an indirect one, of the patient on an antidepressant. These studies looked for anticholinergic reactions, antihistamine effects, alpha-adrenergic blockade, and EKG changes. When we look at people with a depressive illness, the most sensitive indicator to diagnosis of sexual dysfunction is decreased libido. Forty-three percent of persons taking antidepressants experience sexual dysfunction. Part of sexual dysfunction can come from anxiety.
Anxiety causes activation of the autonomic nervous system.
It neutralizes parasympathetic response leading to decreased penile erection in men and decreased engorgement and lubrication in women. So, how do you find out if your patient has sexual dysfunction. Further, he noted that physicians by their manner, phraseology, or body language tell patients that they are uncomfortable with the topic. This type of direct follow up is necessary since SSRIs have an increased odds ratio of 1.62 for adverse sexual side effects when compared with TCAs. One method recommended by Dr. Thompson is to decrease the medication to the minimally effective antidepressant dose.