Before taking action, it must be clarified whether the sexual dysfunction is a result of the antidepressant or the underlying depression. Treatments that may be considered include neostigmine, cyproheptadine and yohimbine. Many antidepressants are prone to induce this symptom. Amitriptyline, doxepin and trazodone are experienced as most sedating, nortriptyline and amoxapine as less sedating, and fluoxetine, sertraline, bupropion, protriptyline and desipramine as least sedating. Sedation often diminishes in the first weeks of treatment, and patients experiencing only minor difficulty from this side effect should be encouraged to allow some time to pass before changing antidepressant agents, all other factors being equal.
Some patients tolerate their medication better when it is given as a single dose before bedtime.
Anticholinergic side effects. While MAO inhibitors are not anticholinergic, their side effects may resemble anticholinergic symptoms. The most common undesirable consequences of cholinergic blockade are dry mouth, impaired ability to focus at close range, constipation and urinary hesitation. Tricyclic antidepressants, MAO inhibitors, and lithium all have the capacity to induce weight gain. Bupropion, fluoxetine, sertraline and trazodone do not usually induce weight gain.