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Introduction <p>Sexual side effects of serotonergic drugs are well documented. However, observational evidence comparing specific antidepressants remains sparse.</p> Objective <p>The aim of this study was to compare the risk of developing healthcare-recorded sexual dysfunction among male patients after initiating treatment with citalopram, sertraline, venlafaxine, or mirtazapine.</p> Methods <p>We conducted a new-user, active comparator cohort study of adult males in Denmark who started treatment with any of the study drugs between 2001 and 2015, allowing multiple cohort entries per person. Data from Danish national healthcare registers included 170,580 new treatment episodes of citalopram, 67,721 of mirtazapine, 51,984 of sertraline, and 19,820 of venlafaxine. A separate analysis examined patients with prior depression-related hospital visits. Results were reported as incidence rates as well as unmatched and propensity score-matched hazard ratios.</p> Results <p>In our primary analysis with 1-year follow-up and washout periods, incidence rates ranged from 18.80 (95% CI 17.60–20.00) to 28.5 (95% CI 26.00–31.30) per 1000 person-years. Venlafaxine was associated with the highest risk of healthcare-recorded sexual dysfunction compared with citalopram (hazard ratio [HR] 1.27; 95% CI 1.02–1.46), which was particularly pronounced among those with previous hospital contact for depression (HR 1.93; 95% CI 1.14–1.27). No significant difference was observed for sertraline (HR 0.99; 95% CI 0.90–1.09), while mirtazapine demonstrated modest evidence of a lower risk relative to citalopram (HR 0.87; 95% CI 0.81–0.93). Findings remained consistent across all analyses.</p> Conclusions <p>The risk of developing sexual dysfunction varies across antidepressant treatment. Healthcare providers should discuss the potential for sexual side effects, particularly when multiple treatment options are available.</p>

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Sexual Dysfunction in Male Patients After Initiating Treatment with Antidepressants

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月8日

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  • Lukas Westphal,
  • Débora D. Gräf,
  • Haoxin Le,
  • Christine E. Hallgreen,
  • Morten Andersen

摘要

Introduction

Sexual side effects of serotonergic drugs are well documented. However, observational evidence comparing specific antidepressants remains sparse.

Objective

The aim of this study was to compare the risk of developing healthcare-recorded sexual dysfunction among male patients after initiating treatment with citalopram, sertraline, venlafaxine, or mirtazapine.

Methods

We conducted a new-user, active comparator cohort study of adult males in Denmark who started treatment with any of the study drugs between 2001 and 2015, allowing multiple cohort entries per person. Data from Danish national healthcare registers included 170,580 new treatment episodes of citalopram, 67,721 of mirtazapine, 51,984 of sertraline, and 19,820 of venlafaxine. A separate analysis examined patients with prior depression-related hospital visits. Results were reported as incidence rates as well as unmatched and propensity score-matched hazard ratios.

Results

In our primary analysis with 1-year follow-up and washout periods, incidence rates ranged from 18.80 (95% CI 17.60–20.00) to 28.5 (95% CI 26.00–31.30) per 1000 person-years. Venlafaxine was associated with the highest risk of healthcare-recorded sexual dysfunction compared with citalopram (hazard ratio [HR] 1.27; 95% CI 1.02–1.46), which was particularly pronounced among those with previous hospital contact for depression (HR 1.93; 95% CI 1.14–1.27). No significant difference was observed for sertraline (HR 0.99; 95% CI 0.90–1.09), while mirtazapine demonstrated modest evidence of a lower risk relative to citalopram (HR 0.87; 95% CI 0.81–0.93). Findings remained consistent across all analyses.

Conclusions

The risk of developing sexual dysfunction varies across antidepressant treatment. Healthcare providers should discuss the potential for sexual side effects, particularly when multiple treatment options are available.