Method: A retrospective analysis was conducted of the change in sexual satisfaction, as measured by item 9 of the Quality of Life Enjoyment and Satisfaction Questionnaire, the primary outcome measure, in 2,280 patients with DSM-IV-TR–defined MDD who were treated with citalopram for 12 weeks. The Quick Inventory of Depressive Symptomatology-Self Report was used to evaluate the impact of depression ratings on impaired sexual satisfaction and on QOL.

Results: Impaired sexual satisfaction was present in 64.3% of MDD patients at pretreatment, but that percentage declined to 47.1% at posttreatment with citalopram (P<. 0001). Those who achieved remission had less ISS and better QOL. The prevalence of ISS in remitters was 21.2% versus 61.3% in nonremitters (P< 10− 8). The mean±standard deviation score for remitters increased from 2.32±1.16 to 3.44±1.23 (P< 10− 8; Cohen d= 0.81 [large effect size]), whereas in nonremitters it increased only from 1.99±1.08 to 2.19±1.19 (P< 10− 8; Cohen d= 0.16). The difference between remitters and nonremitters was highly significant (P< 10− 8). Regression analyses at pretreatment and posttreatment demonstrated significant associations between depressive symptoms and ISS (P<. 0001) and between ISS and lower QOL (P<. 0001) as well as an association between citalopram and increased probability of ISS and a poorer QOL in patients who continue to have moderate-to-severe depression.

Conclusions: A majority of MDD patients have impaired sexual satisfaction, a symptom associated with poor QOL. Despite the sexual side effects of the SSR citalopram, treating depression to full remission was associated with improvements in sexual satisfaction and QOL.

Trial Registration: ClinicalTrials. gov identifier: NCT00021528

J Clin Psychiatry 2013; 74 (3): 256–261

© Copyright 2013 Physicians Postgraduate Press, Inc.

accepted August 2, 2012 (doi: 10.4088/JCP. 12m07933).

Corresponding author: Waguih William IsHak, MD, FAPA,

Cedars-Sinai Medical Center and UCLA, 8730 Alden Drive,

Thalians W-157, Los Angeles, CA 90048 (Waguih. IsHak@ cshs. org).

M ajor depressive disorder (MDD) has a lifetime prevalence of 16.5% and a 12-month prevalence of 6.7% in the adult population, with a median age at onset of 32 years old. 1, 2 This debilitating illness results in substantial quality of life (QOL) impairments in both physical and mental domains. 3, 4 One important medical condition frequently linked to MDD is sexual dysfunction, which entails disturbances in the sexual response cycle such as low desire, arousal difficulties, delayed ability or inability to achieve orgasm, and lack of pleasure from sex. In MDD, low sexual desire is the most commonly reported sexual symptom, followed by delayed orgasm and arousal difficulties. 5–10 Selective serotonin reuptake inhibitors (SSRIs), the treatment of choice for MDD, can unfortunately also cause sexual dysfunction, such as decreased desire, arousal difficulties, and delayed/absent orgasm, with an estimated incidence in 30% to 70% of treated patients, depending on the study. 11–15 Individuals experiencing sexual dysfunction secondary to SSRIs may prematurely discontinue medication, resulting in persistent depression and concomitant QOL deficiencies, 16 or suffer in silence from sexual dissatisfaction.