Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Sexual functioning is associated with symptoms of depression, which occurs at rates much higher than that in the general population. Treatment of depression and remission of depressive symptoms can improve sexual functioning; however, antidepressants and other medications may cause or worsen sexual functioning. Assessment of sexual dysfunction in the past has predominantly relied on the patient spontaneously reporting problems with sexual functioning to their physician or other medical professional. Due to the sensitive nature of the topic, patient reporting is typically low and does not reflect the actual prevalence of sexual dysfunction. This research assessed the rate and level of antidepressant treatment-associated sexual dysfunction as assessed by validated questionnaire in published and unpublished data. Studies eligible for inclusion were randomized, double-blind, placebo-controlled trials evaluating the antidepressant effect in patients with acute major depression. Studies must have included approved antidepressants evaluating doses in the therapeutic range and include a validated questionnaire to assess sexual functioning, i.e., the ASEX or CSFQ. The studies must have included sufficient data to calculated mean standardized effect sizes and/or odds ratios for developing sexual dysfunction.The initial search yielded 320 records. After review for eligibility and completeness, the searched yielded 17 studies for inclusion in this meta-analysis. Sexual dysfunction odds ratios and standardized mean effect sizes for antidepressant versus placebo were calculated. Where available, odds ratios and mean effect sizes were also calculated by sex.The odds of developing sexual dysfunction with paroxetine, escitalopram and duloxetine were significantly worse than placebo. Evaluation by gender indicated that for women the odds of developing sexual dysfunction with desvenlafaxine was also significantly worse than placebo. Standardized mean effect sizes indicated significantly worse sexual functioning versus placebo for escitalopram and paroxetine with both sexes combined. Significant differences were also found for men taking vilazodone. Conclusions of this meta-analysis are limited by the number of studies included. For some antidepressants there was only 1 study that qualified. Not all studies provided data by sex. Gender effects are apparent with some antidepressants so this data is of particular interest when evaluating the risk of developing sexual dysfunction.

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Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.