Selective Serotonin Reuptake Inhibitors (SSRIs) (Adverse effects)

Serotonin reuptake inhibitors are drugs widely used in the treatment of various psychiatric conditions such as depression, anxiety or some personality disorders. Sexual dysfunction is one of the most frequent adverse effects and its occurrence may be influenced by genetics.

Selective serotonin reuptake inhibitors (SSRIs) are a class of widely used antidepressant drugs that share the same mechanism: inhibiting the reuptake of serotonin (a neurotransmitter substance present in the brain that causes alterations in various psychiatric disorders, including depression).

They are effective drugs and have a good safety profile, with fewer effects on other neurotransmitters than other antidepressants, which is why they are called "selective". In general, this means fewer adverse effects and facilitates continuation of treatment.

Between 20% and 70% of people taking SSRIs experience side effects of sexual dysfunction. The underlying disease for which treatment is prescribed (depression and other psychiatric disorders) may also impact sexual function, which poses an additional difficulty to the evaluation of SSRIs as responsible agents. Furthermore, the frequency of occurrence of these side effects is likely to be underestimated, as not all patients mention this complication.

Among the most common effects are low sexual desire, inability to ejaculate or delayed ejaculation, and anorgasmia (inability to reach orgasm during intercourse). Such effects may be related to the prescribed drug itself, as well as to the dose taken. Therefore, in some patients, attempts are made to mitigate the effects by reducing the dose or alternating the antidepressant. Also, in some cases, patients develop tolerance to the drug and symptoms of sexual dysfunction appear transiently; these symptoms tend to disappear or diminish once tolerance to the drug has developed.

BRAND NAMES

  • Celexa®
  • Lexapro®
  • Prozac ®
  • Paxil ®
  • Zoloft ®

Genes analyzed

5-HT2A

Bibliography

Bishop JR, Moline J, Ellingrod VL, et al.Serotonin 2A -1438 G/A and G-protein Beta3 subunit C825T polymorphisms in patients with depression and SSRI-associated sexual side-effects. Neuropsychopharmacology. 2006 Oct;31(10):2281-8.

Radosavljevic M, Svob Strac D, Jancic J, Samardzic J.The Role of Pharmacogenetics in Personalizing the Antidepressant and Anxiolytic Therapy. Genes (Basel). 2023 May 16;14(5):1095.

Wan YS, Zhai XJ, Tan HA, et al.Associations between the 1438A/G, 102T/C, and rs7997012G/A polymorphisms of HTR2A and the safety and efficacy of antidepressants in depression: a meta-analysis. Pharmacogenomics J. 2021 Apr;21(2):200-215.

Zięba A, Matosiuk D, Kaczor AA.The Role of Genetics in the Development and Pharmacotherapy of Depression and Its Impact on Drug Discovery. Int J Mol Sci. 2023 Feb 2;24(3):2946.

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