Sexual dysfunction is an important unwanted phenomenon of psychotropic medications. This is often underreported and not given due importance, which can often lead to impaired quality of life and less-than-optimal medication compliance. All types of psychotropic medications are linked to sexual side effects. As the underlying mental disorder improves, some of the sexual issues abate, but treatment-related sexual adverse effects may persist over time and are unfortunately underrecognized by clinicians and scarcely investigated in clinical trials. When it comes to sexual dysfunction due to psychiatric disorders, there are two important things to understand. First, any mental illness can cause sexual dysfunction, and second, severer the underlying psychiatric disorder, severer is the sexual dysfunction (in both frequency and severity). Even though patients may be suffering from mental illnesses of variable severity, it is important for them to have a normal and enjoyable sex life. The reported incidence of sexual dysfunction found with antidepressant medication varies considerably between different studies, making it difficult to estimate the exact incidence or prevalence. The sexual problems encompass a range of sexual disorders and include decreased sexual desire, decreased sexual excitement, diminished or delayed orgasm, and erection or delayed ejaculation problems. Patients with sexual disorders usually also have anxiety disorder and vice versa; also, women with sexual dysfunction are more prone to anxiety and depression compared with others. This happens because sex steroids and the various neurotransmitters modulate both sexual function and mood. The mechanism by which psychotropic medications affect the sexual cycle is through the interaction between medications and the various above-mentioned neurotransmitters. Physicians should monitor their patients for antidepressant-induced sexual adverse effects, as these may affect compliance with therapy and the ultimate treatment success. Sexual function should be actively assessed at regular intervals. Management of antidepressant-induced sexual dysfunction requires an individualized approach.
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