Sexual Side Effects of Sertraline

Introduction to Sexual Dysfunction

Sertraline causes sexual dysfunction in approximately 14% of males and 6% of females, placing it in the moderate range among SSRIs, according to the American College of Physicians 1, 2

The American College of Physicians recommends bupropion as first-line therapy when sexual function is a major concern, with a significantly lower sexual dysfunction rate of 8-10% compared to sertraline 2, 3
Mirtazapine is recommended as second-line therapy, with minimal to no sexual side effects and potential improvement in sexual function, as suggested by the American College of Physicians 3
Sertraline or citalopram are considered third-line therapies, with moderate sexual dysfunction rates, according to the American College of Physicians 2
Paroxetine is to be avoided due to its high sexual dysfunction rate of 70.7%, as noted by the American College of Physicians 1, 2

The American College of Physicians recommends starting with bupropion when sexual function is a primary concern, and choosing sertraline or citalopram over paroxetine or fluoxetine if an SSRI must be used 2
If sexual dysfunction develops on sertraline, the American College of Physicians recommends switching to bupropion as first-line therapy, with significantly lower rates of sexual dysfunction (8-10%) compared to sertraline 2
An alternative approach is to switch to mirtazapine 15-30 mg at bedtime, which may cause sedation and weight gain but can be therapeutically beneficial, as suggested by the American College of Physicians 2, 3

For breast cancer patients on tamoxifen, the American College of Physicians recommends avoiding bupropion, paroxetine, or fluoxetine due to CYP2D6 inhibition, and considering venlafaxine or citalopram instead 2
For patients requiring treatment for premature ejaculation, the NCCN guidelines recommend SSRIs (paroxetine, sertraline, citalopram, fluoxetine) dosed daily, with sertraline's sexual side effects becoming therapeutic at doses of 25-200 mg daily or 50 mg situationally 4, 5, 6

The American College of Physicians recommends beginning monitoring for therapeutic response and adverse effects within 1-2 weeks of initiation, and modifying treatment if no adequate response is seen within 6-8 weeks 2