Mirtazapine for Mitigating SSRI-Induced Sexual Dysfunction

Dosing and Administration

Mirtazapine can be initiated at 7.5-15 mg at bedtime and titrated up to 30-45 mg daily as needed, according to the American Academy of Family Physicians 1
The most common side effects of mirtazapine include initial sedation, irritability, and potential weight gain, as reported by the American Academy of Family Physicians 1

While mirtazapine promotes sleep and appetite, which can be beneficial in depression, these effects may be undesirable for some patients, as noted by the American Academy of Family Physicians and the European Society for Medical Oncology 1, 2

Other approaches to managing SSRI-induced sexual dysfunction include dose reduction of the SSRI, drug holidays, or switching to another antidepressant with a lower incidence of sexual side effects, as recommended by the American College of Physicians 3, 4
Bupropion has also been shown to have a significantly lower rate of sexual adverse events compared to SSRIs like fluoxetine and sertraline, according to the American College of Physicians 3, 4

The American Family Physician reports that SSRIs and SNRIs carry the highest risk of sexual dysfunction, with paroxetine associated with the greatest rate among SSRIs 5
The Journal of Urology warns that patients should avoid sudden cessation or rapid dose reduction of daily SSRIs as this may precipitate SSRI withdrawal syndrome 6
The Journal of Urology also notes that serotonin syndrome risk is increased when adding adjunctive agents, and monitoring for symptoms such as clonus, tremor, hyperreflexia, agitation, diaphoresis, and fever is necessary 6

The American Family Physician states that approximately 63% of patients on second-generation antidepressants experience at least one adverse effect, including sexual dysfunction, which significantly impacts quality of life and treatment compliance 5