Sildefanil (Viagra) has been shown helpful in treating antidepressant-induced sexual dysfunction (AISD) in men, but no controlled trials had tested its effectiveness in women. In this trial, 98 women with SSRI associated sexual dysfunction were randomly assigned to either sildefanil or placebo; all participants continued their SSRI, and their sexual functioning was assessed at multiple times. The women were encouraged to use the medication prior to attempted sex at least twice per week. After 8 weeks, women taking Viagra had a significant benefit over those taking placebo on the primary outcome variable (Clinical Global Impression), as well as some secondary outcome variables including ability to orgasm, orgasm enjoy- ment, and sexual enjoyment. Clinically, 73% of women taking placebo compared with 28% of women taking Viagra reported no improvement with treatment. Viagra showed no statistically significant benefit over placebo on lubrication, desire, sexual arousal, or sex-related pain. Side effects included those typically seen with Viagra, including headache, flushing, and dyspepsia. (Nurnberg HG et al., JAMA 2008;300:395-404).

TCPR’s Take: These results are sur- prisingly encouraging. One of the most common sexual complaints among women on SSRIs is orgasm delay and decreased orgasm enjoyment, and Viagra appears to help significantly with both these problems. But recall that there are other ways to treat antidepressant-induced sexual dysfunction, such as switching to bupropion, taking weekend SSRI holidays, and switching to psychotherapy.