Erectile Dysfunction

News and Views From the Literature

9. RIU_Lit_Rev_07-13.qxd 7/13/09 6:00 PM Page 116 Erectile Dysfunction Erectile Dysfunction Selective Serotonin Reuptake Inhibitors Cause Erectile Dysfunction: True or False? Reviewed by Jacob Rajfer, MD Department of Urology, University of California at Los Angeles, Los Angeles, CA [Rev Urol. 2009;11(2):116] © 2009 MedReviews®, LLC The Effects of Citalopram and Fluoxetine on Sexual Behavior in Healthy Men: Evidence of Delayed Ejaculation and Unaffected Sexual Desire. A Randomized, Placebo-Controlled, Double-Blind, Double-Dummy, Parallel Group Study Madeo B, Bettica P, Milleri S, et al. J Sex Med. 2008;5:2431-2441. O 116 ne of the dilemmas that sexual medicine doctors face is that many of their male patients have depression and are being treated with antide- VOL. 11 NO. 2 2009 REVIEWS IN UROLOGY pressive medications, specifically selective serotonin reuptake inhibitors (SSRIs). SSRIs are known to cause delayed ejaculatory responses, but many of these patients also complain of erectile dysfunction (ED). Because depression and erectile dysfunction seem to go hand-in-hand for many patients, many practitioners believe both from their anecdotal experience and what is written in the literature that SSRIs can affect erectile function in addition to its well-known effect on ejaculatory function. To help unravel the mystery of whether the SSRIs cause ED, Madeo and colleagues performed a double-blind, randomized, placebo-controlled study comparing 2 SSRIs (citalopram and fluoxetine) with placebo. The patients were normal, healthy volunteers (n  16 for each group). The treatment lasted 4 weeks. Outcomes were ejaculatory function, erectile function measured by the International Index of Erectile Function questionnaire and RigiScan® (Timm Medical Technologies, Eden Prairie, MN) assessment following visual erotic stimuli. The authors demonstrated in this elegant study that both SSRIs caused delayed ejaculatory function compared with placebo, but there was no impact on erectile function in these normal male volunteers. The results of this study demonstrate that SSRIs do not affect erectile function and the cause of the ED in patients on these drugs must be primarily due to another etiology.