Strategies for managing sexual dysfunction induced by antidepressant medication.
If I want to stay on this antidepressant, is adding sildenafil or twice-daily bupropion an option for me, or would switching drugs be the better first move?
Top of the evidence hierarchy, independently funded. how we score evidence
Caveat on this rating: The declarations of interest read literally: "KH has previously acted as a temporary consultant for Pfizer (manufacturers of sildenafil). MT has been paid to lecture and received travel expenses from Bristol-Myers Squibb (manufacturers of buspirone) and Otsuka; his spouse is an employee of GlaxoSmithKline (manufacturers of bupropion)." Two of the six authors therefore have financial ties to the makers of the two drugs the review endorses, which is why independence is scored false despite the funding being public. The reviewers also warn that partial reporting of subscale results in the source trials could bias the effect estimates upward.
Across 23 randomised trials and 1,886 people, adding sildenafil (3 trials, 255 men) or tadalafil (1 trial, 54 men) improved erectile function in men more than placebo; for women the reviewers concluded it remains uncertain whether sildenafil beats placebo. Bupropion 150 mg twice daily beat placebo on rating-scale scores (SMD 1.60, 95% CI 1.40 to 1.81) across three trials, but 150 mg once daily did not (RR 0.62, 95% CI 0.09 to 4.41). Every other augmentation strategy failed, only one trial studied switching antidepressant, and no trial tested psychological approaches or drug holidays.
Worth asking
If I want to stay on this antidepressant, is adding sildenafil or twice-daily bupropion an option for me, or would switching drugs be the better first move?
What to watch for
Evidence quality tells you whether to trust the finding — not whether the treatment is safe. These are the risks this research reports.
- Persistent sexual dysfunction (PSSD)
- Sexual side effects
Source
Strategies for managing sexual dysfunction induced by antidepressant medication. — Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K. (2013)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1002/14651858.CD003382.pub3
DOI: 10.1002/14651858.CD003382.pub3
How this was scored
- Study design
- Systematic review of randomised trials
- Funding
- Independently funded
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 1,886
- Preregistered
- Yes
- Conflicts disclosed
- Yes
- Independent of proponent
- No
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Where we put this study in context
Questions
How strong is the evidence behind this?
Resolv rates this source "gold standard". Top of the evidence hierarchy, independently funded. It scores 87 out of 100 on our published rubric. One caveat travels with that badge: The declarations of interest read literally: "KH has previously acted as a temporary consultant for Pfizer (manufacturers of sildenafil). MT has been paid to lecture and received travel expenses from Bristol-Myers Squibb (manufacturers of buspirone) and Otsuka; his spouse is an employee of GlaxoSmithKline (manufacturers of bupropion)." Two of the six authors therefore have financial ties to the makers of the two drugs the review endorses, which is why independence is scored false despite the funding being public. The reviewers also warn that partial reporting of subscale results in the source trials could bias the effect estimates upward. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Strategies for managing sexual dysfunction induced by antidepressant medication. — Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K. (2013). Published in: Top-tier peer-reviewed journal. DOI: 10.1002/14651858.CD003382.pub3. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Systematic review of randomised trials. Funding: Independently funded. The researchers were not independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.