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Sildenafil as treatment for antidepressant-induced sexual dysfunction.

To the Editor: In their randomized controlled trial, Dr Nurnberg and colleagues showed that sildenafil can be an effective option for the treatment of selective or nonselective serotonin reuptake inhibitor (SRI)–induced sexual dysfunction in women. However, treating one medication-induced adverse effect with another medication is not the only treatment option available. This approach can further increase the occurrence of adverse effects and potentially augment patient drug costs. Nonpharmacological approaches and strategies, such as the use of lubricants, should be considered to reduce druginduced adverse effects. Other strategies include incorporating drug holidays, reducing dosages, or switching to a different antidepressant that causes less sexual dysfunction. These techniques may ameliorate sexual dysfunction without inducing new adverse reactions from additional medications. Sildenafil can cause adverse reactions such as headache, flushing, dyspepsia, nasal congestion, and transient visual disturbances. Although some of these effects may seem benign, they can be just as troubling as sexual dysfunction to some patients. In addition, at a time when many patients have trouble affording their medications, adding drugs can increase the financial burden and consequently lead to premature medication discontinuation. Sildenafil is not yet available generically and is a costly drug (approximately $12/pill). Some insurance companies may not cover sildenafil for women because there is no Food and Drug Administration indication. Although sildenafil can be used for antidepressantinduced sexual dysfunction, it may not be the most appropriate first-line treatment.