Selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction occurs in 30%–70% of patients, depending on the drug and the study. For many years, one of the strategies recommended for such patients has been a weekend “holiday” from the drug, with the rationale that allowing the drug to leave the system temporarily promotes sexual functioning. But actual data have been scant. Recently, two nearly identical studies investigated weekend holidays for SSRI-associated sexual dysfunction.
Lalegani and colleagues studied women taking SSRIs and reporting sexual side effects, and Alipour-Kivi et al studied men. Both excluded patients who were taking fluoxetine (as its long half-life precludes holidays) or other medications with sexual side effects. Most patients across both studies were on sertraline, followed by escitalopram and paroxetine, and then a smaller number taking fluvoxamine or citalopram.
Both studies were 8-week, open-label RCTs of heterosexual married subjects: 50 women with an average age of 35, and 63 men with an average age of 37. Data were not given on the women’s sexual habits or frequency prior to SSRI use. The men filled out a baseline Male Sexual Health Questionnaire (MSHQ).
Participants randomized to drug holidays were instructed to not take their medications for the same two days in a row every week. The control groups were instructed to continue their medications as prescribed. The Female Sexual Function Index (FSFI) and the 28-question General Health Questionnaire (GHQ-28) were used to measure changes in women, and the MSHQ and GHQ-28 were used for men.
Significant improvements in FSFI scores for arousal, desire, orgasm, satisfaction, pain complaints, and overall sexual health (p = <.001 for all) were found in the female drug holiday group compared with the control group. For men, the groups were the same at baseline, but at the fourth and eighth weeks, the holiday group reported improved erections, sexual satisfaction, and overall MSHQ scores. There was no difference for ejaculation. For both sexes and all study arms, GHQ-28 scores significantly improved over the course of the studies. No major adverse effects were reported by women. Men in the holiday group reported nausea (16%), headache (24%), and restlessness (24%), while men in the control group did not.
CARLAT TAKE These open-label studies show that two-day drug holidays can be effective for both men and women reporting sexual side effects from SSRIs—although fluoxetine was not studied due to its long half-life.
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