Antidepressant Side Effects — MRCPsych Paper B MCQ

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ModerateMood DisordersAntidepressant Side EffectsMRCPsych Paper B

A 35-year-old woman with a moderate depressive episode has no pre-existing sexual dysfunction. She wishes to start an antidepressant but is particularly concerned about treatment-emergent sexual adverse effects. Which of the following antidepressants is associated with the lowest risk of sexual dysfunction?

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Correct answer: D — Mirtazapine

Mirtazapine is the best answer. Comparative evidence shows a substantially lower risk of treatment-emergent sexual dysfunction with mirtazapine than with the listed serotonergic reuptake inhibitors. Its mechanism does not involve serotonin reuptake inhibition, although other adverse effects—particularly sedation, increased appetite and weight gain—may influence selection. Sertraline and citalopram are SSRIs and commonly cause reduced libido, impaired arousal and delayed or absent orgasm. Paroxetine is especially strongly associated with sexual dysfunction and is therefore a poor choice when this is the patient's principal concern. Venlafaxine is an SNRI but remains strongly serotonergic at usual doses and also commonly causes sexual adverse effects.

Reference: Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. Journal of Clinical Psychopharmacology. 2009;29(3):259–266. https://pubmed.ncbi.nlm.nih.gov/19440080/