Sexual aspects of anti-depressant therapy in the perimenopause and menopause

Dr Jon-Paul Khoo

Mood disorders, and in particular major depressive disorder account for more worldwide disease disability than any other condition in medicine. Given the prevalence, duration, chronicity, recurrence, disability and limited first-line treatment response, MDD is the most pressing public health concern for women today. During the menopause transition there is a very high incidence of first-onset depression and depressive relapse in those women with a past history. For depression that is moderate to severe in intensity, antidepressant therapies are commonly prescribed. One of the more common reasons for ceasing or changing antidepressant therapies is sexual dysfunction. Sexual difficulties are common in men and women of all ages, and sexual function declines in midlife. Sexual difficulties in midlife women reflect many factors, including the genitourinary syndrome of menopause, the increased prevalence of physical and mental health disorders that reduce sexual function, medication side-effects, life stressors and demands, interpersonal factors, developmental issues and partner sexual dysfunction. One needs to consider the entire biopsychosociocultural milieu in assessing and managing sexual dysfunction that occurs in the setting of antidepressant therapies in the perimenopause and menopause.

This presentation aims to consider: (1) the relevance of MDD to women in our society, and, in particular, the impact of the perimenopause and the menopause on the incidence and prevalence of MDD; (2) the context of antidepressant therapy in managing MDD, and,  in particular, in the perimenopause and the menopause; (3) disorders of sexual function; (4) the sexual side-effects of antidepressant therapies; and an emphasis on (5) the practical management of sexual dysfunction as it presents in those receiving antidepressant therapies.


Dr Jon-Paul Khoo, is a psychiatrist in fulltime private clinical practice. He is co-owner and Director of the Toowong Specialist Clinic, a large, purpose-built, psychiatric practice, accommodating 22 psychiatrists, including 4 senior registrars, University of Queensland medical students, a research facility, a novel RANZCP-approved advanced training program in private practice psychiatry, an Improved Access Program for primary care, and a medico-legal service. He is a Senior Lecturer in the Department of Psychiatry, the University of Queensland, and an Honorary Fellow, School of Medicine, Deakin University. His professional and research interests include: mood disorders; psychopharmacology, phenomenology, psychiatric epidemiology, public health and clinical teaching.