Psychiatric Disorders, Psychopharmacology and Sexual Dysfunction (ICSM 2024)

Antidepressants cause sexual dysfunction in 25–80% of patients; antipsychotics in 16–60% — and most psychiatrists aren't asking

Journal: Sexual Medicine Reviews | Published: 2026-04-01 | Type: Consensus Review | PMID: 41936049 Authors: Nelson CJ (Memorial Sloan Kettering), Clayton AH (University of Virginia), Lew-Starowicz M (Warsaw), Balon R (Wayne State), Eltantawy W (Lewisham), Glina F (São Paulo), Kirana PS (Thessaloniki) Funding/COI: Not listed

Summary

This is the official ICSM 2024 consensus review on how psychiatric disorders and their treatments damage sexual function. The headline number is ugly: antidepressants produce treatment-emergent sexual dysfunction at rates between 25% and 80%, antipsychotics between 16% and 60% — the wide ranges reflecting genuine variance by drug mechanism, not just measurement noise. The committee's frank assessment of the underlying literature: the methodology is broadly weak, and clinicians routinely fail to assess for sexual side effects at all.

Claims

• WHO estimates 1 in 8 people globally live with a psychiatric disorder
• Antidepressants cause sexual dysfunction in 25–80% of patients (rate varies by mechanism of action)
• Antipsychotics cause sexual dysfunction in 16–60% of patients
• Sexual dysfunction prevalence is elevated across all psychiatric disorders studied, compared to non-psychiatric controls where data exist
• Sexual dysfunction is also tied to comorbid conditions associated with psychiatric diagnoses (metabolic, cardiovascular, etc.), compounding attribution difficulty
• Three consensus recommendations issued: (1) screen for sexual dysfunction in psychiatric patients, (2) monitor sexual function during psychotropic treatment, (3) treat etiology as multi-factorial

Study Quality

This is a narrative consensus review using a modified Delphi methodology — not a systematic review or meta-analysis with pre-registered inclusion criteria. Literature searches were conducted per section, but the search strategy, PRISMA compliance, and inter-rater reliability are not described in the abstract. The Delphi process involved expert feedback at the ICSM conference, which introduces consensus bias: the committee's prior positions shape which evidence is weighted.

The frank acknowledgment that "significant methodological weaknesses" pervade the underlying psychiatric-sexual dysfunction literature is the most credible part of this review. The wide ranges cited (25–80% for antidepressants) are a direct consequence of those weaknesses — different assessment tools, different patient populations, different definitions of dysfunction — not a sign of careful meta-analytic uncertainty quantification.

Red Flags

• No funding or COI disclosures provided — for a consensus document with pharmaceutical implications, this is a material omission
• Modified Delphi is not a systematic review; conclusions reflect expert opinion shaped by pre-existing positions
• Wide prevalence ranges (25–80%) suggest heterogeneity that is reported but not resolved
• "When available" qualifier on comparisons to controls signals sparse baseline data across the psychiatric disorder literature
• No effect sizes, confidence intervals, or NNH (number needed to harm) figures extractable from the abstract
• Seven authors from six countries: international consensus can reflect political compromise as much as evidence synthesis

Strengths

• Backed by ICSM, the field's most credible international convening body
• Multi-disciplinary authorship (psychiatry, urology, psychology, sexology)
• Honest about the weakness of the underlying evidence base — unusual candor for a consensus document
• Clinical scope is genuinely broad: covers disorders, medications, and comorbidities together rather than in isolation
• The 25–80% range for antidepressants, however imprecise, is a useful anchor for clinicians who currently cite nothing

Verdict

This paper is worth reading as a map of the field, not as a source of precise effect estimates. Its value is institutional: ICSM 2024 putting official weight behind "assess sexual function in psychiatric patients" is a clinical practice nudge dressed as a review. The actual numbers are real but messy — treatment-emergent sexual dysfunction on antidepressants is genuinely common, and the literature measuring it is genuinely poor. What this paper cannot tell you is which drug, at what dose, in which patient, produces dysfunction at what rate — because that evidence largely does not exist yet. The missing COI disclosures are a problem for a document with direct prescribing implications.