Letters to the Editor
Spontaneous Orgasm Started With Venlafaxine
and Continued With Citalopram
Dear Editor:
Although antidepressants have been commonly associated with anorgasm (1), few case reports highlight unusual sexual responses, including spontaneous orgasm with antidepressants (2). I report the case of a patient who experienced spontaneous orgasm starting with venlafaxine treatment and continuing with citalopram.
Case Report
Mrs A, aged 48 years and married, was admitted as a psychiatric outpatient with depressive symptoms. She had been diagnosed with recurrent severe major depression with melancholic features. She had been unsuccessfully treated for over 2 years with combined moclobomide 900 mg daily and olanzapine 10 mg daily. When she applied to our clinic, her Hamilton Depression Rating Scale (HDRS) score was 34, despite this treatment protocol. She began to take venlafaxine extended release 75 mg daily. At the end of week 1, the dosage was increased to 150 mg daily. At the end of 3 weeks, she recognized spontaneous orgasms occurring 4 to 5 times daily. She stated that she felt strain because of them. Her complaints continued in the fifth week, and venlafaxine was ceased. Her spontaneous orgasms decreased 2 weeks after she stopped taking venlafaxine. Then, she started taking citalopram 10 mg daily, increased to 20 mg daily after 1 week. The side effects returned to their past levels. Because she had either continued depressive symptoms or similar side effects from 2 different groups of antidepressants, drug treatment was given up, and electroconvulsive therapy (ECT) was started. After ECT, she recovered from both spontaneous orgasms and depression.
This is the first report of venlafaxine-induced spontaneous orgasm in women, and this is also the first report of spontaneous orgasm related to citalopram. Because this patient’s HDRS score was 25 and there were no symptoms of mania, her sexual experience did not seem to be owing to drug-induced hypomania. Further, this side effect occurred simultaneously with venlafaxine use and decreased after this drug was given up. Although the mechanism of this adverse effect is not known exactly, venlafaxine’s central effect on serotonin levels and peptides such as endorphine are thought to be related to it (3). It is not clear how this side effect disappeared. Improvement may have been owing solely to stopping citalopram or to ECT treatment. To my knowledge, nothing in the literature discusses how ECT affects sexual function. Therefore, this issue is worthy of research.
References
1. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agent prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. J Clin Psychiatry 2001;62:10–21.
2. Labbate LA. Bupropion SR–induced increased libido and spontaneous orgasm. Can J Psychiatry 1998;43:644–5.
3. Harrison W, Stewart J, Mc Grath PJ, Quitkin F. Unusual side effects clomipramine associated with yawning. Can J Psychiatry 1984;29:546.
Medaim Yanik, MD
Sanliurfa, Turkey
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