In Reply: Dr Harinstein raises concerns that treatment with additional medication such as sildenafil can add to patient adverse effects and cost burdens and suggests further consideration of different management options. Although we agree that no single treatment is definitive, the large number of reports evaluating treatment modalities (including SRI agonists, antagonists, partial agonists, switching, or augmentation, or nonpharmacological approaches such as waiting, drug holiday, or dose reduction) include only a few randomized clinical trials. With the exception of phosphodiesterase type 5 inhibitors,1 no clinically meaningful and significant data support those treatment modalities, leaving patients at risk for excess random pharmacology.2
Nurnberg HG. Sildenafil as Treatment for Antidepressant-Induced Sexual Dysfunction—Reply. JAMA. 2008;300(20):2365–2366. doi:10.1001/jama.2008.694
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