Longitudinal Changes in Fear Learning across Pregnancy: Moderation by Sexual Trauma.

Sexual dysfunction is common in patients with depressive and psychotic disorders and may be present before treatment, emerge during pharmacotherapy, or persist despite improvement of the underlying psychiatric condition (–). Its causes are usually multifactorial and may include illness-related symptoms, psychotropic medication, comorbid medical conditions, substance use, relational factors, endocrine disturbances, and their interaction (–). Its clinical importance extends beyond tolerability. Impairment of desire, arousal, orgasm, ejaculation, genital response, or sexual satisfaction may reduce quality of life, affect intimate relationships and self-esteem, and contribute to poor adherence or treatment discontinuation (, –). Because patients often do not report sexual adverse effects spontaneously, direct questioning and validated instruments are needed for reliable detection (–). Antidepressants and antipsychotics differ substantially in their sexual tolerability profiles. Strongly serotonergic antidepressants, particularly SSRIs and venlafaxine, are consistently associated with a higher risk of treatment-emergent sexual dysfunction, whereas agents with non-serotonergic or multimodal mechanisms, including bupropion, mirtazapine, vortioxetine, agomelatine, moclobemide, and related lower-risk options, generally appear more favorable, although the strength of evidence varies across drugs (, , , , , ). Among antipsychotics, sexual dysfunction is linked to dopamine D2 blockade, hyperprolactinemia, reduced gonadal hormone activity, autonomic effects, sedation, metabolic burden, and illness-related psychosocial factors (, , , , ). Prolactin-elevating agents such as risperidone, paliperidone, amisulpride, and many first-generation antipsychotics generally have a less favorable profile, while prolactin-sparing or partial dopamine agonist agents may be preferable when sexual tolerability is a major clinical priority (, , , , ).