Which agent is most suitable for managing depression in a patient experiencing sexual dysfunction as a side effect of treatment?

Mirtazapine is often considered a suitable option for managing depression, particularly in patients who experience sexual dysfunction as a side effect of other antidepressant treatments. This is due to its unique mechanism of action and side effect profile.

Mirtazapine is an atypical antidepressant that works primarily as a noradrenergic and specific serotonergic antidepressant (NaSSA). It increases norepinephrine and serotonin levels in the brain but has less effect on serotonin compared to selective serotonin reuptake inhibitors (SSRIs), which are commonly associated with sexual side effects. This makes mirtazapine a good choice for patients who have not responded well to SSRIs or who are experiencing intolerable sexual dysfunction as a result of these medications.

In contrast, agents like sertraline and citalopram, while effective antidepressants, are SSRIs and are known to potentially aggravate sexual dysfunction due to their mechanism of action that enhances serotonin availability. Lithium, on the other hand, is typically used to treat bipolar disorder and is not primarily indicated for depression management, particularly in the context of sexual side effects. Therefore, mirtazapine stands out as the most suitable agent in this scenario.