A 27-Year-Old Man Comes to the Office Due to Depressed

A 27-year-old man comes to the office due to depressed mood and low energy for the past several months.  He describes sad and irritable mood, sleeping 12-14 hours a day, decreased appetite, and poor concentration at work.  The patient has stopped going to the gym and playing his guitar and has withdrawn from his friends and girlfriend.  He has no medical problems and physical examination and routine laboratory tests are normal.  Major depressive disorder is diagnosed and he is started on fluoxetine 20 mg.  At his 2-month follow-up, the patient reports, "I'm feeling just a little better.  I am still down on most days but at least I picked up my guitar once this week.  The other thing is sex.  In the beginning, I was so depressed that I didn't care whether I had sex.  Now, I'm interested and get erections, but it's taking too long to ejaculate and it sometimes fails to happen altogether."  The patient says that this is creating problems with his girlfriend and he is considering stopping the antidepressant.  He drinks a beer a day and does not use illicit drugs.  Which of the following is the best management strategy for this patient?

A)Explain that sexual dysfunction will improve as he develops tolerance to fluoxetine
B)Reassure the patient that sexual dysfunction will improve as his depression improves
C)Recommend decreasing the dose of fluoxetine
D)Recommend drug holidays to decrease the severity of dysfunction
E)Recommend switching to bupropion

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