The Psychiatrist Who Fought the FDA Over How Women's Desire Gets Measured | Anita Clayton, MD

Dr. Anita Clayton, chair of psychiatry at UVA and a former Navy physician, built the CSFQ — the validated scale now used across specialties to measure antidepressant sexual dysfunction — after noticing her fluoxetine patients' real rate of side effects was ten times what the drug's label claimed. In this conversation with Dr. Will Sauvé and Dr. Brittany Albright, she breaks down the three sources of sexual dysfunction clinicians routinely conflate: the illness itself, the medication, and the relationship strain that comes with depression. She explains why bupropion doesn't cause sexual dysfunction and can even rescue it from an SSRI, and the case she made to drug companies to stop hiding that fact. The conversation turns to flibanserin (Addyi), the first FDA-approved drug for low sexual desire in women, and the fight over regulators measuring female desire by a standard borrowed from Viagra trials — a saga now documented in the film The Pink Pill. Clayton also previews where she's headed next: zuranolone for postpartum depression, a single-dose psilocybin-analog injectable now being studied in adjustment disorder tied to serious illness, and gepirone ER (Exxua), a new antidepressant with no sexual-dysfunction warning at all. It's a career-spanning episode about what happens when someone refuses to accept "that's just how it's measured" as an answer.   Timestamped show notes Approximate. [00:00] Sauvé on finding psychiatry on an inpatient rotation at Walter Reed [02:30] Welcoming Dr. Anita Clayton and Dr. Brittany Albright [03:00] "Who takes care of all these people?" The nursing-home origin [04:30] One of few women in medical school; choosing OB-GYN and psychiatry [08:00] Wanting to know everyone's story: why psychiatry [12:00] The Navy, HPSP, and becoming a general medical officer at Great Lakes [13:30] Starting an all-women group; treating the whole person [16:30] "I'm examining them": finding what others missed [17:30] The Kmart story and choosing to live your life [18:30] The Pink Pill, and meeting Clayton in it [19:30] Fluoxetine, delayed orgasm, and a label that said 1.9% [21:00] Why you can't trust spontaneous-report side-effect data [21:30] Three kinds of sexual dysfunction: disease, treatment, relationship [24:30] Building the CSFQ scale [25:00] Bupropion, buspirone, and rescuing sexual function [27:00] "Just count the prescriptions": reframing antidepressants for industry [29:30] Should psychiatrists screen for primary sexual disorders? [30:30] Flibanserin, Boehringer Ingelheim, and training actors to model interviews [33:00] The FDA's sedation worries and the fight over approval [35:30] "Successful sexual events" vs. asking women about desire [37:00] Sprout, Cindy Eckert, and patients testifying at the FDA [38:00] Becoming a PI on industry trials since 1991 [40:00] Career and family: a blended family and a summer in Provence [42:30] A father who said "you can do anything" [46:30] Reproductive psychiatry, the midlife clinic, PMDD, postpartum [47:30] Zuranolone and a GABA mechanism that changed the paradigm [48:30] A single-dose psilocybin-analog injectable for postpartum depression [50:30] Adjustment disorder in serious medical illness; an ALS patient at peace [51:30] Gepirone ER (Exxua) and a head-to-head sexual-function design [55:00] What she's proudest of: staying curious [56:30] Mentorship, women in the field, and "I'm still excited" Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice