Switching to tianeptine in patients with antidepressant-induced sexual dysfunction

Firat University, School of Medicine, Department of Psychiatry, Elazig, Turkey.
Human Psychopharmacology Clinical and Experimental (Impact Factor: 1.85). 06/2003; 18(4):277-80. DOI: 10.1002/hup.479
Source: PubMed

ABSTRACT Sexual side effects are frequent and are recently being considered as effects of antidepressant treatment. One method to improve the sexual dysfunction associated with the use of antidepressants is to change to another antidepressant. In the present work, the consequences of switching to tianeptine in patients with antidepressant-induced sexual dysfunction were studied. The study group comprised 23 patients with major depressive disorder who experienced antidepressant-induced sexual dysfunction. These antidepressants were stopped and switched to tianeptine (12.5mg x 3/day). All patients were screened by using the clinical global impression-improvement scale (CGI-I), the Hamilton depression rating scale (HAM-D) and the Arizona sexual experience scale (ASEX) at the beginning of the study, and at weeks 4 and 8. No patient failed to tolerate 37.5mg of tianeptine or to complete the study except for one patient becoming pregnant. Paired t-tests revealed a significant difference between baseline and week 4 or week 8 in scores on both the HAM-D and ASEX. At 8 weeks, six patients were rated as very much improved (CGI-I=1) and ten patients were rated as much improved (CGI-I=2). Thus, with a CGI-I score of 2 or less used to indicate a positive response, 72.7% of the patients were responders. The results suggest that switching to tianeptine appears to be useful for alleviating sexual dysfunction caused by other antidepressants.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The ideal antidepressant would control depression with no adverse effect on sexual function. Erectile dysfunction and other sexual dysfunction associated with antidepressant medication treatment are problems with many antidepressants and can lead to patient dissatisfaction and decreased compliance with treatment. A computerized MEDLINE search (English language, 1966-2003) was performed using the terms antidepressive agents, erectile dysfunction, and sexual dysfunction. Emphasis was placed on studies with specific sexual function measurements taken before and after treatment and placebo control. Mixed mediator, nonserotonergic antidepressants that block postsynaptic serotonin type 2 receptors (nefazodone, mirtazapine) or that primarily increase dopamine or norepinephrine levels (bupropion) were thought to be good choices for avoiding antidepressant-associated sexual dysfunction or for switching patients in whom antidepressant-associated sexual dysfunction emerged. Comparisons with serotonin reuptake inhibitors (SRIs) have revealed less desire and orgasm dysfunction with nonserotonergic bupropion, less orgasm dysfunction with nefazodone, and superior overall satisfaction with sexual functioning with bupropion or nefazodone. However, most of these studies have design flaws that make evidence-based claims of efficacy difficult to substantiate. Agents proposed for antidote use in antidepressant-associated sexual dysfunction have either not been studied in men or not proved efficacious in randomized placebo-controlled trials. Switching to and augmentation with bupropion or nefazodone have also not clearly shown efficacy in controlled trials and require care and monitoring to avoid SRI discontinuation symptoms and loss of antidepressant efficacy. Few proposed treatment options, apart from avoidance, have proved effective for antidepressant-associated sexual dysfunction, which can have negative consequences on depression management.
    The Journal of Clinical Psychiatry 02/2003; 64 Suppl 10(10):11-9. · 5.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Sexual dysfunction caused by psychotropic medications has become an increasingly important clinical topic. Only recently have we acknowledged the extent to which many psychotropic medications, especially antidepressants and antipsychotics, cause sexual side effects. Prevalence rates of sexual side effects are extraordinarily difficult to estimate due to a variety of factors, such as the effect of the disorder being treated, comorbid disorders and baseline sexual dysfunction. Among the antidepressants, those with strong serotonergic properties have the highest rate of sexual side effects. Among the antipsychotics, those with greater D(2) blockade leading to increased prolactin levels are probably associated with more sexual dysfunction. Treatment approaches have been poorly developed for both antidepressants and antipsychotics. Antidotes for antidepressant-induced sexual dysfunction include bupropion, buspirone and sildenafil.
    Expert Opinion on Pharmacotherapy 01/2004; 4(12):2259-69. DOI:10.1517/14656566.4.12.2259 · 3.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The term 'sexual dysfunction' describes a disturbance in sexual desire and the psychophysiological changes that characterise the normal sexual response cycle, and cause marked personal distress and interpersonal difficulty. Epidemiological studies indicate that sexual dysfunction is common in the general population, but more common in depressed individuals in community settings and clinical samples. Most antidepressant drugs have adverse effects on sexual function, but accurate identification of the incidence of treatment-emergent dysfunction has proved troublesome. Futhermore, investigations of sexual dysfunction associated with antidepressants have one or more methodological flaws. There may be some advantages for bupropion, moclobemide, nefazodone and reboxetine over other antidepressants. Many approaches have been adopted for management of patients with sexual dysfunction associated with antidepressant treatment, including waiting for the problem to resolve, behavioural strategies to modify sexual technique, individual and couple psychotherapy, delaying the intake of antidepressants until after sexual activity, reduction in daily dosage, 'drug holidays', use of adjuvant treatments, and switching to a different antidepressant.
    Expert Opinion on Drug Safety 10/2004; 3(5):457-70. DOI:10.1517/14740338.3.5.457 · 2.74 Impact Factor
Show more


Available from