Article

Antidepressant-Induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting

Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Psychiatry investigation (Impact Factor: 1.15). 03/2010; 7(1):55-9. DOI: 10.4306/pi.2010.7.1.55
Source: PubMed

ABSTRACT Antidepressants used to treat depression are frequently associated with sexual dysfunction. Sexual side effects affect the patient's quality of life and, in long-term treatment, can lead to non-compliance and relapse. However, studies covering many antidepressants with differing mechanisms of action were scarce. The present study assessed and compared the incidence of sexual dysfunction among different antidepressants in a naturalistic setting.
Participants were married patients diagnosed with depression, per DSM-IV diagnostic criteria, who had been taking antidepressants for more than 1 month. We assessed the participants via the Arizona Sexual Experiences Scale (ASEX), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI), and assessed their demographic variables, types and dosages of antidepressants, and duration of antidepressant use via their medical records.
One hundred and one patients (46 male, 55 female, age 42.2+/-7 years) completed the instruments. Thirteen were taking fluoxetine (mean dose 21.3+/-8.5 mg/day), 24 were taking paroxetine (mean dose 20.4+/-7.2 mg/day), 20 taking citalopram (mean dose 22.1+/-6.5 mg/day), 22, venlafaxine (mean dose 115.7+/-53.2 mg/day) and 22, mirtazapine (mean dose 18+/-8.7 mg/day). Mean ages, sex ratios, and BDI and STAI scores did not differ significantly across antidepressants. A substantial number of participants (46.5%, n=47) experienced sexual dysfunction. The prevalence of sexual dysfunction differed across drugs: citalopram 60% (n=12), venlafaxine 54.5% (n=12), paroxetine 54.2% (n=13), fluoxetine 46.2% (n=6), and mirtazapine 18.2% (n=4). Regression analyses revealed the significant factors for sexual dysfunction were being female, total scores on the BDI and SAI, and type of antidepressant (F=4.92, p<0.0001). Of the antidepressants, the mirtarzapine group's total ASEX score was significantly lower than the scores of the citalopram, fluoxetine, and paroxetine groups.
The incidence of sexual dysfunction was substantially high during antidepressant treatment. The incidence of sexual dysfunction differed among antidepressants having different mechanisms of action. Our study suggests the need for clinicians to consider the impact of pharmacotherapy on patients' sexual functioning in the course of treatment with antidepressants.

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    • "The SSRIs and venlafaxine resulted in the highest rates of dysfunction. Comparable rates of sexual dysfunction have been found in a more recent study [34]. There is even evidence that some patients may experience genital anesthesia or pleasureless orgasm, a problem that for some patients may persist even after the medication is discontinued [32]. "
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    ABSTRACT: This paper raises the question about whether the data on the medications we call antidepressants justify the label of antidepressant. The authors argue that a true antidepressant should be clearly superior to placebo, should offer a risk/benefit balance that exceeds that of alternative treatments, should not increase suicidality, should not increase anxiety and agitation, should not interfere with sexual functioning, and should not increase depression chronicity. Unfortunately, these medications appear to fall short on all of these dimensions. Many of the "side effects" of these medications have larger effect sizes than the antidepressant effect size. To call these medications antidepressants may make sense from a marketing standpoint but may be misleading from a scientific perspective. Consumers deserve a label that more accurately reflects the data on the largest effects and helps them understand the range of effects from these medications. In other words, it may make just as much sense to call these medications antiaphrodisiacs as antidepressants because the negative effects on libido and sexual functioning are so common. It can be argued that a misleading label may interfere with our commitment to informed consent. Therefore, it may be time to stop calling these medications antidepressants.
    06/2012; 2012:965908. DOI:10.6064/2012/965908
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    ABSTRACT: Around half of all men have sexual problems. The main complaints and prevalence are orgasmic disorders (10%), premature ejaculation (PE) (27%), and erectile difficulties (10%). These statistics do not include the sexual side effects of medications such as antidepressants. Research experiments in humans can be very time consuming or unethical. The present thesis deals with the development of an animal (rat) model that has face, predictive, and construct validity towards human sexual behavior and its disorders, and can be used to study the effects but also the side effects of psychoactive drugs on sexual behavior. Sexually trained male rats have stable low, normal or fast ejaculating behaviors. Low ejaculating rats can be used to examine orgasmic problems, while fast ejaculating rats for premature ejaculations. Normal ejaculating rats can be used to investigate side effects of medication (either stimulatory or inhibitory). The animal model provides face and predictive validity to the human situation where the inhibitory effects of SSRIs appear after chronic administration, and not after acute administration. In line with clinical experience, marked blockade of serotonin transporters (SERT) interfered with male sexual behavior, in contrast to the dopamine (DA) and noradrenaline (NA) reuptake inhibitor, bupropion. Further, other drugs that primarily increase levels of DA and NA versus serotonin (5-HT) (the 5-HT1A agonist, buspirone; the triple reuptake inhibitor, DOV216,303 and the 5-HT2C antagonist, S32006) exerted no detrimental influence or a mild stimulatory effect on sexual performance, and they are predicted to have little or no sexual side-effects in men. It is suggested that blockade of DA transporters (DAT) or NA transporters, as well as 5-HT2C receptor blockade, would be a useful avenue for the treatment of antidepressant-induced sexual inhibition. SERT knockout (SERTKO) rats have a permanent disturbance in the serotonergic system and were used to examine the effects of permanently elevated levels of 5-HT in the brain on sexual behaviors. Experiments with SERTKO rats revealed the existence of separate pools of 5-HT1A receptors with varying degree of sensitivity or desensitivity, revealing a possible mechanism underlying sexual dysfunctions. The SERTKO rat would be an interesting animal model to study modulating effects of various drugs on a perturbed serotonergic central nervous system. In addition, a novel use of the antibiotic clavulanic acid was discovered. This drug showed sexual stimulatory activity. A possible underlying mechanism is unknown, but further research on this seems very interesting. The thesis has provided important insights into male sexual function. Our research may lead to help to find new antidepressants without sexual side effects and drugs for the treatment of male sexual dysfunctions
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