Article

Sexual dysfunction during treatment with serotonergic and noradrenergic antidepressants: Clinical description and the role of the 5-HTTLPR

Central Institute of Mental Health, Division of Genetic Epidemiology in Psychiatry, Mannheim, Germany.
The World Journal of Biological Psychiatry (Impact Factor: 4.23). 03/2011; 12(7):528-38. DOI: 10.3109/15622975.2011.559270
Source: PubMed

ABSTRACT Sexual dysfunction (SD) is a frequently reported side-effect of antidepressant treatment, particularly of selective serotonin reuptake inhibitors (SSRIs). In the multicentre clinical and pharmacogenetic GENDEP study (Genome-based Therapeutic Drugs for Depression), the effect of the serotonin transporter gene promoter polymorphism 5-HTTLPR on sexual function was investigated during treatment with escitalopram (SSRI) and nortriptyline (tricyclic antidepressant).
A total of 494 subjects with an episode of DSM-IV major depression were randomly assigned to treatment with escitalopram or nortriptyline. Over 12 weeks, depressive symptoms and SD were measured weekly with the Montgomery-Asberg Depression Rating Scale, the Antidepressant Side-Effect Checklist, the UKU Side Effect Rating Scale, and the Sexual Functioning Questionnaire.
The incidence of reported SD after 12 weeks of treatment was relatively low, and did not differ significantly between antidepressants (14.9% escitalopram, 19.7% nortriptyline). There was no significant interaction between the 5-HTTLPR and antidepressant on SD. Improvement in depressive symptoms and younger age were both associated with lower SD. The effect of age on SD may have been moderated by the 5-HTTLPR.
In GENDEP, rates of reported SD during treatment were lower than those described in previous reports. There was no apparent effect of the 5-HTTLPR on the observed decline in SD.

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    • "Our results showed that there is an association between sexual dysfunction before and after treatment, i.e., worsening of sexual dysfunction items was more prevalent in patients with prior impairment in these items. The finding can be attributed to antidepressant effects on sexual dysfunction; however, decrease in sexual dysfunction during antidepressant therapy has been reported by Strohmaier et al. [28]. Finally, more impairment in sexual drive and decrease in interest in sexually explicit material were seen in patients who were not responders to treatment . "
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