Review: Bupropion and SSRI-induced side effects.
ABSTRACT Selective serotonin reuptake inhibitors (SSRIs) are a first line treatment option for millions of patients, due to the positive balance between efficacy and tolerability. However, some side effects associated with their use, can impair quality of life and compliance with treatment. This paper reviews the prevalence of sexual dysfunction, weight gain and emotional detachment during SSRI treatment, the profile of bupropion for each of these events and the ability of bupropion to reverse them. Double-blind trials, open-label trials and anecdotical reports derived from Medline were included. First, there is robust evidence that SSRIs can induce sexual side effects and that bupropion causes less sexual dysfunction than SSRIs. There is limited, mainly open-label evidence that bupropion can reverse SSRI-induced sexual side effects. Second, there is good evidence that long-term treatment with some SSRIs can result in weight gain and that long-term treatment with bupropion can result in a small weight loss. There is only anecdotical evidence that bupropion can reverse SSRI-induced weight gain. Third, treatment with SSRIs has been associated with ;emotional detachment', although controversy exists about this concept. No data are available on the profile of bupropion for ;emotional detachment' or for the reversal of SSRI-induced ;emotional detachment' by bupropion-addition.
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ABSTRACT: Pleasurable sexual activity is an essential component of many human relationships, providing a sense of physical, psychological, and social well-being. Epidemiological and clinical studies show that depressive symptoms and depressive illness are associated with impairments in sexual function and satisfaction, both in untreated and treated patients. The findings of randomized placebo-controlled trials demonstrate that most of the currently available antidepressant drugs are associated with the development or worsening of sexual dysfunction, in a substantial proportion of patients. Sexual difficulties during antidepressant treatment often resolve as depression lifts but can endure over long periods and may reduce self-esteem and affect mood and relationships adversely. Sexual dysfunction during antidepressant treatment is typically associated with many possible causes, but the risk and type of dysfunction vary with differing compounds and should be considered when making decisions about the relative merits and drawbacks of differing antidepressants. A range of interventions can be considered when managing patients with sexual dysfunction associated with antidepressants, including the prescription of phosphodiesterase-5 inhibitors, but none of these approaches can be considered "ideal." As treatment-emergent sexual dysfunction is less frequent with certain drugs, presumably related to differences in their pharmacological properties, and because current management approaches are less than ideal, a reduced burden of treatment-emergent sexual dysfunction represents a tolerability target in the development of novel antidepressants.Depression research and treatment 02/2013; 2013:256841. DOI:10.1155/2013/256841
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ABSTRACT: Growing evidence points to a relationship between obesity and both mood and anxiety disorders, but the question of what accounts for this association remains unanswered. The present study examined the use of psychotropic medications as a mediator of the mood/anxiety disorder-obesity relationship. Data came from the public use dataset of the Canadian Community Health Survey Cycle 1.2 (age 15 years and older, N = 36,984). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric diagnoses of 12-month mood disorders (e.g., major depressive disorder, mania) and anxiety disorders (e.g., panic attacks, panic disorder, social phobia, agoraphobia) were examined as was use of psychotropic medications (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics, mood stabilizers) and obesity (defined as body mass index ≥30). A series of multiple logistic regression analyses were completed to test study hypotheses. Covariates in these analyses included sociodemographic factors, physical activity, and physical illness burden. The use of two medication classes, namely antidepressants and antipsychotics, emerged as significant predictors of obesity as well as mediators of the psychiatric diagnosis-obesity relationship after evaluating all psychotropic medication classes simultaneously, while also controlling for other theoretically relevant variables. The use of these two medications accounted for 86% of the relationship between mood disorders and obesity and 32% of the relationship between anxiety disorders and obesity. The study findings guide advances in the theoretical conceptualization of the mechanisms involved in mood/anxiety disorder-obesity relations. Clinical implications are discussed.Journal of Psychiatric Research 04/2010; 44(15):1010-6. DOI:10.1016/j.jpsychires.2010.04.007 · 4.09 Impact Factor
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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