Antidepressant-Induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting
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Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
Abstract
Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
참고문헌 (27)
- Waldinger MD, "Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo- controlled study with fluoxetine, fluvoxamine, paroxetine, and sertraline", J Clin Psychopharmacol, 18, pp.274~281 (1998)
- Lane RM, "A critical review of selective serotonin reuptake inhibitorrelated sexual dysfunction; incidence, possible aetiology and implications for management", J Psychopharmacol, 11, pp.72~82 (1997)
- Waldinger MD, "Selective serotonin reuptake inhibitor-induced sexual dysfunction: clinical and research considerations", Int Clin Psychopharmacol, 13(6), pp.S27~S33 (1998)
- Gregorian RS, "Antidepressant-induced sexual dysfunction", Ann Pharmacother, 36, pp.1577~1589 (2002)
- Clayton AH, "Female sexual dysfunction related to depression and antidepressant medications", Curr Womens Health Rep, 2, pp.182~187 (2002)
- Roose SP, "Tolerability and patient compliance", J Clin Psychiatry, 60(17), pp.14~17 (1999)
- Montejo AI, "Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients", Actas Luso Esp Neurol Psiquiatr Cienc Afines, 24, pp.311~321 (1996)
- Fava M, "Sexual functioning and SSRIs", J Clin Psychiatry, 63(5), pp.13~16 (2002)
- Kennedy SH, "Antidepressant-induced sexual dysfunction during treatment with moclobemide, paroxetine, sertraline, and venlafaxine", J Clin Psychiatry, 61, pp.276~281 (2000)
- Jeong-Ho Chae, "Comparison of Side Effect Profiles between Mirtazapine and Selective Serotonin ReuptakeInhibitors ; A Naturalistic Setting", Clinical Psychopharmacology and Neuroscience, 2(1), pp.31~35 (2004), 대한정신약물학회
- McGahuey CA, "The Arizona Sexual Experience Scale (ASEX): reliability and validity", J Sex Marital Ther, 26, pp.25~40 (2000)
- Association AP, "Diagnostic and statistical manual of mental disorders, 4th edition, text revision" (2000), American Psychiatric Association
- Beck AT, "An inventory for measuring depression", Arch Gen Psychiatry, 4, pp.561~571 (1961)
- Spielberger CD, "Manual for the state-trait anxiety inventory: a comprehensive bibliography" (1989), Cunsulting Psychologists Press
- Spielberger CD, "Manual for the state-trait anxiety inventory" (1983), Consulting Psychologists Press
- Margolese HC, "Sexual side effects of antidepressants: a review", J Sex Marital Ther, 22, pp.209~217 (1996)
- Montejo AL, "Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction", J Clin Psychiatry, 62(3), pp.10~21 (2001)
- Baldwin DS, "Sexual dysfunction associated with antidepressant drugs", Expert Opin Drug Saf, 3, pp.457~470 (2004)
- Stahl SM, "The psychopharmacology of sex, Part 1: Neurotransmitters and the 3 phases of the human sexual response", J Clin Psychiatry, 62, pp.80~81 (2001)
- Goodnick PJ, "Women’s issues in mood disorders", Expert Opin Pharmacother, 1, pp.903~916 (2000)
- Nadeem HS, "Comparison of the effects of citalopram and escitalopram on 5-Ht-mediated neuroendocrine responses", Neuropsychopharmacology, 29, pp.1699~1703 (2004)
- Boolell M, "Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction", Int J Impot Res, 8, pp.47~52 (1996)
- Angulo J, "Differential effects of serotonin reuptake inhibitors on erectile responses, NO-production, and neuronal NO synthase expression in rat corpus cavernosum tissue", Br J Pharmacol, 134, pp.1190~1194 (2001)
- Preskorn SH, "Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine", J Clin Psychiatry, 56(6), pp.12~21 (1995)
- Baldwin DS, "Antidepressant drugs and sexual function: improving the recognition and management of sexual dysfunction in depressed patients. J Clin Psychiatry 1998;59 Suppl 8:39-44. Stahl SM. Basic psychopharmacology of antidepressants, part 1: Antidepressants have seven distinct mechanisms of action", J Clin Psychiatry, 59(4), pp.5~14 (1998)
- Asch DA, "Response rates to mail surveys published in medical journals", J Clin Epidemiol, 50, pp.1129~1136 (1997)
- Dunn KM, "Sexual problems: a study of the prevalence and need for health care in the general population", Fam Pract, 15, pp.519~524 (1998)