J Sex Marital Ther. 2004 Mar-Apr;30(2):57-68. :
A randomized, placebo-controlled, crossover study of ephedrine for SSRI-induced female sexual dysfunction.
Meston CM
.
Department of Psychology, University of Texas at Austin, Austin, Texas, USA.
meston@psy.utexas.eduThe objective of this study was to determine whether ephedrine, an alpha- and beta-adrenergic agonist previously shown to enhance genital blood flow in women, has beneficial effects in reversing antidepressant-induced sexual dysfunction. Nineteen sexually dysfunctional women receiving either fluoxetine, sertraline, or paroxetine participated in an eight-week, double-blind, placebo-controlled, cross-over study of the effects of ephedrine (50 mg) on self-report measures of sexual desire, arousal, orgasm, and sexual satisfaction. Although there were significant improvements relative to baseline in sexual desire and orgasm intensity/pleasure on 50 mg ephedrine 1-hr prior to sexual activity, significant improvements in these measures, as well as in sexual arousal and orgasmic ability also were noted with placebo. These findings highlight the importance of conducting placebo-controlled trials for this condition.
CNS Drug Rev. 2004 Spring;10(1):23-44. :
The selective norepinephrine reuptake inhibitor antidepressant reboxetine: pharmacological and clinical profile.
Hajos M, Fleishaker JC, Filipiak-Reisner JK, Brown MT, Wong EH.
Department of Neuroscience, CNS Discovery, Pfizer Inc., Eastern Point Road, Groton, CT 06340, USA.
mihaly.hajos@pfizer.com.
Reboxetine is the first commercially available norepinephrine reuptake inhibitor developed specifically as a first line therapy for major depressive disorder. In vitro and in vivo pharmacological studies indicated that reboxetine methanesulphonate has high affinity and selectivity for the human norepinephrine transporter over the serotonin and dopamine transporters. Pharmacological specificity is further demonstrated by the absence of affinity for 45 transmitter receptors and CNS targets. Pharmacokinetic studies demonstrated that reboxetine is suitable for twice daily administration (8-10 mg/day) and that it exhibits minimal drug-drug interactions. The starting dose of reboxetine should be reduced in the elderly, in patients with renal or hepatic impairment, or in patients receiving potent CYP3A inhibitors. A total of 20 phase II/III clinical studies comprising placebo-controlled, active comparator-controlled and open-label uncontrolled studies in both short-term and long-term treatment of major depression have been conducted. In the treatment of major depression, reboxetine was superior to placebo in 5 of 12 short- or long-term placebo-controlled studies and was comparable in efficacy to active comparators in 3 out of 3 active-controlled studies. Unlike conventional tricyclic antidepressants (TCAs), reboxetine had only minimal sedative and cardiovascular liabilities, probably due to increased pharmacological specificity of reboxetine as compared with TCAs.
Unlike serotonin reuptake inhibitors, this selective and specific norepinephrine reuptake inhibitor demonstrated a distinct side-effect profile with diminishing sexual dysfunction and GI side effects. The availability of this agent has afforded patients suffering from major depressive disorder a new class of agents to combat the debilitating consequence of this psychiatric disease. The demonstrated pharmacological specificity of this compound has provided the psychopharmacology community with a tool to elucidate the role of norepinephrine in brain functions. Testing this agent in different animal models has enabled the exploration of the role of modulation of norepinephrine tone in the therapy of CNS disorders beyond depression.
1: J Clin Psychiatry. 2004;65 Suppl 4:46-52. :
Newer antidepressants: review of efficacy and safety of escitalopram and duloxetine.
Hirschfeld RM, Vornik LA.
Department of Psychiatry and Behavioral Sciences, University of Texas-Medical Branch, Galveston 77555-0188, USA.
rohirsch@utmb.edu
BACKGROUND: Two antidepressants with different mechanisms of action, escitalopram and duloxetine, have recently been developed for the treatment of major depressive disorder. This article reviews the available controlled data on these agents with regard to efficacy, safety, and tolerability. METHOD: We identified four 8-week, double-blind, placebo-controlled studies of escitalopram in the acute treatment of major depression. Three of the studies involved an active comparator, citalopram. We identified 6 placebo-controlled studies of duloxetine in major depressive disorder. Two of the studies included fluoxetine as an active comparator, and 2 included paroxetine as an active comparator. RESULTS: A review of the data from the controlled studies supports the efficacy of both escitalopram and duloxetine in the treatment of patients with major depression. Three of the 4 escitalopram studies were positive, and 1 was a failed study. Four of the 6 duloxetine studies were positive. Both escitalopram and duloxetine performed better than at least 1 selective serotonin reuptake inhibitor comparator. The safety and tolerability profiles of both drugs are quite benign. The reported incidence of treatment-emergent adverse events was somewhat lower with escitalopram than with duloxetine, with the possible exception of sexual dysfunction. Discontinuations due to adverse events were lower for escitalopram than for duloxetine, although rates were comparable with higher doses of escitalopram (20 mg/day). CONCLUSION: Both escitalopram and duloxetine are useful in the treatment of major depressive disorder.
J Clin Psychiatry. 2004 Jan;65(1):62-7. :
A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction.
Clayton AH, Warnock JK, Kornstein SG, Pinkerton R, Sheldon-Keller A, McGarvey EL.
University of Virginia, Charlottesville, VA 22903, USA.
ahc8v@virginia.edu
OBJECTIVE: This study reports the results of a placebo-controlled, double-blind comparison of bupropion sustained release (SR) as an antidote for sexual dysfunction versus placebo in 42 patients with selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction. Exploratory analyses of the association of testosterone and sexual functioning in women in the study were also performed. METHOD: Patients with DSM-IV major depression who experienced a therapeutic response to any SSRI and were experiencing medication-induced global or phase-specific sexual dysfunction, as measured by the Changes in Sexual Functioning Questionnaire (CSFQ), were randomly assigned to receive either bupropion SR 150 mg b.i.d. or placebo for 4 weeks in addition to the SSRI. Total testosterone levels were assessed at baseline and week 4. RESULTS: The difference in global sexual functioning, based on the total CSFQ score, was not statistically significant between the 2 groups at week 4, nor were differences in orgasm, desire/ interest as measured by sexual thoughts, or self-reported arousal. There was a statistically significant difference between the 2 groups at week 4 in desire as measured by self-report feelings of desire and frequency of sexual activity. Desire/ frequency showed a significantly greater improvement among those patients receiving bupropion SR compared with placebo (Wilk's F = 5.47, df = 1, p =.024). Frequency was significantly correlated to total testosterone level at baseline (r = 0.36, p =.027) and at week 4 (r = 0.41, p =.025). CONCLUSIONS: Bupropion SR, as an effective antidote to SSRI-induced sexual dysfunction, produced an increase in desire to engage in sexual activity and frequency of engaging in sexual activity compared with placebo. A larger study is needed to further investigate this finding.
J Sex Marital Ther. 2004 Jan-Feb;30(1):1-2. :
Reversal of fluoxetine-induced sexual dysfunction by switching to escitalopram.
Ashton AK.
Sexual dysfunction is a common complaint among patients taking selective serotonin reuptake-inhibiting (SSRI) antidepressants. Many options in managing this side effect have been described but none clearly is a first choice among clinicians. This paper describes the first published case of a patient having successful reversal of SSRI-induced sexual dysfunction by switching from an SSRI to escitalopram, the newest antidepressant and SSRI approved for use in the United States. Clinical implication is discussed.
BJU Int. 2003 Sep;92(4):441-6. :
Trazodone for erectile dysfunction: a systematic review and meta-analysis.
Fink HA, MacDonald R, Rutks IR, Wilt TJ.
Geriatric Research Education and Clinical Center, Section of General Internal Medicine, VA Medical Center, Minneapolis, USA.
howard.fink@med.va.gov
OBJECTIVE: To determine the efficacy and safety of trazodone in the treatment of erectile dysfunction (ED) in a meta-analysis. METHODS: The data sources used were Medline and the Cochrane Library databases (January 1966 to May 2002), bibliographies of retrieved articles and review articles, and conference proceedings and abstracts. Trials were eligible for inclusion in the review if they included men with ED, compared trazodone with a control, were randomized, of > or = 7 days' duration and assessed clinically relevant outcomes. Two reviewers independently evaluated study quality and extracted data in a standardized fashion. RESULTS: Six trials (comprising 396 men) met the inclusion criteria; they consisted of heterogeneous populations, were small, brief and in some cases methodologically weak. Three of the six trials showed an apparently clinically meaningful benefit of trazodone for ED compared with placebo, the differences being statistically significant in two. In pooled results, trazodone monotherapy appeared more likely than placebo to lead to a 'positive treatment response', although this difference was not statistically significant (37% vs 20%; relative benefit increase, 1.6; 95% confidence interval, CI, 0.8-3.3). Subgroup analyses suggested that men with psychogenic ED might be more likely to benefit from trazodone than those with mixed or physiological ED. The efficacy of trazodone also appeared greater at higher doses (150-200 vs 50 mg/day). Men randomized to trazodone were not significantly more likely than those receiving placebo to withdraw for any reason or for an adverse event, or to have specific adverse events, but wide CIs could not exclude a greater risk of these adverse outcomes with trazodone. Specific adverse events with trazodone included dry mouth (19%), sedation (16%), dizziness (16%) and fatigue (15%). CONCLUSION: Trazodone may be helpful in men with ED, possibly more so at higher doses, and in men with psychogenic ED. Future high-quality trials should compare trazodone with placebo and other therapies in men with depression and psychogenic ED.
J Sex Marital Ther. 2003 Jul-Aug;29(4):297-303. :
Sildenafil for selective serotonin reuptake inhibitor-induced erectile dysfunction in elderly male depressed patients.
Aizenberg D, Weizman A, Barak Y.
Geha Mental Health Center, Petah-Tiqva, Israel.
daizenberg@clalit.org.il
Treatment with antidepressants, especially agents with potent serotonergic effects, is frequently associated with sexual side effects. In the present study, we examined the efficacy of sildenafil, a potent phosphodiesterase inhibitor, in the treatment of elderly men (n = 10; 70-81 years) with erectile dysfunction induced by antidepressant treatment for major depressive disorder. Eligible subjects were instructed to add sildenafil (25-50 mg/day) to their current drug treatment. Clinical assessment of erectile function was performed at beginning of treatment with sildenafil and at follow up, 4 weeks later. All patients reported an improvement of their erectile capacity, and in 7 out of 10 subjects, erectile function returned to a normal level. Sildenafil appears to be a safe and well-tolerated agent in elderly subjects. We noted side effects in 2 patients (flashes), but the side-effects were bothersome only to one patient (headache). It appears that sildenafil coadministration improves erectile dysfunction associated with selective serotonin reuptake inhibitor ongoing treatment in elderly patients.
Hum Psychopharmacol. 2003 Jun;18(4):277-80. :
Switching to tianeptine in patients with antidepressant-induced sexual dysfunction.
Atmaca M, Kuloglu M, Tezcan E, Buyukbayram A.
Firat University, School of Medicine, Department of Psychiatry, Elazig, Turkey.
matmaca_p@yahoo.com
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. Copyright 2003 John Wiley & Sons, Ltd.
Int J Impot Res. 2003 Jun;15(3):221-4. :
Current drug use as risk factor for erectile dysfunction: results from an Italian epidemiological study.
Ricci E, Parazzini F, Mirone V, Imbimbo C, Palmieri A, Bortolotti A, Di Cintio E, Landoni M, Lavezzari M.
Istituto di Ricerche Farmacologiche 'Mario Negri', Milano, Italy.
ricci@marionegri.it
Several drugs have been associated with an increased risk of erectile dysfunction (ED). We analysed the role of pharmacological treatments on the risk of ED using data from a cross-sectional study on prevalence and risk factors for ED in the general population in Italy. A total of 2450 men aged more than 18 years were randomly identified by 143 general practioners (GP) among their registered patients and invited to a confidential interview by their GP. Patients were asked 'about their ability to achieve and maintain an erection sufficient for satisfactory sexual performance'. If they were dissatisfied, they were defined as having ED. Out of the 2450 men identified, 440 (18%) refused to participate. The present analysis therefore includes information on 2010 men. After adjustment for related pathologies, anxiolytics and antidepressants showed insignificantly higher odds ratio (ORs, respectively, 1.7 and 2.1); antipsychotic drug use significantly increased the risk of ED (OR 9.0, 95% confidence interval, CI 1.8-44.4). Diuretics (OR 3.1, 95% CI 1.4-6.9) and anticholinergic drugs (OR 12.8, 95% CI 2.7-60.1) were associated with ED risk. No association emerged between ED and H2 antagonists, anticholesterolemic or hypoglycemic drugs. In conclusion, after taking account of related pathologies, our results suggest that men treated with antipsychotic, diuretic and anticholinergic drugs are at greater risk of ED.
Int Clin Psychopharmacol. 2003 May;18(3):151-6. :
Lack of sexual dysfunction with the selective noradrenaline reuptake inhibitor reboxetine during treatment for major depressive disorder.
Clayton AH, Zajecka J, Ferguson JM, Filipiak-Reisner JK, Brown MT, Schwartz GE.
University of Virginia, Department of Psychiatric Medicine, Charlottesville 22903, USA.
ahc8v@virginia.edu
Sexual side-effects due to antidepressant treatment are an important consideration when selecting a treatment regimen and can influence patient compliance. Sexual function during treatment with the selective noradrenaline reuptake inhibitor reboxetine, the selective serotonin reuptake inhibitor (SSRI) fluoxetine and placebo has been assessed in a multicentre, randomized, 8-week, double-blind study of 450 patients diagnosed with major depressive disorder. Sexual function was measured by the Rush Sexual Inventory completed by male and female patients and administered at baseline, week 4 and week 8. The results indicate that reboxetine was similar to placebo and superior to fluoxetine in its effect on overall sexual function. There was a greater degree of sexual satisfaction in the reboxetine group compared to fluoxetine (P=0.02). The percentage of female patients able to achieve orgasm increased during the study period for women who received reboxetine and placebo, but decreased for those who received fluoxetine. These results suggest that reboxetine may be of particular benefit for patients at risk for sexual dysfunction with SSRIs.
J Sex Marital Ther 2002 Mar-Apr;28(2):131-8
:
Bupropion-sustained release as a treatment for SSRI-induced
sexual side effects.
Gitlin MJ, Suri R, Altshuler L, Zuckerbrow-Miller J, Fairbanks L.
Department of Psychiatry, University of California School of Medicine, Los
Angeles, California, USA.
mgitlin@mednet.ucla.eduTwenty-four subjects treated with serotonin reuptake inhibitors for a
depressive disorder who had new-onset sexual side effects coincident with
antidepressant treatment were treated with escalating doses of bupropion SR
up to 300 mg daily for 7 weeks. Global response rates were 46% for women and
75% for men. All sexual side effects improved in response to bupropion SR in
both men and women with no differential effect on any one sexual side effect.
Most of the improvement (more than 50%) occurred within the first 2 weeks
and at low dose (100-200 mg/day). When prescribed in an open fashion,
bupropion SR appeared to be effective in treating all the major categories of
sexual side effects.
Bupropion SR (Wellbutrin SR) 150 mg 60 $50.95
Bupropion SR (Wellbutrin SR) 100 mg 60 $49.91
Am J Psychiatry 2000 Feb;157(2):239-43
:
Comment in:
Am J Psychiatry. 2001 Feb;158(2):326-7.
Female sexual dysfunction associated with antidepressant
administration: a randomized, placebo-controlled study of
pharmacologic intervention.
Michelson D, Bancroft J, Targum S, Kim Y, Tepner R.
Lilly Research Laboratories, Indianapolis, IN 46285, USA.
dmichelson@lilly.comOBJECTIVE: Few controlled trials of pharmacologic intervention in women with
antidepressant-associated sexual dysfunction have been reported, and there is
uncertainty about the usefulness of putative treatments and the assessment
methodologies. The authors evaluated the efficacy of buspirone and amantadine
in the treatment of sexual dysfunction associated with fluoxetine
administration. METHOD: Women who had been successfully treated with
fluoxetine for at least 8 weeks and who had reported a deterioration in sexual
function not present before the initiation of fluoxetine entered a 4-week
assessment period. After assessment they were randomly assigned to an 8-week
treatment trial with buspirone (N=19), amantadine (N=18), or placebo (N=20).
Outcomes were assessed by using a patient-rated daily diary and a
clinician-rated structured interview. RESULTS: While the amantadine-treated
women did report significantly greater improvements in energy levels than
women in the placebo group, all treatment groups experienced improvement in
overall sexual function as well as in most individual measures. There were no
statistically significant differences among the three groups. CONCLUSIONS:
Neither buspirone nor amantadine was more effective than placebo in
ameliorating antidepressant-associated sexual dysfunction. All groups
experienced marked nonspecific improvement during treatment, which suggests
the importance of placebo-controlled trials for this condition.
Int J Neuropsychopharmacol. 2002 Jun;5(2):147-51. :
Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs inhibit emotional responses?
Opbroek A, Delgado PL, Laukes C, McGahuey C, Katsanis J, Moreno FA, Manber R.
Anecdotal and published case reports suggest that some patients taking selective serotonin reuptake inhibitors (SSRI) experience diminution in emotional responsiveness. This study aims to define the individual components of emotion disturbed in these patients. Fifteen patients reporting SSRI-induced sexual dysfunction completed the Laukes Emotional Intensity Scale (LEIS), a questionnaire about various emotions. Compared to controls, patients reported significantly (p&0.05) less ability to cry, irritation, care about others' feelings, sadness, erotic dreaming, creativity, surprise, anger, expression of their feelings, worry over things or situations, sexual pleasure, and interest in sex. Total score on the LEIS did not correlate with total score on the Hamilton Depression Rating Scale. In our sample, 80% of patients with SSRI-induced sexual dysfunction also describe clinically significant blunting of several emotions. Emotional blunting may be an under-appreciated side-effect of SSRIs that may contribute to treatment non-compliance and/or reduced quality of life.
Am Fam Physician 2003 Feb 1;67(3):547-54
:
Antidepressants: update on new agents and indications.
Ables AZ, Baughman OL 3rd.
Spartanburg Family Medicine Residency Program, Spartanburg, South Carolina
29303, USA.
aables@srhs.com
A number of antidepressants have emerged in the U.S. market in the past two
decades. Selective serotonin reuptake inhibitors have become the drugs of choice in
the treatment of depression, and they are also effective in the treatment of
obsessive-compulsive disorder, panic disorder, and social phobia. New indications for
selective serotonin reuptake inhibitors include post-traumatic stress disorder,
premenstrual dysphoric disorder, and generalized anxiety disorder.
Extended-release venlafaxine has recently been approved by the U.S. Food and Drug
Administration for the treatment of generalized anxiety disorder. Mirtazapine,
which is unrelated to the selective serotonin reuptake inhibitors, is unique in its
action--stimulating the release of norepinephrine and serotonin. The choice of
antidepressant drug depends on the agent's pharmacologic profile, secondary
actions, and tolerability. Sexual dysfunction related to the use of antidepressants
may be addressed by reducing the dosage, switching to another agent, or adding
another drug to overcome the sexual side effects. Augmentation with lithium or
triiodothyronine may be useful in patients who are partially or totally resistant to
antidepressant treatment. Finally, tapering antidepressant medication may help to
avoid discontinuation syndrome or antidepressant withdrawal.
Bull Menninger Clin 1995 Spring;59(2):232-48
:
Effects of depression and antidepressants on sexual functioning.
Gitlin MJ.
Affective Disorders Program, UCLA School of Medicine, USA.
With serotonergic antidepressants dominating the treatment of depressive
disorders, antidepressant-induced sexual side effects have emerged as a major
clinical issue. Surprisingly, the effects of depression on sexuality are less well
established and more variable than previously thought. It is likely that
antidepressants with strong serotonergic effects--selective serotonin reuptake
inhibitors, clomipramine, and monoamine oxidase inhibitors--are associated with
higher rates of sexual side effects, compared to other antidepressant classes.
Orgasmic and ejaculation difficulties are prominent with these medications,
although alterations in libido, arousal, and erectile function are also common.
Treatment of these side effects includes both general strategies and specific
antidotes, such as cyproheptadine, yohimbine, dopamine agonists, and buspirone.
Periactin (Cyproheptadine) 4 mg 100 $34.29
Buspirone (Buspar) 10 mg 100 $94.29
Buspirone (Generic) 10 mg 100 $62.46
: Curr Womens Health Rep 2002 Dec;2(6):409-16
:
Sexual Side Effects of SSRI Medications: Potential Treatment
Strategies for SSRI-induced Female Sexual Dysfunction.
Kanaly KA, Berman JR.
Department of Urology, Female Sexual Medicine Center at UCLA, 924 Westwood
Blvd., Suite 515, Los Angeles, CA 90024, USA.
kkanaly@mednet.ucla.edu
Depression often coexists with sexual dysfunction, and the medical treatment of
depression can further worsen sexual symptoms or cause de novo sexual dysfunction
in a person who did not experience it prior to treatment. There are many drugs that
can adversely affect sexual response. Among antidepressants, this effect is
commonly observed with selective serotonin-reuptake inhibitors (SSRI). Various
strategies for the treatment of SSRI-related sexual dysfunction have been
studied, including: awaiting spontaneous remission of sexual dysfunction; reducing
the dose of medication; taking a "drug holiday"; adding another drug to help reverse
sexual symptoms; changing antidepressants; or initially starting with a different
antidepressant that is known to have fewer or no sexual side effects. Overall, it is
important to address sexual health when caring for a patient--to improve drug
compliance and the patient's well being.
bupropion -Wellbutrin --sertraline-Zoloft
J Clin Psychopharmacol 2000 Apr;20(2):122-8
:
Evaluation of sexual functioning in depressed outpatients: a
double-blind comparison of sustained-release bupropion and
sertraline treatment.
Segraves RT, Kavoussi R, Hughes AR, Batey SR, Johnston JA, Donahue R,
Ascher JA.
Department of Psychiatry, MetroHealth Medical Center, Cleveland, Ohio
44109-1998, USA.Sexual dysfunction is a frequently reported side effect of many antidepressants,
including serotonin reuptake inhibitors. Bupropion, an antidepressant of the
aminoketone class, is relatively free of adverse sexual effects. In a randomized,
double-blind, multicenter trial, sustained-release bupropion (bupropion SR) and
sertraline, a selective serotonin reuptake inhibitor, were found to be similarly
efficacious in the treatment of outpatients with moderate to severe depression.
This report describes the results of a double-blind comparison of the sexual side
effect profiles of bupropion SR and sertraline. Two hundred forty-eight patients
who had received a diagnosis of moderate to severe major depression were randomly
assigned to receive treatment with bupropion SR (100-300 mg/day) or sertraline
(50-200 mg/day) for 16 weeks. Eligible patients were required to be in a stable
relationship and to have normal sexual functioning. Sexual functioning was assessed
by the investigator at each clinic visit using investigator-rated structured
interviews. A significantly greater percentage of sertraline-treated patients (63%
and 41% of men and women, respectively) developed sexual dysfunction compared
with bupropion SR-treated patients (15% and 7%, respectively). Sexual dysfunction
was noted as early as day 7 in sertraline-treated patients at a dose of 50 mg/day
and persisted until the end of the 16-week treatment phase. Four patients, all of
whom were treated with sertraline, discontinued from the study prematurely
because of sexual dysfunction. Given the similar efficacy of the two drugs in
treating depression, bupropion SR may be a more appropriate antidepressant choice
than sertraline in patients for whom sexual dysfunction is a concern.
Requip (Ropinirole in Canada- 2 mg -$.95 per pill
Ropinirole or Requip is a dopamine agonist which stimulates dopamine receptors
in the brain - acting like dopamine would.Ropinirole or Requip is used in both early and late Parkinson's disease.
-Ropinirole for antidepressant-induced sexual dysfunction.
Sexual dysfunction is a relatively common side-effect of antidepressants,
occurring in approximately one-half of patients, and is associated with
significant distress and treatment non-compliance. Dopaminergic agents have
been reported to be helpful for the treatment of antidepressant-induced sexual
dysfunction and, in this report, we examined the efficacy of the dopamine
agonist ropinirole for this indication. Thirteen patients (three women, 10 men),
aged 42.6 +/- 7.7 years, who reported sexual dysfunction on a stable dose of
antidepressant, were treated openly with ropinirole initiated at 0.25 mg/day
and titrated up to 2-4 mg/day over 4 weeks, as tolerated. Ten of the 13 took
ropinirole for at least 4 weeks, one discontinued due to an adverse event and
two because of lack of response. Sexual dysfunction, as assessed by the
Arizona Sexual Experience Scale scores, was reduced from 18.8 +/- 3.6 to 13.8
+/- 4.3 after 4 weeks on ropinirole at a mean dose of 2.1 mg/day. Overall,
seven of 13 patients (54%) were rated as responders on the Clinical Global
Impression of Improvement Scale. The addition of ropinirole may represent a
potentially useful treatment strategy for antidepressant-induced sexual
dysfunction.
The majority of psychotropic drugs entail sexual side effects.
The sexual side
effects may reduce the quality of life and may give rise to non-compliance. For
example, 30-60 per cent of patients treated with antidepressants are known to
develop a sexual dysfunction. However, some psychotropic drugs with no or very
few sexual side effects have begun to emerge. The treatment of sexual side
effects induced by psychotropic drugs may consist of: modified sexual habits,
reduction in dosage, switching to an alternative medication, possibly in
combination with different psychotropic agents, other varieties of
pharmacologically active substances or specific products for the treatment of
sexual dysfunction such as sildenafil. Above all, it should be acknowledged that
relatively few data are available in this field and in particular that there is a
lack of controlled studies.
siladenafil-Viagra-100mg-$10.00 per pill
Bupropion ( Amfebutamone, Wellbutrin, Zyban ) -150mg-.82 per pill
This review describes female sexual dysfunction (FSD) as an adverse effect to
pharmacological treatment. FSD covers libido, arousal, orgasm, and pain
problems. The existing knowledge of the influence of medication upon female
sexual function is very sparse. Treatment with SSRIs and other
antidepressants may cause decreased libido and organism problems.
Antipsychotic treatment often causes libido, lubrication, and orgasm problems.
Spironolactone may cause decreased libido and impaired lubrication. Whether
antihypertensives, H2-receptor antagonists and sex hormones have sexual
adverse effects has not been clarified properly. Some drugs, such as bupropion
and sildenafil, may enhance the sexual function, but further studies have to be
carried out. The need for further research on the topic is stresse
Nefazadone (Serzone)-200mg $.94 per pill
Remeron (Mirtazapine-30mg $1.58 per pill
Antidepressant-induced sexual dysfunction.
OBJECTIVE: To review the evidence regarding antidepressant-induced sexual
dysfunction and address implications for treatment strategy and health plan
coverage policies for antidepressant medications. DATA SOURCES: Primary
articles were identified by a MEDLINE and HealthSTAR search to identify
English-language studies published between January 1986 and July 2000.
Search terms included sexual dysfunction or sexual function and
antidepressants, fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram,
venlafaxine, nefazodone, bupropion, and mirtazapine. A cross-check of
references cited in 10 published reviews yielded additional in-scope articles.
STUDY SELECTION AND DATA EXTRACTION: Approximately 200 articles
were identified, including 8 randomized controlled trials and numerous
open-label studies, case series, and case reports. Of the randomized controlled
trials, only 5 were designed to evaluate the incidence of sexual dysfunction
associated with antidepressant treatment. Three additional randomized
controlled trials included a structured assessment of sexual dysfunction within
an efficacy trial. Data extraction excluded case reports, letters, and other
limited study designs. A panel survey augmented published reports. DATA
SYNTHESIS: Sexual dysfunction is a relatively common adverse effect of
many of the antidepressants in common use today. Rates of sexual dysfunction
observed in clinical practice may be higher than those reported in the product
information for several agents. Selective serotonin-reuptake inhibitors (SSRIs)
appear to be the class of antidepressants most likely to cause sexual
dysfunction. Published studies suggest that between 30% and 60% of
SSRI-treated patients may experience some form of treatment-induced sexual
dysfunction. Bupropion and nefazodone appear to be much less likely to cause
sexual dysfunction (<=10% of patients). Mirtazapine also appears to be
associated with a low rate of sexual adverse effects. Panel results largely
reflect the consensus of the literature. CONCLUSIONS: Sexual dysfunction is
a common adverse effect of antidepressant treatment. Physicians should monitor
their patients for antidepressant-induced sexual adverse effects, as these may
affect compliance with therapy and ultimate treatment success. In addition to
the consequences for patient health and well-being, managed-care organizations
should be concerned with sexually related adverse effects of antidepressants,
insofar as additional healthcare resources may be required to treat depressed
patients in whom these adverse effects arise.
nefazodone-Serzone
Sexual function and satisfaction in the treatment of chronic major
depression with nefazodone, psychotherapy, and their
combination
BACKGROUND: Changes in sexual interest/satisfaction and function are
frequently associated with major depression and the use of some antidepressant
treatments. This study compares the effects of antidepressant medication,
psychotherapy, and combined treatment on sexual interest/satisfaction and
function in patients with chronic major depression. METHOD: Outpatients with
chronic forms of DSM-IV major depressive disorder (N = 681) were randomly
assigned to 12 weeks of nefazodone, Cognitive Behavioral Analysis System of
Psychotherapy (CBASP), or combined nefazodone/CBASP. The Modified Rush
Sexual Inventory was used to assess sexual functioning, and the 24-item
Hamilton Rating Scale for Depression was used to assess depressive symptoms.
RESULTS: At baseline, 65% of men and 48% of women reported some sexual
dysfunction. Statistically significant linear improvement in sexual
interest/satisfaction was noted across all 3 treatment groups (p < .001).
Additionally, significant improvement in sexual function was observed across all
3 treatment groups on a composite measure of female sexual function (p < .001).
Controlling for depressive symptoms and gender, combined treatment produced
greater improvement in total sexual interest/satisfaction than CBASP alone (p =
.007), but was not significantly different from nefazodone alone. Improvement
in depressive symptoms was associated with improved sexual
interest/satisfaction for men and women and, for men, improved sexual
functioning. CONCLUSION: Chronic depression is associated with high rates of
sexual dysfunction. Treatment with nefazodone, CBASP, and combined
treatment improved sexual interest/satisfaction, with greatest improvement
observed with combined treatment.
Ann Pharmacother 2002 Oct;36(10):1577-89
:
Antidepressant-induced sexual dysfunction.
Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM.
The Lewin Group, Falls Church, VA 22042, USA.
OBJECTIVE: To review the evidence regarding antidepressant-induced sexual
dysfunction and address implications for treatment strategy and health plan
coverage policies for antidepressant medications. DATA SOURCES: Primary articles
were identified by a MEDLINE and HealthSTAR search to identify English-language
studies published between January 1986 and July 2000. Search terms included
sexual dysfunction or sexual function and antidepressants, fluoxetine, sertraline,
paroxetine, fluvoxamine, citalopram, venlafaxine, nefazodone, bupropion, and
mirtazapine. A cross-check of references cited in 10 published reviews yielded
additional in-scope articles. STUDY SELECTION AND DATA EXTRACTION:
Approximately 200 articles were identified, including 8 randomized controlled trials
and numerous open-label studies, case series, and case reports. Of the randomized
controlled trials, only 5 were designed to evaluate the incidence of sexual
dysfunction associated with antidepressant treatment. Three additional randomized
controlled trials included a structured assessment of sexual dysfunction within an
efficacy trial. Data extraction excluded case reports, letters, and other limited
study designs. A panel survey augmented published reports. DATA SYNTHESIS:
Sexual dysfunction is a relatively common adverse effect of many of the
antidepressants in common use today. Rates of sexual dysfunction observed in
clinical practice may be higher than those reported in the product information for
several agents. Selective serotonin-reuptake inhibitors (SSRIs) appear to be the
class of antidepressants most likely to cause sexual dysfunction. Published studies
suggest that between 30% and 60% of SSRI-treated patients may experience some
form of treatment-induced sexual dysfunction. Bupropion and nefazodone appear to
be much less likely to cause sexual dysfunction . Mirtazapine
also appears to be associated with a low rate of sexual adverse effects. Panel
results largely reflect the consensus of the literature. CONCLUSIONS: Sexual
dysfunction is a common adverse effect of antidepressant treatment. Physicians
should monitor their patients for antidepressant-induced sexual adverse effects, as
these may affect compliance with therapy and ultimate treatment success. In
addition to the consequences for patient health and well-being, managed-care
organizations should be concerned with sexually related adverse effects of
antidepressants, insofar as additional healthcare resources may be required to
treat depressed patients in whom these adverse effects arise.
