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Tripathi A, Agrawal A, Joshi M. Treatment-emergent sexual dysfunctions due to antidepressants: A primer on assessment and management strategies. Indian J Psychiatry 2024; 66:293-303. [PMID: 39100123 PMCID: PMC11293283 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_784_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 08/06/2024] Open
Abstract
Antidepressants (ADs) are among the most commonly prescribed drugs worldwide. Persons with mental illness taking ADs commonly report sexual dysfunction (SD) related to treatment. A brief discussion on the neurobiology of sexual functioning and mechanism of treatment-emergent SD (TESD) was performed. The incidence of prevalence of TESD in various studies has been reviewed. TESD impacts patients as it frequently leads to nonadherence, while psychiatrists have challenges in proceeding forward with treatment in such patients. Assessment of patients with suspected TESD is described with a focus on practical tips for clinicians. Five strategies (watchful waiting, drug holiday, downward titration, switching, and add-on therapy) to manage TESD have been extensively discussed with evidence in the literature. Each strategy comes with its own bag of advantages and drawbacks, which have been pointed out for simplicity. A detailed discussion on individual pharmacological strategies is given, and options for non-pharmacological management that can be tried are enlisted. Common clinical case scenarios have been discussed to incorporate the implementation of this literature.
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Affiliation(s)
- Adarsh Tripathi
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Aditya Agrawal
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Mohita Joshi
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
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2
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Montejo AL, Sánchez-Sánchez F, De Alarcón R, Matías J, Cortés B, Matos C, Martín-Pinto T, Ríos P, González-García N, Acosta JM. Switching to Vortioxetine in Patients with Poorly Tolerated Antidepressant-Related Sexual Dysfunction in Clinical Practice: A 3-Month Prospective Real-Life Study. J Clin Med 2024; 13:546. [PMID: 38256680 PMCID: PMC10816261 DOI: 10.3390/jcm13020546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary to SSRIs occurs in >60% of sexually active patients and >80% of healthy volunteers, with this causing treatment discontinuation in >35% of patients. However, this factor is rarely addressed in routine examinations, and only 15-30% of these events are spontaneously reported. A strategy of switching to a different non-serotonergic antidepressant could involve a risk of relapse or clinical worsening due to a lack of serotonergic activity. Vortioxetine appears to have less impact on sexual function due to its multimodal mechanism of action. No studies have been published on the effectiveness of switching to vortioxetine in patients with poorly tolerated long-term antidepressant-related SD in naturalistic settings. STUDY OBJECTIVES To determine the effectiveness of switching to vortioxetine due to SD in a routine clinical practice setting. METHODOLOGY observational pragmatic and naturalistic study to determine the effectiveness of the switch to vortioxetine (mean dosage 13.11 ± 4.03) in 74 patients aged 43.1 ± 12.65 (54% males) at risk of discontinuing treatment due to sexual dysfunction. The PRSexDQ*- SALSEX scale (* Psychotropic-Related Sexual Dysfunction Questionnaire) was applied at two moments: baseline visit and after 3 months of follow-up. RESULTS global Sexual Dysfunction (SD) measured with the SALSEX scale decreased significantly between the baseline visit (10.32; SD 2.73) and the follow-up visit (3.78; SD 3.68), p < 0.001. There was a significant improvement (p < 0.001) at the endpoint including decreased libido, delay of orgasm, anorgasmia and arousal difficulties in both sexes. After switching to vortioxetine, 83.81% of patients experienced an improvement in sexual function (43.2% felt greatly improved). Most patients (83.3%) who switched to vortioxetine continued treatment after the follow-up visit. A total of 58.1% of patients showed an improvement in depressive symptoms from the baseline visit. CONCLUSION switching to vortioxetine is an effective and reliable strategy to treat patients with poorly tolerated previous antidepressant-related sexual dysfunction in real-life clinical settings.
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Affiliation(s)
- Angel L. Montejo
- Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37004 Salamanca, Spain
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente SN, 37007 Salamanca, Spain;
| | | | - Rubén De Alarcón
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Juan Matías
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Benjamin Cortés
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Claudia Matos
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Tomás Martín-Pinto
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Peñitas Ríos
- Hospital Universitario Cáceres, 10004 Cáceres, Spain;
| | | | - José María Acosta
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente SN, 37007 Salamanca, Spain;
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Sánchez-Sánchez F, Ponce-Buj B, Montejo-González AL, Sipán-Sarrión Y, Gimeno-Marqués A, Merino-Gámez A. [Impact of vortioxetine on sexual function compared to other antidepressants]. Semergen 2023; 49:101997. [PMID: 37329592 DOI: 10.1016/j.semerg.2023.101997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression. MATERIAL AND METHODS Analytical, observational, longitudinal and prospective study, which included men and women over 18years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i)study, starting treatment with vortioxetine; (2)control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4weeks and final 3months from inclusion. The total follow-up period was 3months. RESULTS A total of 87 patients were included (mean age 46.85years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42±4.39 and 16.13±7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function. CONCLUSIONS Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction.
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Affiliation(s)
- F Sánchez-Sánchez
- Medicina de Familia y Comunitaria, Centro de Salud Xàtiva, Xàtiva, Valencia, España.
| | - B Ponce-Buj
- Medicina de Familia y Comunitaria, Centro de Salud Alaquàs, Alaquàs, Valencia, España
| | - A L Montejo-González
- Servicio de Psiquiatría, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Y Sipán-Sarrión
- Medicina de Familia y Comunitaria, Centro de Salud Xàtiva, Xàtiva, Valencia, España
| | - A Gimeno-Marqués
- Medicina de Familia y Comunitaria, Centro de Salud L'Alcúdia, L'Alcúdia, Valencia, España
| | - A Merino-Gámez
- Medicina de Familia y Comunitaria, Centro de Salud Rafelbunyol, Rafelbunyol, Valencia, España
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May GB, de Souza BR, Gueuvoghlanian-Silva BY, Dos Reis EC, Mostardeiro SR, Boabaid May PP, Mateo EC, Vietta GG, Hoss GW. Distribution of pharmacogene allele and phenotype frequencies in Brazilian psychiatric patients. Pharmacogenomics 2023; 24:747-760. [PMID: 37846556 DOI: 10.2217/pgs-2023-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Purpose: This work was designed to identify the pharmacogenetic profile of Brazilian psychiatric patients receiving psychoactive drug treatment according to ethnicity. Methods: Based on the GnTech® database, this cross-sectional study analyzed data from self-reported sociodemographic and genetic results from the next-generation sequencing panel composed of 26 pharmacogenes from 359 psychotropic drug users. Results: Variant frequencies of multiple pharmacogenes presented differences between ethnicities (CYP3A5, CYP2D6, CYP1A2, CYP2B6, CYP3A4, UGT1A4, UGT2B15, ABCB1 rs1045642, ADRA2A rs1800544, COMT rs4680, GRIK4 rs1954787, GSK3B rs334558, GSK3B rs6438552, HTR1A rs6295, HTR2A rs7997012, HTR2C rs1414334, MTHFR rs1801131, OPRM1 rs1799971 and 5-HTTLPR), endorsing the necessity of individual-level analyses in drug treatment. Conclusion: A discussion of pharmacogenomic test implementation in psychiatric clinical practice is needed to improve treatment choices, especially in Brazil, a multiethnic country.
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Affiliation(s)
| | | | | | | | - Sofia Rech Mostardeiro
- Universidade do Sul de Santa Catarina (UNISUL)-Campus Pedra Branca, Palhoça, SC, 88137-270, Brazil
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Resolution of Selective Serotonin Reuptake Inhibitor-Associated Sexual Dysfunction After Switching From Fluvoxamine to Fluoxetine. J Clin Psychopharmacol 2023; 43:71-73. [PMID: 36445984 PMCID: PMC10068629 DOI: 10.1097/jcp.0000000000001636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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6
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New Challenges in Sexuality and Sexual Dysfunction. J Clin Med 2022; 12:jcm12010203. [PMID: 36615004 PMCID: PMC9821202 DOI: 10.3390/jcm12010203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Human sexuality constitutes not only a basic need but also a right that significantly enriches interpersonal relationships, providing mutual satisfaction and pleasure [...].
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Espinola CW, Khoo Y, Parmar R, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Males and females differ in reported sexual functioning with escitalopram treatment for major depressive disorder: A CAN-BIND-1 study report. J Psychopharmacol 2022; 36:604-613. [PMID: 35546043 DOI: 10.1177/02698811221095832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Antidepressant use for major depressive disorder (MDD) is frequently associated with sexual dysfunction. AIMS Cross-sectional and longitudinal relationships between antidepressant treatment outcomes and sexual functioning (SF) were evaluated separately for males and females receiving escitalopram. We further assessed the association between pre- and posttreatment SF. METHODS In all, 208 of the 211 CAN-BIND-1 trial participants (77 males and 131 females) with MDD and detectable drug blood levels were eligible for the analyses. All received escitalopram (10-20 mg) for 8 weeks. At baseline and Week 8, participants completed the Montgomery-Åsberg Depression Rating Scale (MADRS) and the SexFx scale, which measures sexual satisfaction and SF frequency. Mixed-model repeated measures assessed baseline to Week 8 SF changes among participants with different response/remission statuses. Multiple linear regression analyses examined SF differences between treatment outcomes at Week 8 as well as associations between pretreatment and eventual SF. RESULTS For both sexes, overall sexual satisfaction improved among responders but not among nonresponders (p < 0.05). For females, overall SF frequency did not change significantly over time regardless of response status. For males, overall SF decreased significantly among nonresponders; orgasm decreased significantly among nonresponders and, to a lesser extent, among responders (p < 0.05). For both sexes, pretreatment SF was significantly associated with SF at Week 8 across all domains (p < 0.05). CONCLUSION For both sexes, sexual satisfaction improves with response to escitalopram. For females, the response does not correspond to improvements in SF frequency. For males, SF frequency, particularly that of orgasm, declines regardless of response/nonresponse.ClinicalTrials.gov identifier: NCT01655706.
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Affiliation(s)
- Caroline W Espinola
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuelee Khoo
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Roohie Parmar
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Keith Ho
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
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8
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Canpolat S, Ulker N, Yardimci A, Tancan E, Sahin E, Yaman SO, Bulmuş O, Alver A, Ozcan M. Irisin ameliorates male sexual dysfunction in paroxetine-treated male rats. Psychoneuroendocrinology 2022; 136:105597. [PMID: 34861466 DOI: 10.1016/j.psyneuen.2021.105597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 01/23/2023]
Abstract
Sexual dysfunction is a common clinical condition due to different causes including the use of selective serotonin reuptake inhibitors (SSRI). Especially, SSRI paroxetine is known to cause numerous types of sexual dysfunction in men. There is growing interest in exercise as a non-pharmacological approach for the treatment of SSRI-induced sexual dysfunction. With these in mind, we investigated the effects of irisin, which is a recently detected exercise-linked hormone, on paroxetine-induced sexual dysfunction in male rats. Our findings showed that circulating irisin levels were lower in paroxetine-induced sexual dysfunction in male rats (20 mg/kg/day for 8 weeks by oral gavage than in vehicle-treated rats). In addition, results from sexual behavioral tests revealed that subcutaneous irisin perfusion (100 ng/kg/day via mini-osmotic pumps for 28 days) ameliorated sexual motivation and copulatory performance in sexually impaired male rats treated with paroxetine. The significantly reduced serum testosterone levels and α1-adrenoceptors (ADRA1A) and tyrosine hydroxylase gene (TH) expression levels in the nucleus accumbens (NAc) in paroxetine-induced sexually dysfunctioning male rats were markedly increased following irisin exposure. Similarly, the expression levels of ADRA1A and TH in the medial preoptic area (mPOA) significantly increased in male rats co-administered with paroxetine and irisin compared to the vehicle-treated male rats. These results demonstrate that irisin may be a therapeutic modality that mimics/supports the beneficial effects of exercise for improving SSRI-associated sexual dysfunction in men through increase in serum testosterone levels and increased expression of α1-adrenoceptors and TH in the NAc and mPOA associated with sexual motivation and copulatory behaviors.
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Affiliation(s)
- Sinan Canpolat
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey.
| | - Nazife Ulker
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Ahmet Yardimci
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Emre Tancan
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Elif Sahin
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Serap Ozer Yaman
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ozgur Bulmuş
- Department of Physiology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Ahmet Alver
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mete Ozcan
- Department of Biophysics, Faculty of Medicine, Firat University, Elazig, Turkey
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Buch-Vicente B, Acosta JM, Martín-Oterino JA, Prieto N, Sánchez-Sánchez ME, Galindo-Villardón P, Montejo AL. Frequency of Iatrogenic Sexual Dysfunction Associated with Antihypertensive Compounds. J Clin Med 2021; 10:jcm10225214. [PMID: 34830496 PMCID: PMC8621060 DOI: 10.3390/jcm10225214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022] Open
Abstract
Iatrogenic sexual dysfunction (SD) caused by antihypertensive (AH) compounds, provoking sexual desire, orgasm or arousal dysfunction, is a common clinical adverse event. Unfortunately, it is often underestimated and underreported by clinicians and prescribers in clinical practice, deteriorating the adherence and patient quality of life. The objective of this study was to investigate the frequency of SD in patients treated with different antihypertensive compounds; a real-life naturalistic and cross-sectional study in patients receiving AH treatment was carried out. Method: A total of 256 patients were included in the study (188 males and 68 females who met the inclusion and exclusion criteria). The validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) was transversally applied once at least every two months following the onset of the treatment in order to measure possible AH-related SD. Although the spontaneous reporting of SD was very low (6.81% females/24.8% males), 66.40% of the patients reported impaired sexual function through the SALSEX questionnaire after the treatment onset, as follows: decreased desire (55.8% females/54.2% males), delayed orgasm (42.6%/45.7%), anorgasmia (42.6%/43.6%) and arousal difficulties (53%/59.6%). The average frequency of moderate to severe iatrogenic SD was 66.4% with AH in monotherapy as follows: angiotensin II receptor antagonists (ARBs), 29.8%; calcium antagonists, 40%; diuretics, 42.9%; beta blockers, 43.8%; and angiotensin-converting enzyme (ACE) inhibitors, 77.8%. Combined treatments showed a higher percentage of main SD (70.3%): diuretic + ACE inhibitor, 42.3%; ARB + calcium antagonist, 55.6%; diuretic + calcium antagonist, 68.8%; and diuretic + ARB, 74.2%. The greatest risk factors associated with SD were poor general health, age over 60 with a comorbid coronary or musculoskeletal disease, mood disorder and diuretic +ARB combined therapy. Conclusion: SD is common in patients treated with antihypertensive drugs, and it is still underreported. The most harmful treatment deteriorating sexual function was the combination of diuretic +ARB, while the least harmful was monotherapy with ARBs. More research is needed on the clinical management of this problem to preserve the quality of life of patients and their partners.
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Affiliation(s)
- Bárbara Buch-Vicente
- Instituto Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (B.B.-V.); (N.P.); (M.E.S.-S.); (A.L.M.)
| | - José Mª. Acosta
- Instituto Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (B.B.-V.); (N.P.); (M.E.S.-S.); (A.L.M.)
- Correspondence: ; Tel.: +34-63975-4620
| | - José-Angel Martín-Oterino
- Internal Medicine Service, Clinical Hospital of Salamanca, Paseo San Vicente SN, 37007 Salamanca, Spain;
| | - Nieves Prieto
- Instituto Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (B.B.-V.); (N.P.); (M.E.S.-S.); (A.L.M.)
- Psychiatry Service, Clinical Hospital of Salamanca, Paseo San Vicente SN, 37007 Salamanca, Spain
| | - María Elena Sánchez-Sánchez
- Instituto Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (B.B.-V.); (N.P.); (M.E.S.-S.); (A.L.M.)
| | - Purificación Galindo-Villardón
- Statistical Department, Campus Miguel de Unamuno, University of Salamanca, Calle Alfonso X El Sabio s/n, 37007 Salamanca, Spain;
- Centro de Investigación Institucional, Universidad Bernanrdo O’Higgins, Av. Viel 1497, Santiago 8320000, Chile
| | - Angel L. Montejo
- Instituto Investigación Biomédica de Salamanca (IBSAL), Paseo San Vicente SN, 37007 Salamanca, Spain; (B.B.-V.); (N.P.); (M.E.S.-S.); (A.L.M.)
- Psychiatry Service, Clinical Hospital of Salamanca, Paseo San Vicente SN, 37007 Salamanca, Spain
- Department of Psychiatry, Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37007 Salamanca, Spain
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Lynch CJ, Prus AJ. Assessment of antidepressant-like effects of dextromethorphan on differential reinforcement of low-rate 72-s performance in rats. Behav Pharmacol 2021; 32:549-560. [PMID: 34417357 DOI: 10.1097/fbp.0000000000000649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effectiveness of ketamine for treatment-resistant depression along with several other clinical advantages, such as rapid onset and reduced adverse effects associated with serotonin transporter inhibition, has garnered interest in other similar acting psychedelics as novel antidepressant drugs. The antitussive dextromethorphan exhibits glutamate N-methyl-d-aspartate receptor antagonism, sigma-1 receptor agonism, and serotonin reuptake inhibition, which has exhibited antidepressant effects in limited human studies and animal models. The present study sought to further examine dextromethorphan using a differential reinforcement of low-rate 72-s schedule, which can be used to screen antidepressant drugs, in male and female rats. The tricyclic antidepressant drug imipramine and the psychostimulant d-amphetamine also were examined. Sex differences were not shown for baseline performance or for the drugs tested. Further, performance did not differ between the estrus and diestrus stages. Dextromethorphan alone and with quinidine produced an antidepressant-like effect by reducing the number of responses emitted, increasing the number of reinforcers earned, and shifting inter-response times to the right, although significant response suppression occurred at these doses. An antidepressant-like effect was shown with imipramine, but d-amphetamine increased the number of responses emitted and did not affect the number of reinforcers earned. The present findings provide additional support for antidepressant effects produced by dextromethorphan.
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Affiliation(s)
- Cayla J Lynch
- Department of Psychological Science, Northern Michigan University, Marquette, Michigan, USA
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11
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Ekemen A, Beydağ KD. Quality of sexual life and factors affecting it in married women undergoing depression treatment. Perspect Psychiatr Care 2021; 57:1019-1025. [PMID: 33089911 DOI: 10.1111/ppc.12650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This descriptive study was conducted to determine the factors affecting the quality of sexual life of married and sexually active women treated with medication due to depression. METHODS Sample included 228 depressive patients on antidepressants for at least 1 month presenting to the Psychiatry Clinic of a hospital in the west side of Turkey, between April and June 2018. RESULTS Women who were in the young age group, did not have any problems in sexual life before starting depression medication, had sexual intercourse 11 times or more per month, proposed to initiate a sexual intercourse together with their husbands were found to have higher Sexual Quality of Life-Female scores. There was a decrease in the women's frequency of sexual intercourse per month after the use of medication.
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Affiliation(s)
- Alev Ekemen
- İzmir Tepecik Research and Training Hospital, Education Family Health Center, İzmir, Turkey
| | - Kerime Derya Beydağ
- Department of Nursing, Faculty of Health Sciences, Istanbul Okan University, Istanbul, Turkey
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12
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Seifert J, Führmann F, Reinhard MA, Engel RR, Bernegger X, Bleich S, Stübner S, Rüther E, Toto S, Grohmann R, Sieberer M, Greil W. Sex differences in pharmacological treatment of major depressive disorder: results from the AMSP pharmacovigilance program from 2001 to 2017. J Neural Transm (Vienna) 2021; 128:827-843. [PMID: 33977402 PMCID: PMC8205885 DOI: 10.1007/s00702-021-02349-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/02/2021] [Indexed: 12/25/2022]
Abstract
Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program "Drug Safety in Psychiatry" (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001-2003) with the last time period (2015-2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12-1.19), especially mirtazapine (RR 1.16; 95% CI 1.12-1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35-1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03-1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83-0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86-0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81-0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015-2017 than in 2001-2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.
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Affiliation(s)
- Johanna Seifert
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Fabienne Führmann
- Department of Psychiatry and Psychotherapy, KRH Psychiatrie GmbH, Wunstorf, Germany
| | - Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Rolf R Engel
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Xueqiong Bernegger
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Susanne Stübner
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Department of Forensic Psychiatry, Bezirksklinikum Ansbach, Ansbach, Germany
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Prosomno, Clinic for Sleep Medicine, Munich, Germany
| | - Sermin Toto
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Renate Grohmann
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Marcel Sieberer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, St. Marien-Hospital Hamm gGmbH, Hamm, Germany.,Department of Psychiatry and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Waldemar Greil
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany.,Psychiatric Private Hospital, Sanatorium Kilchberg, Kilchberg, Switzerland
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13
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Wang Z, Li J, Wu W, Qi T, Huang Z, Wang B, Li S, Li C, Ding J, Zeng Y, Huang P, Zhou Z, Huang Y, Huang J, Wang X, Huang Q, Zhang G, Qiu P, Chen J. Saikosaponin D Rescues Deficits in Sexual Behavior and Ameliorates Neurological Dysfunction in Mice Exposed to Chronic Mild Stress. Front Pharmacol 2021; 12:625074. [PMID: 33776766 PMCID: PMC7990100 DOI: 10.3389/fphar.2021.625074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 01/17/2023] Open
Abstract
Often associated with sexual dysfunction (SD), chronic stress is the main contributing risk factor for the pathogenesis of depression. Radix bupleuri had been widely used in traditional Chinese medicine formulation for the regulation of emotion and sexual activity. As the main active component of Radix bupleuri, saikosaponin D (SSD) has a demonstrated antidepressant effect in preclinical studies. Herein, we sought to investigate the effect of SSD to restore sexual functions in chronically stressed mice and elucidate the potential brain mechanisms that might underly these effects. SSD was gavage administered for three weeks during the induction of chronic mild stress (CMS), and its effects on emotional and sexual behaviors in CMS mice were observed. The medial posterodorsal amygdala (MePD) was speculated to be involved in the manifestation of sexual dysfunctions in CMS mice. Our results revealed that SSD not only alleviated CMS-induced depressive-like behaviors but also rescued CMS-induced low sexual motivation and poor sexual performance. CMS destroyed astrocytes and activated microglia in the MePD. SSD treatment reversed the changes in glial pathology and inhibited neuroinflammatory and oxidative stress in the MePD of CMS mice. The neuronal morphological and functional deficits in the MePD were also alleviated by SSD administration. Our results provide insights into the central mechanisms involving the brain associated with sexual dysfunction. These findings deepen our understanding of SSD in light of the psychopharmacology of stress and sexual disorders, providing a theoretical basis for its potential clinical application.
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Affiliation(s)
- Zhuo Wang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianwei Li
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Wu
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tao Qi
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhansen Huang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Wang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shixiong Li
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Li
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Jiuyang Ding
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Yuanning Zeng
- Research Center for Good Practice in TCM Proessing Technology, Guangdong Pharmaceutical University, Guangzhou, China
| | - Peng Huang
- Foshan Maternal and Child Health Hospital, Affiliated Hospital of Southern Medical University, Foshan, China
| | - Zhihua Zhou
- Department of Neurology, The First Affiliated Hospital, School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yanjun Huang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Huang
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Xiaohan Wang
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Qiyuan Huang
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Guanghuan Zhang
- Department of Nutrition, Hospital of Integrated Traditional Chinese Medical and Western Medicine, Southern Medical University, Guangzhou, China
| | - Pingming Qiu
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Jun Chen
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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14
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Levy A, El-Hage W, Bennabi D, Allauze E, Bouvard A, Camus V, Courtet P, Dorey JM, Etain B, Fond G, Genty JB, Holtzmann J, Horn M, Leboyer M, Llorca PM, Meyrel M, Molière F, Nguon AS, Petrucci J, Rey R, Richieri R, Stephan F, Vaiva G, Walter M, Haffen E, Aouizerate B, Yrondi A. Occurrence of Side Effects in Treatment-Resistant Depression: Role of Clinical, Socio-Demographic and Environmental Characteristics. Front Psychiatry 2021; 12:795666. [PMID: 34938218 PMCID: PMC8685450 DOI: 10.3389/fpsyt.2021.795666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Treatment-resistant depression (TRD) is a disabling psychiatric condition characterized by the failure of two antidepressants (ADs). Since the occurrence of side effects (SEs) appears to be one of the main determinants of early discontinuation of pharmacological treatments contributing to a pseudo-resistance, the purpose of this study was to determine the parameters associated with the occurrence of SEs under ADs in a cohort of patients with TRD. Methods: An observational, cross-sectional, multicentre study was carried out using data from the French network of Expert Centers for TRD. For the 108 patients enrolled in the study, the statistical analyses focused on the overall occurrence and on the profile of the SEs (9 categories, 32 items). Results: SEs were influenced by age and sex and were positively associated with the intensity of anxious, depressive and suicidal symptoms, a history of childhood trauma (sexual abuse, emotional abuse and neglect), and negatively associated with self-esteem, and assessment of overall functioning. Conclusion: Using variables accessible in common practice, these results fall within the dynamic of a more tailored approach to medicine that could allow, through integrated pharmacological management, the continuation of antidepressant treatments, and therefore limit the risk of therapeutic failure.
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Affiliation(s)
- Anna Levy
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie et de Psychologie Médicale de l'adulte (Department of Psychiatry and Adult Medical Psychology), Centre Expert Dépression Résistante FondaMental (FondaMental Advanced Centre of Expertise in Resistant Depression, CHU de Toulouse (University Hospital Centre), Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), INSERM, UPS, Toulouse, France
| | - Wissam El-Hage
- Fondation FondaMental, Créteil, France.,U1253, iBrain, CIC1415, Inserm, CHRU de Tours (Regional University Hospital Centre), Université de Tours, Tours, France
| | - Djamila Bennabi
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie, Centre Expert Dépression Résistante FondaMental, CIC-1431 INSERM, CHU de Besançon, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Etienne Allauze
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - Alexandra Bouvard
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie Générale et Universitaire (Department of General and University Academic Psychiatry Cluster), Centre de référence régional des pathologies anxieuses et de la dépression (Regional Reference Center for the Management and Treatment of Anxiety and Depressive Disorders), Centre Expert Dépression Résistante FondaMental (FondaMental Advanced Centre of Expertise in Resistant Depression), CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (Integrated Nutrition and Neurobiology Laboratory) (UMR INRAE 1286), Université de Bordeaux (Bordeaux University), Bordeaux, France
| | - Vincent Camus
- Fondation FondaMental, Créteil, France.,U1253, iBrain, CIC1415, Inserm, CHRU de Tours (Regional University Hospital Centre), Université de Tours, Tours, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Jean-Michel Dorey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: from Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier (Hospital Centre), Bron, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Université de Paris et AP-HP - GHU Lariboisière-Fernand Widal - Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France.,Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Jean-Baptiste Genty
- Fondation FondaMental, Créteil, France.,Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Cluster), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Scientific Cooperation Foundation), Créteil, France
| | - Jérôme Holtzmann
- Fondation FondaMental, Créteil, France.,Service Hospitalo-Universitaire de Psychiatrie, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences (Institute of Neurosciences), Grenoble, France
| | - Mathilde Horn
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Cluster), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Scientific Cooperation Foundation), Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - Manon Meyrel
- Fondation FondaMental, Créteil, France.,Université de Paris et AP-HP - GHU Lariboisière-Fernand Widal - Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Fanny Molière
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, INSERM U1061, Montpellier University, Montpellier, France
| | - Anne-Sophie Nguon
- Fondation FondaMental, Créteil, France.,Service Hospitalo-Universitaire de Psychiatrie, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences (Institute of Neurosciences), Grenoble, France
| | - Jean Petrucci
- Fondation FondaMental, Créteil, France.,Université Paris-Est, UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie génétique (Team 15 Genetic Psychiatry), Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de psychiatrie (Psychiatry Cluster), Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique (Scientific Cooperation Foundation), Créteil, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, University Lyon 1, Lyon Neuroscience Research Centre, Psychiatric Disorders: from Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier (Hospital Centre), Bron, France
| | - Raphaelle Richieri
- Fondation FondaMental, Créteil, France.,Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Florian Stephan
- Fondation FondaMental, Créteil, France.,Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02 (University Hospital Department of General Psychiatry and Psychosocial Rehabilitation), Centre Expert Depression Résistante FondaMental, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Guillaume Vaiva
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie adulte (Department of Adult Psychiatry), Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France.,Centre National de Ressources et Résilience pour les psychotraumatismes (Cn2r Lille Paris), Lille, France
| | - Michel Walter
- Fondation FondaMental, Créteil, France.,Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02 (University Hospital Department of General Psychiatry and Psychosocial Rehabilitation), Centre Expert Depression Résistante FondaMental, EA 7479, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Emmanuel Haffen
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie, Centre Expert Dépression Résistante FondaMental, CIC-1431 INSERM, CHU de Besançon, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie Générale et Universitaire (Department of General and University Academic Psychiatry Cluster), Centre de référence régional des pathologies anxieuses et de la dépression (Regional Reference Center for the Management and Treatment of Anxiety and Depressive Disorders), Centre Expert Dépression Résistante FondaMental (FondaMental Advanced Centre of Expertise in Resistant Depression), CH Charles Perrens, Bordeaux, Laboratoire Nutrition et Neurobiologie intégrée (Integrated Nutrition and Neurobiology Laboratory) (UMR INRAE 1286), Université de Bordeaux (Bordeaux University), Bordeaux, France
| | - Antoine Yrondi
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie et de Psychologie Médicale de l'adulte (Department of Psychiatry and Adult Medical Psychology), Centre Expert Dépression Résistante FondaMental (FondaMental Advanced Centre of Expertise in Resistant Depression, CHU de Toulouse (University Hospital Centre), Hôpital Purpan, ToNIC Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), INSERM, UPS, Toulouse, France
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15
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Du Y, Zheng Q, Ou ZH, Cao YJ, Su XP, Li C, Qu M. Efficacy and safety of Morinda officinalis oligosaccharide capsules for depressive disorder: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2020; 43:306-313. [PMID: 32997072 PMCID: PMC8136385 DOI: 10.1590/1516-4446-2020-0945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/12/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of Morinda officinalis oligosaccharide (MOO) capsules for depressive disorder. METHODS Eight electronic databases were searched for relevant studies from inception to April 19, 2020. Randomized controlled trials comparing MOO capsules with antidepressants were included. Data analysis was conducted using Review Manager 5.3 software. The risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of the studies was evaluated by two researchers using the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) software. RESULTS Seven studies involving 1,384 participants were included in this study. The effect of MOO capsules for moderate depressive disorder was not different from that of antidepressants (risk ratio [RR] = 0.99, 95%CI 0.92-1.06). Regarding adverse events, no significant difference was found between MOO capsules and antidepressants (RR = 0.84, 95%CI 0.65-1.07). In addition, the quality of evidence related to these adverse events was rated as low. CONCLUSION This systematic review suggests that the efficacy of MOO capsules in the treatment of mild to moderate depression is not inferior to that of conventional antidepressants, which may provide a new direction for clinical alternative selection of antidepressants. However, more high-quality research and detailed assessments are needed.
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Affiliation(s)
- Yun Du
- Neurology Department, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qin Zheng
- Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zheng-Hang Ou
- Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Jia Cao
- Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Peng Su
- Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Miao Qu
- Neurology Department, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
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16
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Montejo AL, Lourenço M. Editorial: Safety and Tolerability of Psychotropic Compounds. Front Neurosci 2020; 14:509. [PMID: 32625046 PMCID: PMC7314897 DOI: 10.3389/fnins.2020.00509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Angel L Montejo
- Faculty of Nursing, IBSAL, University of Salamanca, Salamanca, Spain
| | - Mario Lourenço
- Department of Psychiatry, Hospital da Senhora da Oliveira Guimarães, Guimarães, Portugal
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17
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Freeman MP, Fava M, Dirks B, Jha MK, Papakostas GI, Shelton RC, Thase ME, Trivedi MH, Liu K, Stankovic S. Improvement of sexual functioning during treatment of MDD with adjunctive pimavanserin: A secondary analysis. Depress Anxiety 2020; 37:485-495. [PMID: 32301591 DOI: 10.1002/da.23017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sexual dysfunction is common among patients with major depressive disorder (MDD). In the CLARITY study, the safety and efficacy of adjunctive pimavanserin, an inverse agonist at 5-HT2A receptors, were demonstrated when added to existing treatment for MDD. This analysis provides a detailed assessment of the effects of pimavanserin on sexual function from the CLARITY study. METHODS Patients with a diagnosis of MDD in a depressive episode, inadequate response to ongoing antidepressant therapy, and a Montgomery-Åsberg Depression Rating Scale total score >20 were randomized to pimavanserin 34 mg/day or placebo added to ongoing treatment with an immediate revision of all selective serotonin or serotonin-norepinephrine for 5 weeks (Stage 1), and nonresponders (<50% improvement from baseline in Hamilton Depression Rating Scale [HAMD-17]) were re-randomized for an additional 5 week (Stage 2). Effects of pimavanserin on the Massachusetts General Hospital Sexual Functioning Index (MGH-SFI) and HAMD-17 Item 14 (sexual interest) were examined. RESULTS Among 203 patients (51 on pimavanserin; 152 on placebo), pimavanserin demonstrated significant improvement from baseline to Week 5 on the MGH-SFI (least square [LS]mean difference -0.634, 95% confidence interval [CI] [-0.964, -0.304]; p = .0002; effect size [ES], Cohen's d: .614). Across Stages 1 and 2, the weighted LSmean difference was -0.468 (95% CI [-0.720, -0.216]; p = .0003) for pimavanserin versus placebo. Mean changes from baseline to Week 5 for MGH-SFI Items 1, 2, 3, and 5 and HAMD Item 14 were significantly (p < .05) greater with pimavanserin versus placebo. CONCLUSIONS Adjunctive pimavanserin improved sexual function in patients with MDD. Adding pimavanserin to ongoing treatment for MDD may be especially useful for patients experiencing sexual dysfunction.
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Affiliation(s)
- Marlene P Freeman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Bryan Dirks
- Medical Department, ACADIA Pharmaceuticals Inc., San Diego, California
| | - Manish K Jha
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George I Papakostas
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Keith Liu
- Medical Department, ACADIA Pharmaceuticals Inc., San Diego, California
| | - Srdjan Stankovic
- Medical Department, ACADIA Pharmaceuticals Inc., San Diego, California
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18
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Lorenz TK. Antidepressant Use During Development May Impair Women's Sexual Desire in Adulthood. J Sex Med 2020; 17:470-476. [PMID: 31937517 PMCID: PMC7197954 DOI: 10.1016/j.jsxm.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/15/2019] [Accepted: 12/07/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Although antidepressants are well known to cause sexual side effects in adults, the long-term effects of antidepressant use during development on adult sexual function is unknown. AIM To explore differences in sexual desire and sexual behavior between adults who did vs did not use antidepressants during childhood or adolescence. METHODS An online survey of 610 young adults (66% women) assessed childhood and current mental health and use of antidepressants and other psychiatric medications before the age of 16 years and currently, partnered and solitary sexual desire, and frequency of masturbation and partnered sexual activity. Antidepressants were coded into either selective serotonin reuptake inhibitors (SSRIs) or non-SSRI antidepressants. MAIN OUTCOME MEASURE Scores on the Sexual Desire Inventory, and self-reported frequency of masturbation and partnered sexual activity. RESULTS For women, childhood SSRI use was associated with significantly lower solitary sexual desire, desire for an attractive other, and frequency of masturbation. This was true even when controlling for childhood mental health concerns, current mental health, and current antidepressant use. However, there was no effect of childhood SSRI use on women's partnered sexual desire or partnered sexual activity. There was no significant effect of childhood antidepressant use on men's sexual desire or masturbation. However, in men, childhood use of non-SSRI antidepressants was associated with significantly higher frequency of partnered sexual activity. Childhood use of non-SSRI antidepressants, or nonantidepressant psychiatric medication, was not associated with adult sexual desire or behavior in either women or men. CLINICAL IMPLICATIONS It is possible that SSRI use during childhood interrupts the normal development of sexual reward systems, which may be a risk factor for sexual desire dysfunction in adult women. STRENGTHS & LIMITATIONS Strengths include a large sample, use of attention checks and validated measures, and careful assessment of childhood mental health history; however, generalizability is limited by a predominantly white, young adult sample. These data are cross-sectional, and therefore, causal explanations for the association between childhood SSRI use and adult sexual well-being should be considered preliminary, warranting replication. CONCLUSION These findings point to a critical need for well-controlled, prospective research on possible long-term effects of antidepressant use, particularly SSRI use, on the development of adult sexual well-being. Lorenz TK. Antidepressant Use During Development May Impair Women's Sexual Desire in Adulthood. J Sex Med 2020;17:470-476.
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Affiliation(s)
- Tierney K Lorenz
- Department of Psychology and Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, NE.
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Montejo AL. Sexuality and Mental Health: The Need for Mutual Development and Research. J Clin Med 2019; 8:jcm8111794. [PMID: 31717765 PMCID: PMC6912629 DOI: 10.3390/jcm8111794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 01/25/2023] Open
Abstract
Research in the field of sexuality has shown growing scientific development in recent years, although there’s a lack of well-trained professionals who could contribute to increasing its benefits. Sexuality continues to be a taboo with different interpretations and difficult delimitation of either normal or pathological behavior. More resources are needed for the understanding of new emerging pathologies, and to increase the research in new models of sexual behavior. All psychiatric diseases include symptoms affecting sexual life, such as impaired desire, arousal, or sexual satisfaction that need to be properly addressed. Health providers and prescribers must detect and prevent iatrogenic sexual dysfunction that can highly deteriorate a patient’s sexual life and satisfaction, leading to frequent drop-outs of medication. Approaching and researching aspects of sexual intimacy, life desires, frustrations, and fears undoubtedly constitutes the best mental health care.
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Affiliation(s)
- Angel L Montejo
- University of Salamanca, Psychiatry Service, Clinical Hospital, Faculty of Nursing and Institute of Biomedical Research of Salamanca (IBSAL), Avenue of Donantes de Sangre SN, 37007 Salamanca, Spain
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Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med 2019; 8:jcm8101640. [PMID: 31591339 PMCID: PMC6832699 DOI: 10.3390/jcm8101640] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
Major depressive disorder is a serious mental disorder in which treatment with antidepressant medication is often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) has a low rate of spontaneous reports by patients, and this side effect therefore remains underestimated in clinical practice and in technical data sheets for antidepressants. Moreover, the issue of TESD is rarely routinely approached by clinicians in daily praxis. TESD is a determinant for tolerability, since this dysfunction often leads to a state of patient distress (or the distress of their partner) in the sexually active population, which is one of the most frequent reasons for lack of adherence and treatment drop-outs in antidepressant use. There is a delicate balance between prescribing an effective drug that improves depressive symptomatology and also has a minimum impact on sexuality. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antidepressant with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: for low sexual desire, switching to a non-serotoninergic drug, lowering the dose, or associating bupropion or aripiprazole; for unwanted orgasm delayal or anorgasmia, dose reduction, “weekend holiday”, or switching to a non-serotoninergic drug or fluvoxamine; for erectile dysfunction, switching to a non-serotoninergic drug or the addition of an antidote such as phosphodiesterase 5 inhibitors (PD5-I); and for lubrication difficulties, switching to a non-serotoninergic drug, dose reduction, or using vaginal lubricants. A psychoeducational and psychotherapeutic approach should always be considered in cases with poorly tolerated sexual dysfunction.
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Casado-Espada NM, de Alarcón R, de la Iglesia-Larrad JI, Bote-Bonaechea B, Montejo ÁL. Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review. J Clin Med 2019; 8:E908. [PMID: 31242625 PMCID: PMC6617135 DOI: 10.3390/jcm8060908] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
In recent decades, hormonal contraceptives (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied. However, the influence of these drugs on female sexual functioning is not so clear, although variations in the plasma levels of sexual hormones could be associated with sexual dysfunction. Permanent hormonal modifications, during menopause or caused by some endocrine pathologies, could be directly related to sexual dysfunction in some cases but not in all of them. HC use seems to be responsible for a decrease of circulating androgen, estradiol, and progesterone levels, as well as for the inhibition of oxytocin functioning. Hormonal contraceptive use could alter women's pair-bonding behavior, reduce neural response to the expectation of erotic stimuli, and increase sexual jealousy. There are contradictory results from different studies regarding the association between sexual dysfunction and hormonal contraceptives, so it could be firmly said that additional research is needed. When contraceptive-related female sexual dysfunction is suspected, the recommended therapy is the discontinuation of contraceptives with consideration of an alternative method, such as levonorgestrel-releasing intrauterine systems, copper intrauterine contraceptives, etonogestrel implants, the permanent sterilization of either partner (when future fertility is not desired), or a contraceptive ring.
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Affiliation(s)
- Nerea M Casado-Espada
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Rubén de Alarcón
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Javier I de la Iglesia-Larrad
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Berta Bote-Bonaechea
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Ángel L Montejo
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
- Nursing School E.U.E.F., University of Salamanca, Av. Donantes de Sangre SN 37007 Salamanca, Spain.
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Frequency of Sexual Dysfunction in Patients Treated with Desvenlafaxine: A Prospective Naturalistic Study. J Clin Med 2019; 8:jcm8050719. [PMID: 31117203 PMCID: PMC6571783 DOI: 10.3390/jcm8050719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 01/23/2023] Open
Abstract
Despite being clinically underestimated, sexual dysfunction (SD) is one of the most frequent and lasting adverse effects associated with antidepressants. Desvenlafaxine is an antidepressant (AD) with noradrenergic and serotonergic action that can cause a lower SD than other serotonergic ADs although there are still few studies on this subject. Objective: To check the frequency of SD in two groups of depressive patients: one group was desvenlafaxine-naïve; the other was made up of patients switched to desvenlafaxine from another AD due to iatrogenic sexual dysfunction. A naturalistic, multicenter, and prospective study of patients receiving desvenlafaxine (50–100 mg/day) was carried out on 72 patients who met the inclusion criteria (>18 years old and sexually active), who had received desvenlafaxine for the first time (n = 27) or had switched to desvenlafaxine due to SD with another AD (n = 45). Patients with previous SD, receiving either drugs or presenting a concomitant pathology that interfered with their sexual life and/or patients who abused alcohol and/or drugs were excluded. We used the validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) to measure AD-related sexual dysfunction and the Clinical Global Impression Scale for psychiatric disease (CGI-S) and for sexual dysfunction (CGI-SD) at two points in time: baseline and three months after the commencement of desvenlafaxine treatment. Results: In desvenlafaxine-naïve patients, 59.2% of the sample showed moderate/severe sexual dysfunction at baseline, which was reduced to 44% at follow-up. The PSexDQ-SALSEX questionnaire total score showed a significant improvement in sexual desire and sexual arousal without changes in orgasmic function at follow-up (p < 0.01). In the group switched to desvenlafaxine, the frequency of moderate/severe SD at baseline (93.3%) was reduced to 75.6% at follow-up visit. Additionally, SD significantly improved in three out of four items of the SALSEX: low desire, delayed orgasm, and anorgasmia at follow-up (p < 0.01), but there was no significant improvement in arousal difficulties. The frequency of severe SD was reduced from 73% at baseline to 35% at follow-up. The CGI for psychiatric disease and for sexual dysfunction improved significantly in both groups (p < 0.01). There was a poor tolerability with risk of treatment noncompliance in 26.7% of patients with sexual dysfunction due to another AD, this significantly reduced to 11.1% in those who switched to desvenlafaxine (p = 0.004). Conclusion: Sexual dysfunction improved significantly in depressed patients who initiated treatment with desvenlafaxine and in those who switched from another AD to desvenlafaxine, despite this, desvenlafaxine treatment is not completely devoid of sexual adverse effects. This switching strategy could be highly relevant in clinical practice due to the significant improvement in moderate/severe and poorly tolerated SD, while maintaining the AD efficacy.
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Serotonergic, Dopaminergic, and Noradrenergic Modulation of Erotic Stimulus Processing in the Male Human Brain. J Clin Med 2019; 8:jcm8030363. [PMID: 30875818 PMCID: PMC6463265 DOI: 10.3390/jcm8030363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 01/23/2023] Open
Abstract
Human sexual behavior is mediated by a complex interplay of cerebral and spinal centers, as well as hormonal, peripheral, and autonomic functions. Neuroimaging studies identified central neural signatures of human sexual responses comprising neural emotional, motivational, autonomic, and cognitive components. However, empirical evidence regarding the neuromodulation of these neural signatures of human sexual responses was scarce for decades. Pharmacological functional magnetic resonance imaging (fMRI) provides a valuable tool to examine the interaction between neuromodulator systems and functional network anatomy relevant for human sexual behavior. In addition, this approach enables the examination of potential neural mechanisms regarding treatment-related sexual dysfunction under psychopharmacological agents. In this article, we introduce common neurobiological concepts regarding cerebral sexual responses based on neuroimaging findings and we discuss challenges and findings regarding investigating the neuromodulation of neural sexual stimulus processing. In particular, we summarize findings from our research program investigating how neural correlates of sexual stimulus processing are modulated by serotonergic, dopaminergic, and noradrenergic antidepressant medication in healthy males.
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